I DO NOT ACCEPT INSURANCE REIMBURSEMENT for mental health services or coaching. The following explains why:
ACCEPTING INSURANCE REIMBURSEMENT IS A HUGE CONFIDENTIALITY RISK TO YOU! IF, AFTER CONSIDERATION OF THE CONCERNS DESCRIBED BELOW, YOU STILL CHOOSE TO USE INSURANCE, YOU MAY HAVE “OUT OF NETWORK” BENEFITS THAT WOULD APPLY TO YOUR SESSIONS WITH ME. I WILL BE GLAD TO COMPLETE INSURANCE FORMS FOR YOU TO SUBMIT TO YOUR INSURER.
Insurance reimbursement necessitates that a client be given a mental illness diagnosis. Most insurance plans do not cover any treatment not deemed 'medically necessary' (this means that at a minimum, your symptoms must significantly impair your ability to function), nor do they cover treatment for relationship problems or marriage counseling, stress management or coaching. In short, you may not have a diagnosable mental disorder. Ethical considerations do not permit a therapist to “invent” a diagnosis just to ensure a client can obtain insurance reimbursement.
Most insurance companies use a managed care company to manage (ration) the utilization of mental health benefits. Most managed care plans require a treatment plan be submitted after the initial authorization for sessions. This means that I would have to answer questions that pertain to your treatment and give any additional information requested in order for more sessions to be approved. The approval of additional sessions would require a review by a case manager not known to you or to me. Effectively, an UNKNOWN PERSON has access to your private and detailed information and is in charge of the course of your treatment.
In order to “take” insurance, I would be required to sign a contract with your insurer. In every contract there is a paragraph that gives the company the right to come into my office and access the files of the clients they cover to determine if I am following their requirements. Insurers claim the right to examine everything in your file. More confidentiality risks!
As a client who files insurance claims for reimbursement, your
diagnosis is entered into a computer database which the company says is
confidential; however, often your diagnosis and other pertinent
information is fed into a national medical information database (MIB)
that centralizes information for approximately 700 insurance companies.
At the very least it would be on record that you saw a therapist for
some type of psychological condition. This database information is
accessed if you subsequently apply for any individual life, disability
or health insurance during the next 7 years. To receive reimbursement,
you signed a general release for the insurance company, so they can also
get more detailed information from the previous insurance company that
paid for your treatment. The information at MIB can influence
whether or not the insurance company rejects the application or charges
a higher rate. MIB says it is illegal to reject insurance based solely
on its report, but because of the red flags at MIB, additional
information is easily obtained once you've signed a general release.
(These general releases for medical records are usually found on
applications for employment, background checks for employment, security
clearances, seeing a new health care provider, adoptions, life,
disability or health insurance applications.)
PLEASE NOTE: This lack of confidentiality could impact your minor children even more negatively. Should they ever desire to apply for certain jobs or educational programs, such as law enforcement, law school or the military, the information in their insurance files could be used against them. The FBI and law enforcement officials can access your insurance information.