Insurance and Psychotherapy

in Fees ~ Insurance

Insurance allows many people to receive medical treatment, including therapy, that would otherwise present a financial burden. The only negative consequence to having insurance pay for therapy is that doing so impacts a provider’s ability to protect the confidentiality of your medical record. The laws regarding confidentiality and insurance apply to therapy in exactly the same way as to other types of medical care. However, in therapy many people address issues that they would not necessarily discuss with their MD or PA, so the question of confidentiality may have different ramifications.

When an insurance company pays for medical treatment, they have the legal right to demand information that will allow them to determine if the treatment being received is appropriate for the condition. Because of this, whenever you receive medical care you should either be presented with HIPAA forms (Health Insurance Portability and Accountability Act) or see them on display in your practitioner’s office. You will also be required to complete a PHI (Protected Health Information) release, acknowledging that you’ve seen the HIPAA description of your rights to privacy and providing you with an opportunity to specify anything you do not want released. This does not mean that you can completely control the information that is and isn’t provided to an insurance carrier, but you can state your preferences.

As a practitioner, my policy is to do my utmost to protect client confidentiality. When insurance companies require information, whenever possible I discuss with a client what they are requesting. I am open to feedback about what I feel would be the best way to respond to the request while simultaneously safeguarding a client’s privacy.

At a minimum, insurance companies require any medical provider to indicate a diagnosis and the form of treatment provided (individual therapy, family therapy,etc.) Sometimes they also require a treatment plan or other details regarding the approach that is being used in therapy, the number of sessions thought to be required to address the presenting issues, and other specifics. My customary approach in providing a diagnosis is to discuss with each client what I think is appropriate before submitting anything to their insurance provider.

The forms and PHI statement that I utilize are industry-standard. The only thing that may be unique about my practice in this regard is that I tend to be a bit more formalized about the process than some other therapists. This is for two reasons:

  • I’m aware of what can be involved in insurance coverage, and I want clients to avoid any unwanted surprises later on; and
  • I never assume that it’s OK to release information as required by insurance companies without the clients having full knowledge of what this involves.
  • I have had clients involved in workman’s compensation claims, and other legal processes, so I am intimately familiar with legal and insurance requirements; more so than some therapists who have not had this level of exposure. Because of this background, I spend time discussing this before treatment begins, to avoid any problems later on.

For many clients, the legal intricacies of using insurance means there are three basic choices:

  • Do not have the treatment you desire, which can have consequences of its own;
  • Seek the help you want, and pay out of pocket to avoid insurance issues;
  • Find someone you trust and work with them to ensure that the information that is released is consistent with your desire for privacy.

The clients I see who use insurance to pay for their sessions fall into this third category. They have described me as very much an advocate for their privacy, releasing only information that is required and doing so in a way that is specific enough to generate payment yet protective of any sensitive details.

Another option to minimize the need for disclosure is to pay for the treatment up front, then to send an invoice (which I provide) to your insurance provider for reimbursement; my experience is that in those situations providers are even less likely to ask for additional information then when a provider bills them directly.

Each insurance carrier has its own demands for information. PPOs are usually very relaxed about this, so it is rare when a PPO requires more than a diagnosis and an indication of the type session. HMOs, in-network plans, and Workman’s Compensation often demand more information.

In addition to concerns about privacy, using insurance may also require addressing other issues. Insurance companies:

  • Usually only for a certain number of sessions, or a certain percentage of the session fee up to a predetermined amount. This varies by provider and plan, so you will need to check with your provider to see what they cover.
  • Often have different policies for different diagnoses. If you speak with your provider you should inquire about the differences between parity and non-parity coverage.
  • Do not pay for missed sessions. For any session that is missed without prior notification, except for emergencies, the full fee must be paid directly by the client.
  • In rare cases, require a client to take legal action to obtain payment. In these situations, parts of your medical record may be included in the court record. When this occurs, I work closely with each client to provide the required information while maintaining their privacy.

None of these are insurmountable obstacles; they are simply additional things to address in therapy.

To ensure your privacy and deal with the other challenges sometimes presented when insurance is involved, it is important to work with a practitioner you feel understands your needs and whom you trust to respect your concerns.

If you have specific questions or concerns regarding the impact of using insurance to cover therapy costs, please contact me by phone or email. I will happy to discuss your individual situation.