In the world of HMO's, PPO's, high premiums and co-pays, it is understandable to want to use your medical insurance as much as you can. Insurance panels are becoming more receptive to the positive benefits of therapy and are approving therapists, psychologists and social workers to become in-network providers. There are benefits and risks of using insurance to cover therapy sessions and you should be educated on what it means to use your insurance benefits for psychotherapy.

Benefits

The benefits of using insurance are outweighed by the risks. Namely, insurance panels will pay for a good portions of your sessions, leaving you to usually pay a small co-payment and/or your deductible. In some cases, insurance may even pay for the entire session!

It is understandable with the increase in premiums, you would want to maximize the benefits you are paying into. Why consider paying out-of-pocket when you are potentially spending hundreds of dollars for your insurance?

Risks

In order to use medical insurance, the insurance company has to feel that the service is medically necessary. In other words, you cannot go to your primary care physician for multiple, routine check-ups every year, but they do allow one check-up per year. The insurance companies want to know that your insurance is also "medically necessary." In order for this to be justified, a diagnosis will be provided to the panel and they decide if the benefits will cover this diagnosis. The treatment plan must also reflect how the diagnosis is being treated, which may or may not agree with the issues that initially brought you into therapy.

Using insurance also means that your level of confidentiality is compromised. When a therapist submits a bill to the insurance company, many people have access to all the information provided on that bill: the processor, case managers, peer reviewers and customer services representatives, just to name a few. In the short-run, this may not affect you; however, if you ever decide to apply for life insurance or other similar types of policies, all medical records are requested. This includes all mental health records. If you are summoned in a court proceeding, such as a divorce, custody hearing or as a witness, your medical records can also be subpoenaed.

If the number of authorized sessions is used up, the therapist may need to contact the panel and discuss your case with a case reviewer to determine if your case warrants additional sessions. The only information they have to base their decision is what your therapist provides. The insurance company will make that determination regardless of what your therapist or you feels is appropriate. Insurance panels may recommend a psychiatric evaluation for medications if they believe therapy alone is not reducing the symptoms.

What Does This Mean For You?

Consider the pros and cons of using insurance for therapy sessions, including the cost factor, the paper trail and the confidentiality factor. Determine the purpose of your therapy and how much you want to maintain your confidentiality, treatment and number of sessions strictly between you and your therapist, or if the issues are better maintained through your insurance. Only you can make this decision. If you are worried about the inherent cost of therapy, realize that on average, many people tend to feel better within 2 to 5 months.