Mental health benefits give more people access to treatment. Expanded access is especially significant during stressful times. However, using medical insurance to pay for therapy comes at a price. If you’re considering using insurance to pay for therapy, it’s necessary to weigh the pros and cons to make the best decision for yourself and your family.
When Someone is Determined to Use Insurance for Therapy
Many people call my office and immediately ask, “do you take my insurance?” If we say no, we often hear, “I’ll keep calling around until I find someone that does.” This pattern even happens after they tell us that we’re a perfect fit for what they need.
Most of us pay a lot of money for health insurance and want to use it as often as possible. Additionally, most people assume that therapy is part of health care. Therefore, they believe they should be able to use their medical insurance to pay for it.
Unfortunately, it’s not that simple.
Using Insurance for Therapy is Complicated
First, many people don’t realize that there are real, long-term consequences to using insurance to pay for therapy. Unfortunately, we don’t get this information when we sign up for our plans.
This information is not top-secret information. You can Google it. Depending on your medical history and needs, the details can be scary. It’s no wonder insurance companies and employers don’t highlight this information.
Second, fewer therapists are taking insurance. Among therapists who still accept insurance, more are letting patients know about the risks of using health insurance to pay for therapy.
They’re not doing this to scare people into paying out-of-pocket for therapy. It’s part of respecting patients enough to give them the information they need to make a fully informed decision.
The Pros of Using Insurance for Therapy
There are some benefits to using insurance to pay for mental health care. It’s helpful to consider these, especially if it can make or break your ability to get treatment.
Here are some of the key benefits:
- Increased Access
First, and most importantly, the ability to use insurance to pay for therapy increases access to services. Before insurance covered mental health treatment, therapy was a luxury. As a result, too many kids, adults, and families struggled with severe mental health and substance abuse issues without professional help. Therapy services are now more available simply because more people can pay for them.
- Seeing Multiple Specialists at Once
Using insurance to pay for therapy allows individuals and families to get treatment from multiple experts at once. Seeing numerous specialists is essential when dealing with complex issues like chronic illness, trauma, developmental delays, or parental divorce. These major life events require a team approach because they impact the whole person or family. Someone may need a combination of doctors, mental health therapy, a psychiatrist, and educational/job support to recover. Using insurance means people don’t have to pick and choose between the different areas of their life.
- The Ability to Afford Intensive Care
When a therapist meets with a patient, they constantly check to ensure that the level of care is suitable for the person. Is seeing a therapist once a week for an hour enough, or does the person’s current emotional, life, and safety situation call for a different approach?
Issues like severe anxiety and/or depression, substance use, and active eating disorders often call for hours of therapy every day for weeks or months. Without this level and intensity of care, the person will likely get worse. These programs are expensive and cost hundreds of dollars per day. Most people and families can’t afford that. When these programs accept insurance, more people can attend. That helps all of us because it makes our communities healthier.
Using Insurance to Pay for Therapy: Key Takeaway
If your finances are limited and using insurance is the only way you or your loved one can get the help you need, please do it. Getting treatment is always the number one priority.
If your co-pay is too high or your mental health coverage is limited, look into other low-cost treatment options. These include community mental health centers, university training programs, and non-profit organizations that support different under-served groups.
You can also look for therapists that offer a sliding scale. This means they set aside a few sessions a week to see people who need low-cost therapy.
The Cons of Using Insurance for Therapy
As I mentioned earlier, paying for therapy with insurance involves serious risks. It is crucial that you fully understand some of these significant risks so that you can make the best decision for yourself and your family.
- You Will Have a Pre-existing Condition on Your Insurance Record.
In order to bill your insurance company, a therapist needs to diagnose you with a mental illness. This information will be on your insurance record forever as a pre-existing condition.
Although we hear that insurance plans often cover pre-existing conditions, it’s not that simple. Even if you get help and overcome your mental health issue, it will stay on your record. Depending on how health care laws change, having a mental health diagnosis on your record can make buying health, disability, and life insurance harder and more expensive for you and your family. You will likely only qualify for limited, high deductible plans with high co-pays.
- You Might Have to Wait Months for an Appointment.
The average wait time for an appointment at an insurance practice is at least 2-4 months. It can be at least 6 months for a psychiatrist who takes insurance. This wait time usually goes up significantly during stressful times because more people want therapy and treatment.
By the time you can see someone, you may have lost the motivation that pushed you to ask for help. You may also be worse than before and need more intensive treatment by that point. This can often result in having to take time off from work in order to get the therapy you need.
- Your Confidentiality isn’t Protected.
A mental health diagnosis goes on your permanent insurance record. This record is accessible to any insurance company, government agency, or potential employer during background checks.
If you need a certain level of security clearance for work, want to join the military, are applying for jobs that require a criminal background check, or are involved in a Workman’s Compensation case, institutions can access your mental health information.
That means that potential employers, lawyers, or judges will have access to information you thought was private. This information may embarrass you and/or potentially impact a personal or professional goal.
- You May Have to Work with a Therapist That is a Poor Fit for You.
One of the most important factors that impact whether or not you’ll succeed in therapy is the quality of the relationship you have with your therapist. If you work with a therapist simply because they are in-network, you risk not succeeding due to lack of:
- The therapist’s experience in treating your specific issues.
- Fundamental personal values and/or experiences that are important to you in a therapist, such as commitment to diversity or openly identifying with a particular group of people.
Therapy is a partnership and collaboration between you and your therapist. To succeed, you have to feel like they understand you and have your back. Otherwise, you’ll constantly question whether the process is working. You’re also less likely to bring up any concerns. Most of the time, this leads to negative results for you or your loved one.
- Your Insurance Company Decides what Treatment is Covered.
Your insurance company is allowed to limit the type of treatment you get as well as the number of sessions. They are allowed to do this for both physical and mental health treatment. Their decision is based on what they decide is medically necessary.
Their decision and what you need may not line up. As a result, if you rely entirely on your insurance plan, you may not be able to get all of the treatment that your specific situation requires. As a result, you may have to end therapy early and risk losing the progress you made.
Is Therapy Worth the Cost?
How we spend our money is based on what we value. How much do you value your privacy? How much do you value getting the treatment you need as quickly as possible?
If you’re set on using insurance even though you have other options, then please do so. However, make sure you understand that there could be long-term consequences to this decision.
If you have out-of-network benefits or the means to pay out of pocket, consider the benefits of doing that. It’s so hard to protect our privacy now. Wouldn’t you want to protect yourself if you could?
Does Medical Insurance Actually Pay for the Treatment You Need?
The unfortunate trend in the US is that fewer specialists across health care are accepting insurance. The reason for this is three-fold:
First, the cost of on-going training, malpractice insurance, running a practice, and earning enough to support a family doesn’t match up with what insurance companies pay.
Second, medical and mental health treatment has become more specialized. The more experienced a therapist, the more likely they focus on a specific type of disorder, group of people, or treatment method. Experienced therapists value the ability to provide the care you need instead of being limited by insurance restrictions.
Finally, overall insurance costs, deductibles, and co-pays continue to go up every year. Some patients pay an $80 co-pay to see a therapist who would otherwise charge them $100-$120 per session. If you can manage the difference in cost, is saving $20 worth the risk?
Next Steps for Using Insurance to Pay for Mental Health Care
We’ve seen for years that if you want good healthcare for yourself or a loved one, you’ll have to pay out-of-pocket. As healthcare costs in the US go up every year and insurance laws continue to change, each of us will have to figure out how to get good care and pay for it.
If you need to use your insurance to get the help you need, please do so immediately. It may take more time and effort to find someone who can see you. However, please don’t give up.
Whenever possible, go with the provider that’s the best fit for your personality and needs. If this person accepts your insurance, great. However, if they don’t, consider the actual costs of not getting better. What would this mean for your quality of life now and in the future?
How we think, manage stress, and build healthy relationships are a few of the most significant predictors of how long we’ll live. Ensure that you fully consider the investment you’re willing to make to help yourself, and your loved ones thrive.
The original version of this post is published on https://buckscountyanxietycenter.com/why-using-insurance-for-therapy-is-a-bad-idea/ by Dr. Ronit Levy Dr. Levy is a clinical psychologist who specializes in treating teens and adults struggling with anxiety due to Anxiety Disorders, OCD, chronic illness, and life events. She is also the CEO and director of Bucks County Anxiety Center in Newtown, PA.