Although having mental health benefits gives many more people access to therapy, it comes at a price. Given changes happening in health care law, it’s essential to know the long term costs of using health insurance to pay for therapy.
When someone is set on staying in-network
Many people call my office and immediately ask, “do you take my insurance?” If we say no, we often hear, “I’ll keep calling around until I find someone that does.”
I’m really baffled when someone says, “wow! You guys are exactly what I’ve been looking for! But I’m going to call around until I find someone in-network.”
When someone is set on using insurance, there’s little we can say to change their minds.
Most of us pay a ton for health insurance and want to use it as often as possible. I definitely do.
Lots of people lump therapy in with health care. If health insurance is for health care, then they should be able to use insurance to pay for therapy.
If only it were that easy.
Insurance comes with strings attached
Many people don’t realize that there are real, long-term costs to using insurance to pay for therapy. Unfortunately, we don’t get this information when we sign up for our plans.
It’s not like this is top-secret. It’s in the public domain. You can Google it. When you read what’s up, it’s no wonder insurance companies and employers don’t highlight it in your benefits package.
Fewer therapists are taking insurance. Among therapists who still accept insurance, more are letting patients know about the risks of using health insurance to pay for therapy.
This isn’t a scare tactic. It’s part of informed consent.
If you’re going to use insurance to pay for therapy, you should know the risks.
Once you learn what these risks are, you have to ask, “is using my insurance worth it?”
The real costs of using insurance to pay for therapy
- You will have a pre-existing condition on your insurance record:
In order to bill your insurance company, a therapist needs to diagnose you with a mental illness. This means that your insurance record will forever contain that information.
Given expected changes in health care laws, this will make buying health, disability, and life insurance harder and more expensive for you and your family. You will only qualify for limited, high deductible plans with high co-pays. The first phase of these restrictions is already in place.
Basically, insurance companies use the information you give them against you.
You may be thinking, “who cares? Everything is a pre-existing condition now.” Mental health diagnoses can be treated differently. If you don’t believe that, just ask someone who is considered uninsurable due to a diagnosis they received after psychological testing. I have patients who’ve been devastated by that.
- You might have to wait months for an appointment:
The average wait time for an appointment at an insurance practice is 2-4 months. By the time you can see someone, you’ll have lost the momentum that pushed you to call in the first place, and/or you’ll be worse than before. You may even require an intensive treatment program instead of weekly sessions by that point.
- You lose control over confidentiality of your information:
A mental health diagnosis goes on your permanent insurance record. This record can be accessed by any insurance company or government agency during background checks.
If you need security clearance for work, want to join the military, are applying for jobs that require a criminal background check, or are involved in a Workman’s Comp case, all your mental health information can be accessed.
Finally, if you’re ever sued, the opposing party can subpoena your medical and mental health records to build a case against you. This becomes a disaster quickly in divorce cases.
- You’re less likely to be committed to the process:
Paying $100-$150 for a therapy session, sometimes weekly for months or years, can make you nauseous. However, there’s a lot of research showing that people value what they pay for. The more you pay, the more invested you are in making sure you get something out of it.
Here’s a basic example. If you’re about to pay $150 for a meal, you’re more likely to research the restaurant, get dressed up, ask the server questions, and savor each bite. How often do you do this when you pay $15 for a meal?
Therapists see the same thing all of the time. In general, people who pay out of pocket tend to be more invested in the process, are more likely to complete challenges, and are more likely to reach their clinical goals.
It’s not personal. It’s basic human behavior.
Are there exceptions? You bet. Based on what I’ve seen, it’s when people have to save and sacrifice to pay a high weekly co-pay. Again, real skin in the game equals progress.
Yes, there are exceptions
If your finances are so limited that using insurance is the only way you’ll get the therapy you need, then please do it. If your co-pay is too high, please contact community mental health centers or university training clinics that offer discounted therapy. Getting treatment is always the priority.
We spend money based on our values
I’ve seen people take out loans to pay for therapy with a top expert because they knew it’s what they needed. I’ve also seen people who drive luxury cars quit therapy because their co-pay went up $20.
How we spend our money depends on how we determine value.
If you’re set on using insurance even though you have other options, like using out-of-network benefits or money you would rather spend on other purchases, then please do so.
However, if you have out-of-network benefits or the means to pay out of pocket, I strongly recommend you do so, at least for therapy and other specialists.
The unfortunate trend in the US is that fewer specialists across health care are accepting insurance. We’re also seeing this in countries with socialized medicine like the UK and Canada.
Another reality is that deductibles and co-pays will continue to rise. There are patients in my practice who pay an $80 co-pay to see a therapist who would otherwise charge them $95. If you can manage it, is saving $15 worth the risk?
Insurance companies and politicians have said it loud and clear: If you want good treatment for yourself or a loved one, you’ll have to pay for it.
How I practice what I preach
I had major surgery two years ago. I decided to go with a surgeon who was out-of-network because he was the best fit for my needs. His colleague took my insurance but wouldn’t let me have a say in the rehab process. That was a deal breaker.
My decision cost me thousands of extra dollars that will ultimately take me 3-4 years to pay back.
I would make the exact same decision again because of how well the process worked out.
Every member of my family sees specialists that are out-of-network. We spend a lot of money on medical and sacrifice a lot elsewhere.
I’m not willing to risk my family’s physical or mental health. I’ve seen what happens when people do…So has every therapist, physician, OT, and PT I’ve ever worked with. Those stories don’t usually end well.
Invest in yourself and your loved ones
We’re in unknown waters when it comes to health care. As insurance laws continue to change, we’ll have to figure out our own health care and pay for it.
Using out of network benefits will still result in a diagnosis on your record, but you’ll have so much more control over what else is there. You can protect your privacy. You’ll regret it later if you don’t.
Whenever possible, go with the provider that’s the best fit for your personality and needs.
This is especially important in therapy where treatment by someone who isn’t a specialist and/or a good fit for your personality could make you worse and prolong your suffering.
If how you think is one of the biggest predictors of how long you live, isn’t it worth the investment?
I’d really like to know your answer. I read and respond to every email.
Bucks County Anxiety Center