Therapy, Health Insurance and Diagnosis
I recently had someone contact me and they wanted to know the reason I have to give them a diagnosis in order to use their health insurance. This prompted me to write this post, so that others who may have questions can find some answers.
Therapy
Many people seek therapy for different reasons. Usually due to some sort of breaking point where they realize they don’t like whatever is going on in their lives. Or for those who are a little more insightful, they come as a preventative measure to keep things stable and from getting worse. Whatever the reason, mental health issues are on the rise, not only in the United States but globally. This is due to societal changes, economic stressors, the impact of the pandemic and the influences of these things on our daily lives.
Therapy offers many benefits for those that are struggling with mental health issues, personal challenges and life transitions. It can provide the emotional support and understanding. It allows clients to speak freely about their struggles within an empathetic, understanding and judgment free environment.
I believe therapy originated from altruism. The idea of being concerned for the well-being of others and having a desire to help people. As a therapist myself, that was the reason I went back to school to get my Masters in Counseling. I wanted to help people who seemed to be struggling to really thrive in life. As I continued my journey in counseling, I came face to face with the bureaucracy of therapy. Yes, there’s bureaucracy in therapy and it’s called health insurance.
Health Insurance
What do I mean in regards to bureaucracy and health insurance? I mean that if you plan to use your insurance to cover therapy sessions, there are lots of rules and regulations that must be followed. Once upon a time, in order to even receive treatment for mental health issues, the insurance companies required pre-authorization or pre-approval for therapy sessions. This meant, your insurance company determined if you were in a dire enough state of mind that required mental health services. So, if you were just struggling with a life transition, you would probably be denied services. Although some insurance companies have relaxed those requirements there are still insurances that require pre-authorization.
In addition, some insurance companies also regulate how many sessions you can have with a therapist within a timeframe, usually within a 6 month or a year period. Anything beyond this amount would be denied or need to go through the pre-authorization process again. Some insurance companies have relaxed this requirement but not for altruistic reasons. It was because it ended up being cheaper for the client to see a therapist multiple times in a week than have the client go in-patient at a hospital.
So, how do insurance companies determine if a person is eligible for mental health services or even that they will reimburse these services? Based on your mental health diagnosis.
Diagnosis
Have you ever heard of the DSM (Diagnostic and Statistical Manual of Mental Disorders)? I hadn’t until I started working as a therapist. The American Psychiatric Association (APA) published the first DSM in 1952 as a way to classify psychiatric disorders, with descriptions of the disorders and diagnostic guidelines. It has since been updated five times.
Health insurance companies require that you have a diagnosis from the DSM in order for insurance to pay for services. So, the life changes you’re going through, a therapist has to give you a diagnosis. It can range from an Adjustment Disorder (with depression, anxiety, disturbance in conduct or all of the above) to Major Depressive Disorder, Generalized Anxiety Disorder and more.
Some people don’t want to have a diagnosis attached to their medical record nor do they want insurance companies to have access to it. But if you want your therapy sessions to be covered by insurance then unfortunately there needs to be a diagnosis. What the insurance company does with this information and who has access to this information is unknown. If you don’t want a diagnosis to be part of your medical records, then your best bet is to “cash pay” where you pay out of pocket and don’t seek reimbursement from your insurance company. I offer this option, like many other therapists. If you’re on a tight budget, you can always ask if a sliding scale is offered.
I hope this post offered you some insights in the world behind therapy and insurance. If you have further questions or are looking for counseling, feel free to contact me.
Judy Wang, LCPC, CPC provides online therapy services in Nevada, Maryland and South Carolina. She works with those struggle with anxiety, obsessive compulsive disorder and trauma.