Ah, yes, this is such a good question!
I can’t tell you the number of times potential clients are shocked when I tell them that I will need to give them a mental health diagnosis if they want to submit paperwork for reimbursement to their insurance companies. Many of them have been to therapy before, used their insurance, and this has never been explicitly explained to them. This is why talking about the pros and cons of using insurance is vital to ethical informed consent.
Before I begin laying out the pros and cons of using your insurance to pay for therapy sessions, I want to note that sometimes based on where we are at in life we just need to do what we need to do. And, sometimes that’s making a choice that doesn’t fully align with our values because it will help us in the long run. I think many of us have had to make these decisions in our lives for various reasons. There is no shame in making those tough decisions.
Now that that’s out of the way, let’s dive into the pros and cons of using insurance to pay for therapy.
Pro’s
Many people find that this is the most financially feasible way to access counseling. You’re already paying for your insurance, so why not use it to pay for sessions, right? I get that.
As a result of said insurance coverage, you may find you can continue with your therapist for longer. This can be a big advantage for some people.
Con’s
You will need to be given a mental health diagnosis in order for insurance to cover your sessions. Some people are totally okay with this while others are not. Unfortunately, many people with military and government jobs can be penalized if they seek therapy are given a mental health diagnosis, because management may use this to say they are “unstable” even if their symptoms are minor and they are able to function well.
These diagnoses go into your permanent medical record.
I’ve also heard of life insurance companies turning people down because once they look into your medical history they find you hold a diagnosis that feels too “risky” even if you’re not a risk.
Insurance can dictate people’s treatment. Insurance may only agree to cover a certain amount of sessions even if you and your therapist determine you need more. Insurance companies may also dictate what type of therapy they feel you need and the modalities they are willing to cover may not be what you feel is best for you.
Many insurance companies limit sessions to 45 minutes.
Other Considerations
Even if you choose to use your insurance you may need to pay out of pocket to meet your deductible before insurance will cover your sessions.
Some people use their health savings account to pay for therapy if their insurance company will allow them to do so.
When deemed appropriate between therapist and client, some clients will schedule a session every other week instead of weekly to cut down on cost and still have their needs met. You may ask if your therapist is willing to give you homework in between sessions to supplement your off weeks.
While insurance companies don’t have immediate access to your therapist’s clinical notes, they can audit your therapist which may include access to your clinical notes.
It is absolutely your right to talk with your therapist about what diagnosis they plan to use when billing your insurance. Not only can this lead to a meaningful therapeutic discussion, but it’s important you have an understanding of what’s being placed on your permanent medical record.
If you have insurance that offers out-of-network benefits but you want to see a therapist who is private pay only, you can ask the therapist if they’re willing to provide you with paid invoices and superbills that you can submit to your insurance company for potential reimbursement. Please note that your therapist will still need to give you a mental health diagnosis. And, I always recommend you call your insurance company to ask them about your out-of-network benefits and potential reimbursement percentage. For those of you interested in working with me, I do offer this for my clients.
Helpful Links
If you need to work with insurance and are struggling to meet your deductible, are uninsured, or are seeking lower-cost care without using your insurance, please check out Open Path Collective.
Many therapists offer sliding scales based on income, equity, or community care models, so it doesn’t hurt to ask what they offer, especially if you relate to their approach.
I hope this is helpful for you in making a decision for yourself and your care!
With fierce compassion,
Leah