People sometimes ask me why I don’t take insurance as payment for the mental health services I provide.

It comes down to these important reasons:

1. You should have control over your therapy. You and I, in consultation, decide what you are here to work on, how to proceed and when you have achieved your purpose. Insurance companies dictate what they will pay for and how long they will pay. They rely on “evidence-based practices” and their estimation of how long it should take for treatment to “work.” If it takes longer or you require a different treatment, they may or may not allow it, thus also affecting the amount they pay.
2. Your privacy is important. When you use insurance to pay for counseling, I must provide the insurer with a diagnosis and reports on your progress. Thus, the confidentiality of the work we do is breached. The diagnosis will stay on your medical record, even if it wasn’t truly warranted. And you may experience what some call diagnosis “blowback,” a future negative consequence of having a diagnosis on your record (like higher premiums, for example).
3. Not all counseling is “medically necessary”. The rule is that insurance companies only pay for services that are considered “medically necessary”. This means that in order to utilize your medical insurance for mental health treatment, you must be diagnosed with a mental illness disorder. The problem is that many of life’s difficulties, and the reasons why people seek mental health treatment, are not mental illness disorders and are not diagnosable. When this is the case, your medical insurance may not cover the treatment. Meaning your insurance company may not cover “I am having a hard time” or “I am grieving a loss” or “I’m having a difficult time with my spouse”.
4. Is it truly couples therapy? Most insurance companies will not pay for the diagnosis of “marital counseling”. So when an insurance company says they do, what they most often mean is that you, the identified patient, must have a diagnosed mental illness disorder and you are permitted to have your partner present in the room while you receive treatment for your disorder. The problem again lies in that many couples seeking therapy do not meet the criteria for a diagnosable mental illness. This again brings up ethical issues for the counselor.

So even though it may seem more economical and convenient to use insurance for mental health care, you may want to consider the long term and negative consequences as well as the short-term benefit.