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  • nataliecherrix

Making Sense Of Health Insurance In Therapy

As many of you know, health insurance is complicated. Perhaps now more than ever actually, considering how many people have lost their health insurance because of the rise in unemployment, and also how expensive it is. Among all the confusing things about health insurance, the understanding of its role in therapy can get lost. In my private practice, I accept health insurance and the overwhelming majority of my clients choose to use theirs to cover the expenses of therapy services. Especially in certain areas (lower Delaware included) most people do not have the financial means to pay out-of-pocket for therapy and, therefore, depend on their health insurance to allow them to get the help they need from a therapist. This is the advantage to health insurance: people are able to get health care that they otherwise would not be able to afford without it. There are also some disadvantages, however. By using your health insurance, therapists such as myself must give a diagnosis in order for the insurance plan to cover it. There are many mental health diagnoses, ranging from Adjustment Disorder to Post Traumatic Stress Disorder, to Major Depressive Disorder. The most appropriate diagnosis is given according to the symptoms of the individual. The diagnosis is then forever documented with the insurance company and follows you in your medical history. Another disadvantage of using health insurance is that your privacy and confidentiality can be compromised. Insurance companies reserve the right to do case reviews or audits. This entails a representative of the company reviewing clients' files to ensure that the therapist is meeting the documentation requirements. Last, some insurance plans put limitations or restrictions on mental health benefits that prevent clients from getting the length of treatment they really need. In this sense, health insurance holds too much control by dictating what is best for you without ever meeting you. Fortunately, there have been recent changes in the health insurance industry that prohibits companies from doing this. For the most part, clients that I see tend to have insurance that allows unlimited therapy sessions as long as "medical necessity" is met (translation: there is a diagnosis given as mentioned above). As someone who accepts health insurance at my office and uses my own health insurance at medical offices, I can understand the divided love-hate relationship with this issue. Most important though is educating yourself and making an informed decision for what is best for YOU!

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