What you need to know before choosing to use your insurance for mental health benefits.
Most health insurance companies now include some form of mental health coverage and at times employers even offer a limited number of “free counseling” sessions, also known as an EAP. But before deciding to use your insurance, there are some important issues to consider. You can always decide to use your benefits, but you can’t undo many of the negative consequences of using them.
Most people with insurance benefits assume they can use them based merely on their desire to participate in counseling. The reality is that insurance companies require that mental health treatment be “medically necessary”. To be medically necessary, treatment must address a mental disorder. Counseling intended solely for self-improvement or to help cope with normal life stressors is not considered medically necessary by insurance companies.
A Mental Health Diagnosis
Medical necessity is established by psychiatric symptoms being matched to a diagnosis. Insurance companies require that the counselor assign a mental health diagnosis for the patient. To be able to bill insurance, paperwork for counseling includes a release, which allows the insurance company to have access to any and all records including session notes.
Confidentiality & Privacy
Once your insurance company receives information about you from your counselor, there is no way to protect your privacy and confidentiality. The diagnosis and other pertinent information is given by your insurance company to a national Medical Information Database that centralizes information for approximately 700 or more insurance companies. The Medical Information Database was created to alleviate fraud on insurance applications.
The Effects of a Diagnosis
This diagnosis can impact jobs with the government or military, jobs with security clearances, aviation, or any other job requiring health-related checks before hiring an employee.
After receiving a diagnosis, an individual will have to answer yes to any question pertaining to seeking treatment for a psychiatric problem. If you apply for individual health, life, or disability insurance, the mental health diagnosis can increase your rate for coverage and determine if you are rejected from coverage.
Many individuals who have lost their jobs and have to seek private coverage are not able to find an insurance company who will cover them due to their mental health diagnosis. A diagnosis given to a child can impact their future in many ways including being labeled throughout their schooling years and impacting future employment with military, government jobs, or any employment requiring a health-care related check.
What Is An Option Other Than Insurance? To avoid each of the risks listed above, our office offers self-pay rates. Contact our office to schedule an appointment time. Most appointments are scheduled within 1 – 4 weeks.
If you choose to use your insurance benefits, it is the client’s responsibility to verify benefits prior to the first appointment. Call the number on your insurance card and ask about “outpatient mental health” benefits. The first page of our New Client Paperwork gives all of the information needed to determine your benefits.
An average number of play therapy sessions needed for change to occur in a child’s life is 10-14 sessions. Some children need fewer sessions while others may need more due to the child’s attitude or behavior, persistent difficulties at home or school, and other stressors that may be occurring in the child’s life. The initial checklist the parent brings to the first appointment will be used through the counseling process to determine improvement in the child’s behavior and symptoms that may still be present. The child will move to biweekly or monthly appointments as goals are being accomplished to maintain progress that has occurred.