Deciding whether or not to be paneled with an insurance company is a big decision for any therapist. I'd like to share with you a few reasons why I decided to become Fee-For-Service after taking insurance for several years.

Insurance companies require that a client has a diagnosis from the DSM (Diagnostic and Statistical Manual for Mental Health Disorders) after the therapist has worked with them for several sessions at the very first session. This is often difficult to do after one meeting, and the diagnosis is a permanent part of the client's health record. Many clients experience concerns about this information impacting their ability to get life insurance, or even future health insurance. The Affordable Care Act addressed this issue, but concerns remain ongoing.

Based on the diagnosis, insurance companies determine the length of the treatment for each client. This is done through an algorithm. Many insurance companies will allow 6 weeks of treatment, or 6 sessions to resolve the client's issue. Most therapists agree that each client is a unique case, and it can be difficult to determine the length of treatment at the onset of therapy. This may result in the insurance company stopping payment for therapy services while a client is still in need of treatment. As a fee-for-service provider, I do not have to give you a mental health diagnosis. This enables you and me - not your insurance company- to determine the length of treatment. This includes creating a unique treatment plan based on each individual client's needs and not a plan based on statistical research of the 'average' client. One such factor in determining medical necessity is the degree of impairment to daily functioning and level of personal distress. What if you are not feeling quite 'distressed enough' for your insurance company? That's a problem.

In order to maintain this strict timeline of treatment session, many insurance companies pre-determine the type of therapy to be used will be Solution Focused Therapy. While this is a valid and research-based type of therapy, it is not appropriate for every situation. Many situations will require other types of therapy such as Cognitive Behavioral Therapy, Dialectical Behavior Therapy or one of many other therapeutic approaches. A fee-for-service provider is able to decide which type of therapy is best for each client.

An insurance company requires that each session be "medically necessary" in order to provide coverage. They require that session notes provide evidence of this. Most clients seek support beyond what is considered just 'medically necessary' - such as improvements related to personal growth, life transitions, or deeper self-understanding. However, insurance coverage is limited to services that meet specific criteria for medical necessity. Fee-For-Service providers do not deny you continued treatment because it exceeds what is simply 'medically necessary.' Here is an example: Say your dentist says you need a tooth pulled due to infection but also states that a replacement tooth is not medically necessary, so one will not be provided for you. Many people would feel that a replacement tooth is indeed necessary, and I completely agree. Other examples of treatments that are not technically 'medically necessary' but that may people consider essential: exploring long-standing patterns in relationships. improving emotional intelligence, processing life events without showing significant distress of impairment of functioning.

An important note about records:

When using insurance, the insurance company can access your records at any time. This includes using your insurance for reimbursement. When seeing a fee-for-service provider, your records are not released to anyone without your consent. This assures that everything discussed in your therapy is confidential.

Do I think it is unfair that many people do not have access to mental health support due to lack of insurance, or lack of mental health coverage? Absolutely! I am very vocal about this issue with my professional organizations, state representatives, etc.

I hope this helps give you a broader understanding of some of the issues related to health insurance coverage. Still have questions? I'm happy to talk with you about it!