Do You Take Insurance?

There are several reasons why Sovereignty Counseling Services chooses not to directly accept or bill insurance. Some of those may also be reason for you to reconsider attempting to use your insurance for counseling. If finances are a barrier for you or your family, keep reading.

Insurance companies only pay for what they see as “medically necessary.” In other words, they want to make sure that your mental health issue is so severe that it impacts your everyday functioning at work, school, social situations, or daily living such as bathing, eating, etc. When billing your insurance, your therapist needs to make a strong justification for what your or your child’s diagnosis is and how it impairs the individual from being functional.

This can be a big problem. First, many clients come in to work on issues that aren't mental health disorders. They seek treatment before their issue would meet the criteria for diagnosis as a mental health disorder (and that is a good thing). Rather than being supported in taking a proactive approach to dealing with their mental health, clients are penalized and by their carriers because what they are seeking help with is not “medically necessary.”

Who is the client when working with families or couples?

When it comes to insurance, there can only be one client. For an individual client, this may not be much of an issue but for couples or families, this can be a problem. It means that we have to identify someone as “the client,” the one with the problem. The other person can be there as a support according to the insurance records (coded as “family therapy”). However, only the one person is listed on the insurance claim. 

Couples or family issues are best seen as something that the pair or group of you are addressing together, and even subtle notions that someone’s diagnosis can be blamed for all of the issues can create difficulties in therapy. Therapy is about everyone coming in and owning their own parts in the problems within the bigger system. Having an one person as the “identified patient” can get in the way of that.

What is the impact of diagnosis?

Another issue with insurance requiring a diagnosis is simply that you now have a diagnosis. Every clinician has more than a few clients that get caught up in their diagnosis and see it as part of their identity. Rather than dealing with an issue they are facing, they become their issue. We don’t see our clients as disorders and symptoms and we don’t find that they benefit from seeing themselves that way either. Our clients are whole and complete people who, like everyone, struggle at times to adapt to what life brings them. We believe that they benefit the most when they are able to take this perspective also.

That being said, a diagnosis can be important. In cases of children needing access to services through school or other providers, a diagnosis may be required. Having access to 504 plans and IEP can be part of an individual’s road to increased wellness and success. Each situation will be evaluated to do what is needed for each client to receive the care and support they need.  

What is the benefit to me as the client or consumer?

Once that diagnosis is reported to the insurance company, it will remain on your medical records for the rest of your life. Many people don’t realize how that can impact them and how they lose control of access to that information when that file is shared with those who need access to it. A diagnosis says nothing about who you are now, how you have adapted and grown, your strengths, and what actual symptoms you experience. And yet, a diagnosis will say a lot for those who read it and may negatively impact you in the future. Your diagnosis can follow you around in school or college and be a barrier to doing certain things such as working with the military, being hired for federal jobs, obtaining security clearances, working in aviation, and any other jobs requiring health-care related checks. In fact, many schools and healthcare institutions are now employing policies to screen out employees who may be unstable or cost too much money in mental health care and lost work days. Your choice in who knows your diagnosis disappears once that diagnosis is provided to your insurance.

Further, insurance companies require clinicians to reveal diagnoses, symptoms, behaviors, and treatment plans that itemize the issues we are working on and the goals we have set. We are unwilling to reveal confidential, potentially damaging information to the insurance company to justify our clients’ needs for emotional support. Avoiding interactions with insurance companies protects the confidentiality of our clients. 

Insurance companies also limit the number of sessions they will pay for a client. Your treatment method, approach, and length is decision is between you and your therapist. We do not believe it is appropriate for healthcare decisions to be determined by insurance screeners and treatment to be decided based on production pressures from a corporation whose operating philosophy is based on attempting to increase profits and minimize payouts.

What’s the benefit to you as the therapist?

It would be disingenuous to not acknowledge that there are personal reasons we have for not wanting to take insurance. Accepting insurance demands a significant amount of time and patience to fulfill paperwork demands, pursue reimbursements, re-authorizations for treatment, etc. Additionally, insurance companies pay what they believe a provider should be paid, sometimes as little has half of a provider’s session fee, and make it increasingly difficult to get paid. This means your clinician spends more time working in order to get paid less. This time spent trying to get paid a portion of our fee would detract from the clinician's time spent on better things such as engaging in consultations and research on your case, broadening their expertise in order to provide higher quality services, seeing other clients, and taking the time they need for self-care so that they can be focused, energized, and refreshed when they sit with you.

Is there any way to see you and use insurance?

Some insurance carriers will reimburse for out-of-network mental health services. In those cases, we are able to provide clients with a “super bill,” itemized statement of the services rendered, how much you have paid for your services, and a diagnosis. Whether such reimbursement is an option, what diagnoses are covered, and the percent that is reimburse will all vary from plan to plan and carrier to carrier. You’ll want to check with your insurance company for specific details. Please be aware that all of the concerns listed above about privacy, diagnoses, and your medical records still apply when a super bill is submitted.

In Conclusion

You know that you want to better yourself. Don’t let the cost of counseling or therapy services scare you away. This is an investment in your and/or your relationships overall wellbeing and health. Working with a therapist with whom you connect and have confidence is a big part of building that wellbeing. After all, it is more important to invest in your health early on rather than experiencing greater struggles later on in life.