WHY I DO NOT ACCEPT INSURANCE

Insurance, or managed care, allows access to some mental health services that some would not be able to afford without financial assistance.  As a licensed mental health professional, I think it is important that potential clients are thoroughly informed about the disadvantages of going through a managed care company to access services.

CONFIDENTIALITY IS COMPROMISED

Managed care is just that: your care is managed by case managers who make it their business to know private information related to your case.  While the new federal HIPAA (Health Insurance Portability and Accountability Act) regulations provide greater degrees of privacy than before, your personal information is accessible to many people who are not directly involved with your care.  This information is necessary for determining benefits, but some government agencies and law enforcement organizations could get access to this information which could put you at a disadvantage should a legal issue arise.  

If you pay for services yourself, there are only a very few, limited reasons determined by law for which anyone other than your therapist needs to know you are in therapy.

DIFFICULTY ACCESSING TREATMENT

Managed care companies are in a constant struggle to keep costs down.  This means less control over your treatment for you.  For example, most managed care companies put limits on which conditions are covered by their plans.  They may require that your primary physician refer you.  In some cases, the physician and/or managed care company may deny therapy in lieu of prescription medication.  Then you may have to do a telephone interview with a case manager to find out if they will cover your particular problem.  If you are covered, your treatment may be delayed while you find a therapist in the managed care network that is taking new clients, that has expertise in your issues, and that is located conveniently.  Then there may be a wait while the therapist gets authorization for treatment from a case manager.  Which leads us to another disadvantage of managed care:

GETTING TREATMENT AUTHORIZED

Almost all managed care companies impose limits on the number of sessions they will allow.  Some insurers will only authorize 3 to 6 sessions at a time.  When you reach their limit, whether it’s 3 or 20 sessions, there is most often a delay while your therapist gets permission from the managed care company to conduct more sessions.  It is up to the case manager --- not you or your therapist --- when your treatment is “complete”.  Some reasons that people seek out therapy may not qualify for coverage at all, as insurers require a mental health diagnosis before they will agree to pay.  For example, most managed care companies do not cover marriage counseling or family counseling, unless it is part of a substance abuse treatment plan.  In some cases, this may lead to misdiagnosis or over-diagnosis in order to get treatment authorized. While many people who seek therapy have a mental health condition that would be covered by insurance, many others do not have a diagnosable mental illness, but would like to get therapy to improve and enhance their lives and relationships.

CHOICE

With managed care, you must choose from the insurance company’s list of contracted service providers.  Generally, you will have less choice within their “network”. Finding a good match between your needs and personality and the skills and personality of a therapist becomes more difficult –although it is certainly possible.