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Even reading that question may seem a little ridiculous right? If you have insurance, why wouldn’t you use it?! That’s exactly why you have it! I get that. Given my current medical journey, I understand this thought more than you know. That said, there are pros and cons to almost everything in life and it can be important to consider these and think critically in order to make the best choice for you. After all, it’s your health we’re talking about here.
The Pro's of Using Insurance: The 4 C's
So, let’s start with the pros to using insurance when seeking mental healthcare (which probably seem more obvious)...
Cost: Using insurance can make services much more affordable. This is probably the #1 (if not the only) reason people use insurance when seeking mental health services. Just be aware that the amount you pay out of pocket varies between plans.
Consistency: Insurance often helps improve the consistency of care when it comes to therapy. Depending upon your insurance plan, you're often able to see your therapist more frequently when you use insurance as opposed to when you're paying out of pocket (harkening back to the pro above). There are a lot of positives that come with this one.
For example, if you have to pay out of pocket you may only be able to afford sessions every other week or once a month. With insurance, you may be able to afford more frequent sessions (such as weekly). Depending on the reason for therapy, more frequent sessions may be more efficient as it allows you to focus on deeper processing each session versus providing an update each session due to the amount of time that has passed between sessions.
Coverage: When using insurance, payments for therapy, including co-payments, can help meet your deductible faster. This could help cover other medical expenses during the remainder of your plan year.
Convenience: Many insurance plans offer the convenience of out-of-network options to help reduce your overall cost. This means that you may pay your therapist's full-rate out of pocket at first, but then you send a receipt of payment or “superbill” to your insurance company and sometimes they’ll reimburse you for a small or significant portion of what you’ve already paid. If this option is available with your plan, it can allow you to see the specialist/therapist you prefer instead of selecting from a limited number of providers that accept your insurance. This way, you have the convenience of choosing the therapist that’s the best fit for you and your needs.
The Cons of Using Insurance: The 4 D's
Now let’s look at some of the cons of using insurance for mental healthcare.
Determination: In order for an insurance company to pay for services they require a reason, or diagnosis, for treatment. This is so they can determine if services are “medically necessary”, which means you must have a diagnosable reason to receive services. There are a 3 primary issues with this.
First, not everyone seeking therapy requires a diagnosis. You may be in a place in your life where it would be beneficial to have a mental health "check in" with a therapist; however, having a healthy and safe person to process or check in with does not mean that you need (or should have) a diagnosis. It's the equivalent of an annual physical. There may not be anything "wrong" or diagnosable for you to have an annual physical or check in, but it is still beneficial for you to go. The same is true with therapy. There doesn't have to be anything "wrong" in order for you to visit and "check in" on your mental health. The difference is, unfortunately, one health visit is covered while the other one often is not.
"There may not be anything "wrong" or diagnosable for you to have an annual physical or check in, but it is still beneficial for you to go. The same is true with therapy. There doesn't have to be anything "wrong" in order for you to visit and "check in" on your mental health. The difference is, unfortunately, one health visit is covered while the other one often is not. "
Second, just because you have insurance and a diagnosis does not mean that your plan will pay for services (also known as denied claims). There are a number of reasons that people seek therapy that may not be approved by insurance. For example, some people seek therapy to help with grief, life transitions, relationship problems, couple’s therapy, sex therapy, etc. While these are very real concerns that therapy can be very helpful in dealing with, some insurance plans will deem therapy for the diagnosis “medically unnecessary” and reject these claims. This ultimately leaves you with difficult, sometimes impossible, and often unjust choices: pay out of pocket, seek a new therapist (that has a lower out of pocket cost), or discontinue therapy.
Third, while you and your therapist may believe that a certain treatment plan is best for you and your concerns, your insurance provider may not agree and therefore there may be some loss of control by you and the provider over your treatment plan. Insurance companies often determine how many sessions they will pay for and the length of those sessions (for example, only 20 sessions in a plan year or 50 minutes per session). Insurance companies also have the right to review your treatment records to monitor for progress and can reject some treatment methods (refusing to pay). For those that do not use insurance, this allows the client and therapist to use more time and various therapy styles than they may have been able to otherwise.
Discovery: While we’re on the topic of diagnosing, when using insurance your diagnosis becomes a part of your permanent record. If you switch insurance companies, apply for life or disability insurance, or apply for a job that requires certain background information, the new insurance/job may discover, or have access to, this information. This may have an impact on your ability to obtain other insurance or on employment. Additionally, if you are a dependent or family member on an insurance plan, it is important to note that when using insurance, your family member carrying the insurance policy may become aware of the diagnosis and services you receive.
Delay: Sometimes there are longer wait times when you use insurance. Due to changes in policies and lower insurance reimbursement rates for mental health providers (versus medical providers), there are many therapists who do not take insurance at all or only accept specific insurances. This can mean that those that take a wider range of insurances often have larger caseloads and subsequently longer wait lists because, as stated earlier, who wouldn’t want to use insurance if they have it? This also means that unfortunately, therapists with higher caseloads also tend to have fuller schedules, making it harder to schedule appointments regularly or at optimal days and times that work for you.
Decision: Restricting yourself to therapists that are in-network with your insurance company means that you may have fewer options in deciding who you want to see. It’s well known that the number one reason that change happens in therapy is due to the relationship between the therapist and the client. The reason for this is pretty simple. If you don’t vibe with or trust your therapist, you’re not going to talk about more vulnerable topics. If you aren’t talking about those topics, are you really getting the help you need? No. So, if you’re not restricting yourself to in-network providers you may have an easier time finding a therapist that’s a good fit for you. For example, you may require a therapist that is unique or has a specialized skill set such as a specialist in art therapy, or a therapist that is a Person of Color, or an expert in your particular concern. It can be harder (though not impossible) to find the right fit for you if you’re so restricted.
"If you don’t vibe with or trust your therapist, you’re not going to talk about more vulnerable topics. If you aren’t talking about those topics, are you really getting the help you need?"
The Choice is Yours
There are multiple reasons why someone would use insurance if they have access to it. It is important to state that having access to health insurance or the option to choose to use insurance is a privilege that everyone does not have access to.
If there is an option, there are also reasons why someone may choose not to use insurance. There is no wrong choice when deciding whether or not to use insurance for treatment. The goal is to be informed and, as possible, and when possible, select the option that works best for you.
If you are interested in learning more about your choices with a therapist at Hope & Serenity Health Services, contact us! You can reach us via email at contact@hopeserenityhealth.com or call us at 407-308-0345.
If you are interested in learning more about low cost mental health support, there are options available. Some resources include:
In Florida
The Mental Health Association of Central Florida - Follow @mhacf
Peer Support Space, Inc. (non-clinical support) - Follow @peersupportspace
National Resources
The Mental Health Coalition (resources) - Follow @mentalhealthcoalition
National Association of Free and Charitable Clinics - Follow @nafclinics
Open Path Collective - Follow @openpathpsychothearpy
Wishing you Hope & Serenity on your healing journey.