Dear Clients;

An important part of your counseling is what we call “informed consent” about how to pay for services. We have created this disclosure statement to explain the issues for you to consider.

If you are a member of an Insurance HMO or PPO plan which pays for your mental health counseling, please read this page before making your choice regarding accessing those benefits. There are several issues to consider in deciding whether to use your insurance or not. 

Interesting Facts:

• Most insurance companies do not cover “marriage counseling” which is one of the main reasons people seek treatment.
• Some insurance companies require therapist notes, or that the therapist actually discuss your case with an insurance company representative before they will allow you to continue your treatment.
• If you run out of sessions before you have completed treatment, insurance companies will not extend your benefits unless it is an extreme emergency. You’re done when THEY say so!
• Mental health records become part of your medical history and can be accessed like your credit history and driving record

Reason # 1: LACK OF CONFIDENTIALITY

All Managed Care Plans (MCP’s) involve direct clinical management of your ‘case’ by the plan’s case managers. If your insurance company pays for your counseling, your therapist must disclose almost anything they ask for related to your case, which involves your privacy.

While we make every attempt to give only limited information, the fact is that insurance companies have the right (because they pay for the services) to ask for and get information such as;

• your diagnosis
• number of visits
• current mental status
• the reason why you are seeking counseling
• who is in treatment with you
• the counseling techniques used in your therapy
• your progress
• drug and alcohol use/abuse

In some cases, they may also give this private information to your employer.

We feel that this is extremely intrusive into your privacy, but we are unable to limit their involvement when they pay part of the bill.

Reason # 2: DIFFICULTY GETTING “PERMISSION”

One of the ways insurance companies prevent you from easily accessing the sessions you have available to you is to require “authorization” before you seek treatment. This is unnecessarily difficult and costs a lot of time and money to monitor.

You have the right to the sessions, and they are in your insurance plan. However, most MCP’s require that your therapist call them personally to “ask” for authorization to see you. In fact, they will withhold payment of your claim without this authorization, or if your session occurred outside the time the authorization was in effect.

Insurance companies often attempt to influence the methods or course of treatment so as to save money for themselves.

When you are upset and stressed and have a lot on your mind, it can be very annoying to have to keep close track of how many sessions you have, whether they are within the time frame, and if you need to call to get more authorized.

In other words, your insurance company dictates how often you come, and when you’re done, whether you’ve decided to stop or not.

Reason # 3: YOU MUST BE GIVEN A ‘DIAGNOSIS’ IN ORDER FOR YOUR INSURANCE COMPANY TO AUTHORIZE AND PAY FOR YOUR SESSIONS

Insurance companies will not cover treatment unless it is a “medical necessity”. This may mean the client has to ‘pretend’ they are “sick”, or worse off than they are in order to receive their benefits.

Most people have no idea that before your insurance company will pay for your sessions, they REQUIRE that the therapist give you an actual mental illness/disorder diagnosis. THIS DIAGNOSIS BECOMES A PERMANENT PART OF YOUR MEDICAL RECORDS.

A psychiatric diagnosis may affect your ability to obtain future health or life insurance at a reasonable cost.

For that reason, you should think carefully about the insurance company paying for your services, because your records follow you and you may not want people to have access to such personal information.

Paying out-of-pocket for your services ensures that no-one will see or have access to your private records.

If you elect to pay out-of-pocket, I will be happy to provide you a simple billing statement you can submit to your insurance company for ‘out-of-network’ reimbursement and/or tax purposes.

Thank you,

Julie Nise, MA, LPC, LMFT