On Insurance

Thu, 20 Mar 2008 09:28:33 -0500

Over the past 60 years health insurance has become a fact of life for those of us who are fortunate enough to have it. More recently, mental health benefits were added to most plans. At first, it seemed like a good idea, providing the benefits of mental health coverage at little or no cost to the consumer. However, as the system has developed, there is a dark side that is rarely made clear to those who make claims for mental health coverage. This is a very brief summary of a complex issue. Here are some of the reasons that I recommend that my clients think long and hard before using their mental health benefit. As you read this, please remember that this is true of any provider of mental health services with whom you use your mental health benefit. Most do not inform their clients or are unaware of these issues.
1. In order for you to receive mental health benefits, you must be diagnosed with a mental illness. For instance, many people are surprised to learn that their medical coverage will not pay for marriage counseling. The problem with being diagnosed with a mental illness is that it goes onto your record. It can affect such things as your ability to purchase insurance coverage in the future, run for public office or gain custody of your children. If you sue someone, it is common for that person to legally gain access to your medical records. No diagnosis should be taken lightly, in my opinion.
2. Medical records released to insurance companies are no longer under the control of your therapist. In short, the privacy that is the heart of therapy is compromised. The popular press periodically exposes abuse of this information. NPR reported on June 6, 2002 that the medical record of an Illinois woman who had an abortion was posted on a pro-life web site. The Wall Street Journal has reported that it is not unusual for companies to look into the medical records of their employees which they can do legally after employees unwittingly sign release forms. The Medical Information Bureau is a clearing house of medical data and makes it available to nearly every insurance company in the country.
3. Managed care influences treatment. Some insurance companies decide what types of problems get discussed, how long treatment will last, who can be in the room while therapy takes place, and what kinds of interventions can be made. Typically, insurance will reimburse only for treatment that is of "medical necessity." That is an insurance term that means that you can receive treatment until you are working and functioning enough to survive. It doesn't mean that you feel that you resolved an issue.
4. Managed care wastes enormous amounts of time and energy on the part of therapists and their staffs as well as employees of insurance companies. In order to make up for this waste, fees are raised, punishing those who pay out of pocket. It is not unusual for someone paying out of pocket to shell out double what a managed care company reimburses for the same service.
If you choose to work with me on a fee-for-service basis, you protect your privacy. You and I are free to work on whatever issues we choose and we can do it in a way and for any length of time that we agree upon.
I still participate in managed care panels because some of my clients want to use their insurance benefits. I simply feel that I have an obligation to inform you of these issues. If you have questions, or want to discuss this in more depth, I would be glad to speak with you.
A final note. This should not be taken as criticism of the insurance industry. They are paying for services and I think it is entirely reasonable to expect that they will want to control how that money is used. However, I do think that third party reimbursement often interferes with the work of therapy.

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On Insurance