Quit trying to manage me! Six things to know about therapy and managed care

For many people, managed care (aka, insurance) makes therapy affordable. And, if you are on a tight budget, finding a therapist on your insurance plan could be the right option for you. Before you print out that list of approved providers, though, you should stop and consider first what it means to have your insurance company foot part of your bill for therapy.

Here are the top six things to consider before making a decision:

1.) Using insurance does not necessarily mean your therapy will be inexpensive

The fact is, therapy is a deep investment in yourself that requires time, money, and emotional energy. This is true whether you pay for therapy out of pocket or through your insurance. And, it’s certainly true that using your insurance can add up to a lot of savings in most circumstances. However, there are a few up front expenses that many people forget to consider. In most insurance policies, an individual has a yearly deductible. This is a dollar amount that you must pay out of pocket each year, typically before your insurance plan begins to pay for your treatment. This means that you are, in essence, footing the bill for the first few weeks or months of treatment.

The average deductible ranges widely depending on your policy. After you have met your yearly deductible, you will be responsible for a weekly copay that may run from $10 to $30 per session. Be aware that your insurance typically does not cover the fee for missed appointments—you’re responsible for the therapist’s full fee if you miss without notice. If you have a high-deductible plan, you may need to spend $5000 per year or more out of pocket before your insurance benefits kick in. In that case, you’re probably better off paying for your therapy yourself and seeing someone who offers a sliding scale.

2.) Limitations in choosing your therapist

Working with an insurance company limits your choice of therapist. If you want to get the most savings from your coverage, you will likely be required to pick from a list of contracted providers. It can be a challenge finding a therapist who is a good interpersonal match, who specializes in your specific concern, and is conveniently located near you. Your therapist is an important ingredient in your therapy—they bring their training, personality, and expertise to bear on your treatment, so you want to choose your therapist with care.

Many skilled therapists are not on insurance panels, and the ones that are frequently have full practices and are not accepting new clients. Choosing a therapist from a provider list limits your choices. The exception to this is if you choose to see someone using your out-of-network benefits. If your insurance plan has this option, you can see any therapist of your choosing whether or not they are contracted with the insurance company—though it probably will cost you more out of pocket to do so. Many people find it is worth the added expense.

3.) Pre-authorizations and paperwork hassles

Many insurance companies require pre-authorization before you can obtain services. This means that you must gain approval from the insurance company before receiving treatment. Some insurance companies will provide authorization for ten or more sessions at a time, but some may only provide authorization every two to three sessions. The review process can vary widely, with some insurance companies approving authorization requests almost immediately, while others take longer to approve requests and may require follow-up to see it is completed. At its worst, this can be a time-consuming process, causing delay in scheduling regular appointments, or deterring you from continuing treatment.

4.) Your treatment may be on someone else’s timeline

Having someone else fund part of your treatment means that they get a say in how it happens. In this case, you have a case worker who works for the insurance company who reviews documentation about your treatment periodically. This documentation may include your diagnosis, treatment plan, and progress notes. This case worker can decide not to authorize additional sessions if they feel you have made good progress—in essence, they can choose to end the treatment. This may or may not match with how you or your therapist feels you are doing in therapy.

Also, most insurance policies have a yearly or lifetime maximum number of sessions that they will cover. For example, an insurance company might cover 8 to 10 sessions of therapy—two to two and a half months if you are meeting once weekly. In some cases, this may be sufficient if you want to address a problem with small scope. If you are wanting to go more in depth on a topic over a period of months or years, however, in this scenario you will find that you have had enough time to build a strong and trusting relationship with your therapist just in time to end the treatment!

Be aware that many insurance policies will not cover alternative modalities of therapy, including group therapy, couples or marital therapy, or family therapy.

5.) More than two people (i.e., you and your therapist) know you are in treatment

As mentioned in the previous topic on timelines, your information is subject to review by an insurance company. This means that your participation in therapy becomes a part of your healthcare record. The Health Insurance Portability and Accountability Act (also known as HIPAA) provides guidelines about protecting your healthcare information. While these regulations provide a greater level of privacy by applying these standards, your personal information is accessible to many people who are not directly involved with your care for the purposes of billing and authorization. You should also be aware that some government agencies and law enforcement organizations could get access to this information which could put you at a disadvantage should a legal issue arise.

6.) Diagnosis and your healthcare record

Most insurance companies require that you have some sort of qualifying mental health diagnosis on record in order to cover your treatment. If you happen to have a qualifying diagnosis, this is not a problem. However, many people seek therapy and do not meet the guidelines for a diagnosable disorder. Some health care professionals have felt pressured to give a diagnosis when an individual does not meet criteria so that insurance can cover the cost of the treatment (a really bad idea, as this constitutes healthcare fraud).

You should know that your diagnosis becomes part of your file, something that insurance companies maintain in their records over time. You could be offered an insurance plan that costs more in the future or you could be denied coverage altogether on the basis of a diagnosis you received in the past. If you pay for your therapy out of pocket, your diagnosis remains a topic of discussion between you and your therapist only.

These are some of the advantages in paying for your therapy out of pocket instead of using your insurance benefits. If paying for your therapy privately just isn’t in the cards financially, you should be aware that there are many excellent therapists and clinics in Austin that offer therapy on a sliding scale. This option provides you a budget-friendly option with greater privacy and choice about who you see and for how long, without the problem of authorizations, diagnosis, and session limits.

Finances shouldn’t stand in the way of getting the care you need. If you would like some help finding affordable therapy in Austin, please contact me. I have a resource list of therapists and clinics that offer services on a sliding scale that I would be happy to share with you.