Pros/Cons of using Insurance

There are pros and cons to using your health insurance benefits to pay for mental health care.

Pros:

  • If you have coverage to see the provider you choose, it will probably be cost effective to use your health insurance to pay for services.

  • Whether you are self-employed or work for an employer, you effectively pay a lot of money to have health insurance and it may make sense to get the most out of your benefit package by using insurance for therapy.
     

Cons:

  • There are many circumstances in which you might want to keep the fact that you are in treatment, as well as any information about that treatment, completely private between you and your therapist.

  • In order to qualify for benefits you must surrender a level of confidentiality to the insurance company that would otherwise remain between you and your therapist.

  • Insurance company employees may ask for personal information to determine whether or not they think treatment is warranted.  These employees decide if you are eligible for treatment, rather than leaving that decision up you and your clinician.

  • In order for insurance to reimburse your treatment you will receive a mental health diagnosis that goes in your permanent medical record.  This diagnosis constitutes a “pre-existing condition” that may be a disqualification from benefits in the future or may otherwise interfere with your coverage if you change plans.  Once you have used health insurance for mental health care you will also have to disclose your treatment history if you apply for life insurance and in certain other circumstances.

  • Insurance policies often limit the number of sessions you are allowed to attend each year.  They may or may not authorize more sessions based on what they determine is a “medical necessity”.  Your therapist will have little say in this decision and making your case may involve a lot of paperwork and footwork on your part.

  • Employers often change insurance companies to save money.  You may form a bond with your therapist only to find out that he or she is not a provider on your new plan.