Why You May NOT Want to Use Your Health Insurance for Counseling

Why not use your health insurance for counseling? Isn’t that what it is for?

Perhaps.

But using health insurance for mental health services is a little different than other medical issues. Sometimes mental health issues are not covered by your health insurance. Once you use your health insurance for mental health, you will have a mental health diagnosis on file – a mental health disorder/mental health illness must be on the insurance claim in order for insurance to pay for treatment. This will be in your permanent medical record.

Of course you want to consider using your health insurance for counseling, but there are some good reasons for you to consider why you may not want to use your insurance for counseling services.

Why doesn’t my counselor accept my health insurance?

Many counselors choose not to accept health insurance for very good reasons. They want to focus 100% of their time in treating you. If they accept health insurance, there is a lot of extra work involved in accepting insurance, in addition to agreeing to work for a discounted fee. The counselor may spend hours on the phone getting benefit information, authorizations, or following up on claims payments. The counselor has to wait a month for payment from the insurance company. The counselor has to file progress reports with the insurance company. The counselor is required to submit treatment reports and other details about your medical history with the insurance company.

It’s not that counselors don’t like insurance companies, or don’t want you to use your insurance (we have health insurance too!), but many counselors prefer to focus 100% of their time and energy in helping clients, rather than doing paperwork for insurance companies.

But this isn’t the only reason counselors may not be in network with your health insurance company.

The other reasons are more compelling, and you need to consider them BEFORE you decide to use your health insurance.

Many counselors prefer not to work in network with health insurance companies so that they can better protect your confidentiality. Any information (claims, reports, or treatment plans) filed with health insurance leaves the protection of their office and their locked files and your personal, private, emotional information is outside of your counselor’s office. In order for any insurance company to reimburse or pay for counseling (both in network and out of network), you must be considered “ill”. You must be diagnosed with a mental health illness or disorder. If you are not ill enough to warrant a diagnosis, then insurance will not pay for counseling services. If you do qualify for a mental health diagnosis, your illness will be listed in your permanent medical record. Many counselors don’t like this “medical model” of declaring someone ill, so they choose not to accept insurance because they want to focus on their client’s strengths, and not label them as mentally ill.

Do you want to be considered mentally ill? If you have a mental health diagnosis already, because you have been to counseling or psychiatric appointments in the past, find out what your diagnosis on file is. If you already have a mental health diagnosis, this may not be a concern to you, but if not, you may not want this in your medical record.

Counselors also do not like releasing information to others to protect your confidentiality. Once a claim is submitted to the insurance company, who knows how many people take a look at it and rubber stamp it while it travels through the system? If insurance pays for any counseling sessions (in network or out of network), then the insurance company has the right to audit your complete file. They can request copies of counseling notes, assessments, and other personal emotional information to determine if you really are “sick enough” to warrant their payment. They can deny services to you if they think you aren’t sick enough or if they think your counseling is not “medically necessary”.

Additionally, there are many counseling issues that are not even covered by insurance at all. Stress management and anger management are usually not covered. Marriage counseling is usually not covered. Certain medical conditions/mental health conditions may be excluded (such as attention deficit disorder or adjustment disorder). Even if your illness or disorder is covered by your insurance plan, they may limit the number of visits they will cover (sometimes only 20 per year), and they will set a maximum amount they will pay per calendar year or in your lifetime.

Additionally, counselors prefer not to have someone in the insurance company telling them how to treat their clients. Insurance companies can decide what type of counseling is covered, what diagnoses are allowed, and how many times the client needs to come before they are cured. Many counselors prefer to work directly with clients to serve their needs, without interference from an insurance company.

Using your health insurance for counseling services can also affect your security clearance, life insurance rate, employment, or future health insurance coverage.

For the above reasons, I recommend that you be informed about using health insurance for counseling. You may choose to file anyway, but be an informed consumer.

Be an informed consumer.
Know your mental health diagnosis.
Talk to your counselor about the diagnosis.
Ask your counselor about your treatment reports.
Decide if you have, or want to have, a psychiatric illness.

If you have clinical, severe depression, anxiety, or other issues, then you probably already have a diagnosis.

But if you are stressed, having relationship problems, or trying to figure out your purpose in life, your symptoms may be minor, and you may not want to have a mental health diagnosis in your records.

Once an insurance claim is submitted to your health insurance company, your diagnosis becomes part of your permanent medical record, and can affect future life insurance, preexisting conditions, or the cost of private health insurance.

Jama Thurman is a Licensed Professional Counselor in Manassas, VA. She helps teens and adults who are stressed and anxious find peace and purpose.

You can get a FREE download of her book, How to Find a Counselor at [http://www.howtofindacounselor.com]. This book will help you figure out if you need professional help, how to find it, and whether you want to use your health insurance for payment for counseling services.

She offers practical suggestions and answers questions most consumers have about counseling services. You’ll discover

*Seven Reasons You MUST Seek Professional Help

Dos and Don’ts When Completing Individual Health Insurance Application

If you do not have access to a group employer plan then the other option you have is to apply for individual health insurance plan. Individual health insurance application require more information from you then group health insurance plans that you might have had through job. The reason for that is that individual, and that applies to family health plans, are medically underwritten. That means that a person called medical underwriter will go over your medical application and decide if you are a good risk for the insurance company. The main reason for medical underwriting is to keep over all cost for every one low. The more insurance company has to pay out in claims the more they have to charge every one for health insurance to keep the average cost down.

If you have already had a chance to take a look at individual application then you probably know that it can be long. How much of the application you have to fill out depends on your previous medical history. If you are in perfect health then there is not much that you can write on your application other then some basic information. If you are some one who has been to the doctors for lab work, test or takes prescription medication then you would have to include that on your application. Most individual application require you to provide information of your doctor or the last doctor you have been to. If you are not sure of the name of the doctor you can always include the hospital name, clinic name or doctors practice name. When it comes for the dates of your last doctor office visit or any other dates. If you do not remember exact dates, just put down your best estimate.

The most important thing to keep in mind when filling out individual or family application, especially if you do have some medical issues, is to understand this. Until there is a permanent change to health care system and health insurance is not medically underwritten. Insurance company will consider every condition that you have and every medication that you take. The reason for that is that in most states in the US health insurance companies require to cover everything once you are approved. That means that all of your medical conditions and prescription drugs have to be cover by law once you have been approved for coverage. That is if you are approved. I hate to use this analogy because we a talking about human lives, but the simple way to explain health insurance is to compare it to car insurance. For example lets say you get in the minor car accident and you do not have car insurance. Your car is still drivable and it looks like you will need a new bumper and some paint. The next day you go out and purchase car insurance to cover your accident. Well we know it does not work like that. If you could just go out and get car insurance only after you had an accident then no one would pay for car insurance. Why pay if you can just get it after you had an accident. No one would pay for car insurance and car insurance companies would not exist. Then you would be fully responsible for all the damages out of your own pocket. I know I would rather pay that $100 a month just in case something does happen.

Most people do not recognize that health insurance works in the same way. Health insurance companies are not going to approve some one who requires immediate medical assistance. That includes pending follow up visits to the doctor, recent surgery (after a surgery a lot of complications can arise), prescription drugs and anything that is known upfront that could potentially be covered expense. Insurance companies use a “actuarial tables” to underwrite individual applications. If based on what you have put down on the application could potentially cost insurance company money, chances are your application will not be approved.

If health insurance companies automatically approved all the application then it would be the same scenario as with car insurance example, that no one would pay for health insurance. I know I would not, why pay for insurance if I can get it when I get sick. If no one would pay for insurance then there would no insurance companies to cover us for unforeseen large medical expenses. I am certainly not prepared to pay $400,000 or higher for medical emergency.

Getting approved for health insurance could take some preparation. If you are currently taking prescription drugs, find out how to can slowly get off them. I am not a doctor and certainly would never tell anyone to not take drugs that were subscribed by their doctor. I think sometimes great health starts with us, with small daily choice we make. Take care of your body and it will take care of you. When completing application sometimes being too honest can cost you also. That does not mean lying. Going to chiropractor and writing on the application that you have had back pains and you will need to see a specialist. On top of that is that you have not has any health insurance previous is just way to suspicious. It looks like you are trying to get health insurance to get medical care for something that you do not want to pay yourself. Do not make it worse then it is and always phrase everything in the positive. Instead of you writing that you are having back pain, taking Advil and going to chiropractor. Phrase it that you went to chiropractor for maintenance just to realigning your back. I see a lot of people get declined for coverage even though they are in perfect health just because how and what they wrote on the application.

Real people will be looking at your application if you are making it worse then it is or you are volunteering too much information then it is only your fault if you get declined. Your answers should be, everything is fine, just a check up, results were normal. Also before you know that you might be looking for health insurance do not go see your doctor until you do have coverage. If you go to the doctor and they find something “wrong” with you then bye, bye health insurance. Now you are stuck. When at the doctors office, again, be careful what you tell your doctor because it will end up in your medical records. When self diagnosing your self do not volunteer that information to your doctor, it is your doctors job to find if there is an issue. If you have been declined for health insurance there are options available to you so is having or not having health insurance. Having any health insurance plan is infinitely better then not having anything at all. It is a know fact that you will get a better treatment if the hospital knows that you have some way to pay for your medical care and that they are not just working for free taking care of you. The one and the most important thing that you can do is to take care of your health. Eat your broccoli.