When telling people about the counseling services I offer I am often asked if I accept health insurance as a means of payment for my services. The response I tend to get when I say "No" is the question, "You don't take insurance?"
It's true, I do no not take insurance. Why?
There are a number of reasons for which I do not directly accept and bill insurance. When a mental health provider directly bills your insurance for counseling or psychotherapy services, your insurance requires a lot of personal information about you to ensure that you have a "medical necessity" which requires the need for mental health and counseling services.
"Medical necessity" means that you have a mental health diagnosis that is severe enough to be impacting your daily functioning, meaning your ability to get your day to day things done (eg. work, school, social interactions, activities of daily living such as bathing, eating, etc.). This means that a therapist directly billing your insurance needs to make a strong justification what your diagnosis is and how it impairs you from being a functional individual. Also, most insurance companies require treatment plans which itemize the issues we are working on in therapy and the goals we have set to help you resolve the issues you are working on in therapy. Some insurance carriers only authorize a certain number of visits and require reauthorization by asking the therapist to share more of your personal information with the health insurance provider each time you need more sessions.
Sound complicated and intrusive enough yet? It is.
One primary reason I don't accept insurance is due to my desire to protect my clients' privacy as much as possible. A second reason is because my clients are not so sick that their day to day functioning is impaired in a significant way. Most of my clients are educated, high functioning, successful people who are simply having a hard time right now and just need a caring, neutral, third-party to meet with to discuss their thoughts and feelings, and with whom to uncover other underlying hidden strengths.
However, I know that using insurance can really help the financial aspect of any type of treatment. Therefore, most therapists, myself included, offer a monthly Super Bill to their clients who request them for reimbursement purposes.
A Super Bill itemizes the services rendered, how much you paid for your services, and a diagnosis that is sufficient enough for the insurance carrier to pay you back a portion of the fees you paid for your services. As an "Out of Network" provider, I am outside of your insurance company's preferred provider network, meaning that some of the fees for mental health services might be reimbursable to you through your insurance provider.
If you are considering counseling services, don't let the cost of the services scare you away. Insurance is a great resource to have, and can be helpful, but in reality, investing in our overall wellbeing is a more cost effective way of managing our health. A part of that wellbeing includes investing in a really good therapist with whom you connect who can help you on your current journey through life.
Above all, if you are interested in counseling services and would like to use a preferred "In Network" therapist, I encourage you to lean on that. You could ask your insurance carrier to refer you to someone who is covered by your insurance plan, but remember, that therapist will have to share a lot of personal information about you to justify your need for counseling services. Keep in mind, sometimes paying more out of pocket for someone who you really connect with that is outside of your network can really make a big difference in how the therapeutic process works for you.
So, find out what your benefits are, crunch the numbers, and then, go out and pick that really amazing therapist with whom you really connect and let your healing process begin.
If you have any questions or would like to schedule an appointment, give me a call for a free phone consultation: 904.404.1763
Amy Pope-Latham, LCSW is a clinical psychotherapist in Ponte Vedra Beach, FL.