Providing Psychological Healthcare Since 1983

Some Thoughts on Utilizing Your Insurance Benefits


During the past decade there have been major changes in the way your insurance benefits are managed. As a result of these changes, you may want to carefully consider the advantages and disadvantages of using health insurance in paying for treatment.


Advantages of Using Health Insurance


The advantage is clear. Health insurance subsidizes the cost of your treatment. For many individuals, health insurance makes treatment an affordable option.


Potential Disadvantages of Using Health Insurance


There are three areas of concern related to using your insurance benefits. These areas are loss of privacy, reduced control of treatment, and the necessity of a medical diagnosis.


LOSS OF PRIVACY: All insurers request some information about your treatment in order to allow payment. Insurance companies and managed care companies potentially may access this information at several levels. Some companies have proposed creating internet sites which would contain an individual’s medical history. While this would increase access to information, many individuals have concerns about risks to personal privacy with such availability of medical information.


REDUCED CONTROL OF TREATMENT: Insurance companies help pay for treatment of conditions that are deemed “medically necessary.” There is no universally accepted definition of this term. When you utilize insurance benefits, you have invited the insurance company into decisions about what can be treated and how treatment is conducted.


THE NECESSITY OF A MEDICAL DIAGNOSIS: Since insurance covers medically necessary care, there must be an “illness” and a diagnosis for reimbursement to occur. However, there are other ways to think about the range of personal concerns that bring people to treatment. Some problems are a result of life transitions such as divorce, chronic physical illnesses, or the addition of a new family member. There may be a subtle psychological impact when someone’s efforts to cope with a difficult situation lead to being labeled with a medical diagnosis.


Advantages of Choosing Self-Pay


If you choose to pay for your treatment, your decisions remain between you and your therapist. Your privacy is more protected and treatment decisions develop solely from discussions with your therapist. When a medical diagnosis does exist, it remains within the privacy of the clinician’s records. For some people, this allows a level of control and comfort that offsets the cost of paying for treatment.


What’s the Solution?


Making a decision to obtain therapy is a serious and important one. You should know that 90% of outpatient therapy episodes last less than 25 visits and 75% last less than 10 visits. Your therapist will be able to give you an estimate of the length of your treatment after a few sessions. This will allow you to think about the investment you are making in yourself, and to weigh all the issues involved in choosing whether or not to utilize your insurance benefits. Please feel free to discuss any of the concerns identified in this brief paper with your therapist, who wants to insure you have a clear awareness of these issues when making the decision that best fits your particular circumstances.