Fran Weiss, LCSW-R, BCD, DCSW, CGP, Psychotherapist
Just because it is hard to do, does not mean it is impossible to achieve
Should I Use Insurance to Pay for Psychotherapy or Not?
Before you decide whether to use your health insurance to cover psychotherapy, you may want to consider two potential downsides:
Possible Intrusion into the Therapy Process
Psychotherapy works best when all communications remain confidential between the therapist and the client (or clients in the case of couples therapy). This arrangement insures a safe environment in which problems can be fully explored and privacy is secure.
"Managed care" is the name that has been given to insurance carriers or companies who try to contain costs by, among other things, withholding some care. This can also apply to insurance policies which have "out-of-network benefits" for mental health. In an effort to decide who needs care and how much of it they need, these companies have appointed gate keepers and reviewers to monitor decisions about the therapy. This means that mental health benefits and number of sessions are "managed" by the insurance company. In practical terms, after a number of sessions, the insurance company may request "out-patient treatment reports" from the psychotherapist about your care. If the reviewer does not agree with the length of time of treatment, they may terminate reimbursement.
Some insurance and managed care companies, for example, encourage their subscribers to use a very brief therapy that lasts only a few sessions. Unfortunately, research has not shown that this kind of therapy is durably effective. It is clear that there is no single approach that is good for everyone, or for every problem or goal.
Confidentiality of Records
In order for you, as an individual, to get health insurance benefits, the therapist or clinician is required to make a formal diagnosis. This diagnosis becomes part of your permanent record, and it can be accessed by other insurance or managed care companies — or even others who might be interested. In addition, insurance companies sometimes request detailed records and notes, presumably to insure that treatment procedures are "correct." Once again, these materials are potentially available to others.
The Medical Information Bureau, Inc. in Cambridge, Massachusetts maintains a nationwide database of health insurance claims, and makes information available to many interested parties. Insurers have been known to withhold life insurance from people with certain diagnoses, and to withhold health or disability insurance from people who have submitted mental health claims to another insurer.
While therapists are ethically bound, with some very explicit exceptions, to maintain the confidentiality of their clients, they cannot guarantee that insurers will maintain the same strict ethical standards.
Psychotherapy is a long‑term investment in yourself.
As you weigh the cost of psychotherapy, it is important to consider the life goals you have not yet reached — your goals as they relate to your work, your relationships, or simply the day-to-day quality of your life. Because psychotherapy can help you make choices that will affect your entire future, it might be thought of as an investment in yourself — an investment on a par with education or other forms of self-development. The positive effects of psychotherapy last a lifetime. Only you can decide whether the potential gains will compensate for your investment in time and money.
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