Medical Insurance: Use At Your Own Risk

"I pay good money for my insurance," you say, and you're right.  Either that, or you receive insurance benefits as part of your compensation for your hard work.  So why shouldn't you use it?  Well, it turns out things happen when you use your medical insurance for counseling: things you really should know about.  That way, you can make an informed decision about when and whether to use it--especially for counseling.

The first thing you need to know about using your insurance for counseling is that your therapist will probably need to submit a diagnosis of a serious mental illness to the insurance company to get compensated for your visit.  The diagnosis submitted carries an explicit assumption (otherwise you wouldn't meet the criteria for the diagnosis) that you have a long-term impairment to your ability to function.

You should also know that this diagnosis, shows up on electronic records for the rest of your life. And not just records of the insurance company.  Have you ever heard of a company called MIB?  Would you be surprised to know that every diagnosis you've ever had, and in fact, every service you've received that was billed to your insurance goes to MIB and gets mingled with the information from over 750 other insurance companies in their permanent (and accessible) files?  That database has been around for over 100 years, but its use was only recently officially authorized with the passage of HIPAA (the Health Insurance Portability and Accountability Act of 1996).  Under HIPAA you give permission for that sharing when you sign the release when you visit a new doctor.

The government and others can access your personal health information in order to make decisions about you.  In a recent poll, for example, 30% of employers admitted using applicant's medical information when deciding whether to hire/promote someone.

If your treatment is paid by insurance, an uncaring insurance company will decide, typically without considering your individual needs, how many sessions you can have and what kind of therapy they'll pay for.  If you and your therapist decide, for example, that you need to spend a session or two working on a specific social skill, it doesn't matter how much that skill would improve the quality of your life, virtually no insurance company will reimburse for it.

So all these things tend to push some therapists toward doing things that are illegal, unethical, and not in your best interest so they can get reimbursed for sessions.

• Reporting to an insurance company that you have a serious diagnosis you don't really have.
• Reporting to the insurance company that you are more impaired by your symptoms than you really are.
• Providing to the insurance company a treatment plan they have no intention of following.

As a Licensed Marriage and Family Therapist, I want to do the best I can for you, and I want to operate in an honest and ethical way.  That's why I inform all my clients about the consequences of using their insurance before they do so.

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Michael H. Bean, LMFT is a licensed marriage and family therapist, with sole proprietorship of his private practice.