What are the Benefits to NOT using insurance for my mental health?

Confidentiality

One of the biggest concerns about using medical insurance for mental health treatment is the possibility of losing confidentiality. When your insurance is billed, not only do they require a diagnosis, but they gather information about the type of treatment you are receiving and whether you have improved or not. The insurer can also audit your records at any time they wish, which means they have full access to any details your therapist has, including information the therapist intentionally did not include in the claim submitted to the insurance company. 

Similarly, the average insurance claim passes through 14 people while it is being processed. These people are able to view information about your treatment including your diagnosis, treatment plans, progress notes, as well as any other information pertinent to them approving your claim. 

These details should be private, but are open to anyone with access when you use your health insurance. Confidentiality is also often lost when your information is being faxed to anyone in the health care industry who ever requires access to it, which often occurs while claims are being processed.

Lastly, if you a hold a high security clearance for a job, are seeking a military or federal job, a political position, an aviation position or any other job that requires health-care checks (many institutions are now screening out employees who may be unstable or cost too much money in mental health treatment and lost work days) or have other reasons you want your information to remain confidential, this is important to know. Additionally, children often have an even more difficult time when given a diagnosis, as their diagnosis follows them for much longer and can impact school, college, and be a barrier to pursuing certain careers. If your child’s condition warrants a diagnosis, you may want to have some say over how that diagnosis functions in their life – you may want to keep all treatment private.

Loss of Control of Treatment

When you see an in-network provider through your insurance, neither you nor the clinician get to decide how you spend your time in treatment. Insurance companies require that a treatment plan be submitted in order to approve the number of sessions and ultimately, they use this to determine how your time in therapy is spent. The number of sessions is determined ahead of time by the claims specialist (a non-mental health professional who you have never met and does not know your plight) and is not based on need.

Rather than giving you the care that best meets your needs, the therapist is responsible to the insurance company for “completing” your treatment within the pre-determined number of sessions. Bottom lime, an in-network therapist works for the insurance company, not for you. This is because of the contract with the insurance company that the therapist is required to uphold. 

Your Medical Record

While using insurance, it is required that you recieve a diagnosis in order to recieve treatment. How is this fair if you do not meet the criterion for a diagnosis? Is this something you want on your record for health insurance?

Simply put, when you don’t use your insurance, this information remains private. When you use your insurance, your mental illness diagnosis, as well as your treatment, becomes part of your permanent medical record. You don’t get to take this information out once treatment is over, or ever.

This can make applying for new health insurance, life insurance, or a new job incredibly difficult as they can require an authorization to release information to view your entire medical record.

Companies can charge significantly higher premiums because of having ever been treated for a mental illness diagnosis. If you are someone who might ever be unemployed, self-employed, or need to purchase your own benefits, a mental health diagnosis can make the difference between preferred coverage or none at all.

This is often one of the more significant reasons that resonates with patients, and why many who are insured often choose to not use their medical insurance for mental health treatment.

Surprise Costs

Insurance companies will warn you, “A quote for benefits does not guarantee payment…” This means that despite being told verbally (over the phone) that something is covered and possibly even being given an authorization number, you can still be denied once they review the diagnosis. 

If you attend therapy sessions under the belief you are using health insurance to cover your visit, and the therapist receives a denial of the claim, you are still responsible for the full payment to your therapist. You can attempt to appeal the claim with your insurance company, but be prepared to go through several levels of appeals, which can take weeks to months – all while your treatment is likely interrupted.