Most individual and small group health insurance plans are required to cover mental health and substance abuse services. However, using health insurance can be interpreted quite differently when dealing with care for the body versus care for the mind. There are many little-known factors to consider that should be carefully looked into when deciding the best options to pay for your mental health care.
To help you decide whether or not to use insurance for your mental health care, here are a few factors to consider:
Reduced Costs for Prescribed Medications
For those who are diagnosed with a mental illness and are prescribed medications, oftentimes medical insurance can significantly lower the out-of-pocket costs that you have to pay. For those who have illnesses that rely on medicated treatment, but don’t have the funds to frequently purchase prescriptions on their own, this aspect of medical insurance is extremely beneficial.
It is important to note, however, that even if you are seeing a therapist for talk therapy and paying out of pocket, many insurance carriers will still cover your prescribed medications from a psychiatrist. With LARKR, the mobile platform is largely focused on talk therapy and psychiatric drug prescriptions are widely available through medical doctors. In some cases, those costs may even be eliminated.
Pre-existing Conditions Don’t Impact Coverage
Currently under the Affordable Care Act, all Marketplace plans must cover behavioral health treatment (i.e. psychotherapy and counseling), mental and behavioral health services, and substance abuse disorders. In addition, Marketplace plans cannot legally deny coverage and/or charge more for pre-existing medically diagnosed mental health conditions. Therefore, regardless of the reason you are seeking mental health care, Marketplace plans are required to have a package that can provide services for your needs.
There are two things to watch out for though: changes in legislation and caps on number of visits. There have already been proposals to eliminate or limit the pre-existing condition clause in recent legislation. Healthcare is a constantly changing field so it’s important to know that these changes to pre-existing conditions are relatively new and many experts don’t consider them to be permanent changes in our healthcare system. Additionally, many insurance plans limit the number of times you can see a therapist. While some plans may allow you to see someone for a year without interruption, other plans may only allow for 10 sessions while others require you and/or your therapist to file for allowances to extend the number of sessions allowed.
Difficulty Finding a Therapist Who Accepts Insurance
Until trying to utilize insurance, most people don’t realize that the majority of mental health professionals do not take insurance. It can be frustrating trying to find a therapist who takes your insurance and when you finally do, often times people aren’t happy with their limited choices.
A major reason why many therapists chose not to take insurance is reflective of the poor relationship between therapists and insurance companies. Usually, working with insurance can cause therapists to make significantly less money or take on an enormous amount of paperwork for which they are not compensated. Therapists require a master’s degree and years of registered intern hours before obtaining their license. Yet after their expenses, its possible for many to work more than 50 hours a week making less than $50,000 a year.
As a result, therapists who agree to work with insurance companies come few and far between, thus causing extensive wait times for clients. Going through your insurance company to see a therapist can have a wait time of up to four months before having your first session. Those kind of extended wait times are just not practical when dealing with a mental issue.
Required Mental Illness Diagnosis
One of the main reasons that therapists and mental health clinics decline the use of insurance is that insurance companies typically only cover services that are declared as a medical necessity. In other words, your clinician is required to diagnose you with a mental illness in order for the services to qualify for coverage under insurance.
With the ups and downs in life that many people go through every day, many people seek mental health treatment for reasons that are not defined by a specific mental health disorder. If the reason that you are seeking a therapist is not a diagnosable disorder, like OCD or BiPolar Disorder, then it can be quite difficult to get your insurance to cover the sessions..
Being that many people go to therapy to repair relationships, recover from a traumatic experience or just generally to improve their lives, finding a medical diagnosis is often not applicable. As frustrating as this can be for patients, it would be unethical for a therapist to diagnose someone with a mental illness that they don’t really have, just for the sake of using insurance and doing so can result in the therapist losing their license.
Documented Sessions & Lack of Confidentiality
Another reason that therapists are hesitant to accept insurance from their patients is due to the fact that any documented health treatment filed through your insurance is required to be recorded on your permanent medical record.
In addition to your treatment being permanently filed, health insurance companies have access to the type of treatment that you receive and what your progress has been. Any details and private information that your therapist has, your insurance company would have. If an insurance company decides to do an audit on your records in an attempt to prevent fraud, they would have access to details about what happened during each of your therapy sessions and other private details that patients would normally prefer to be left confidential. Using health insurance to receive mental health care opens a floodgate of your personal information to anyone who has access to your account at your insurance company.
Also, when such a mental health diagnosis is filed on your record, it is considered a pre-existing condition. In the future, this could potentially increase the costs of your insurance or prevent you from getting coverage altogether. When thinking about your mental health care in the long-term, this is a major factor that should be taken into consideration.
Lack of Specialists
Even if you find a therapist through your insurance, it often won’t be someone who specializes in your area of need.
When a clinician signs a contract with an insurance company, they are required to provide services for any and all patients that request to book a session. This means that if you would like to see a therapist for anxiety, you may instead be stuck with a therapist who specializes in couples and families, simply because that’s what your insurance company has to offer.
Contrary to popular belief, many therapists want to take insurance. Clinicians get into the profession of therapy with the main goal to help people improve people’s lives. But the reduced rates, extensive paperwork and rigid restrictions that are imposed on therapists by the insurance companies has pushed many of the most talented therapists away from working on insurance panels.
Insurance benefits should be weighed and researched carefully when considering their use for mental health care. We know that life can be complicated enough and figuring out the best way to access your mental health care shouldn’t add to it. That’s why LARKR provides easy, affordable and private mental health treatment that is accessible on-the-go for the millions of people in need every day.