Unethical to offer therapy through insurance plans?

I´ve got some therapy sessions paid by my insurance company and now I´ve used most of it and feel dispair towards the fact that there´s a high risk that I won´t be able to complete the therapy just because of the funding.

I knew I would get 10 times for free before I started therapy but I had then never went into any kind of therapy before so I couldn´t know that 10 times is far too few sessions to get my issues solved. Both my therapist and my insurance company knew my financials before I started therapy.

The question that now came into my mind because of my very hard situation is that how it can be ethical to even offer therapy were the number of sessions is regulated on beforehand? The therapist him- or herself must know that there are a lot of issues that won´t be cured in just 10 times. 10 times, that is 10 weeks in general if you visit the therapist once a week so it´s not likely that the client "suddenly finds the money to pay" during the 10 weeks of therapy.

I know there are other options ( I live in Sweden and we can seek therapy through public health care) buth that´s NOT the point.

When you started of a quite painful process, you feel comfortable with your therapist and you make progress and then you get rejected just because of the funding?! How can a person, that is the therapist, be part of such unethical situation?

He or she knows and also notices during the sessions that 10 times won´t be enough and still goes on with this? It would then be wiser and more kind to the patient to adwise him or her to seek other therapy options or don´t start at all.

The insurance company did not inform me of this and as a client new to therapy I didn´t know the "danger" in this.

Hoping for some perspectives and answers in this matter.

No one knows before, how long your therapy will take, how much therapy you will want, if "this" therapist will help you or not. Therapy can be ongoing with breaks, it can be quick (most is now), people can use insurance or save and pay on their own or any number of things, that is not the insurance people's concern. Depending on what options you choose, insurance is clear what it will pay for. Therapy is not like having a broken arm, with a clear beginning and end for all people. But insurance has to have some "base" to work with otherwise how do they keep paying? They only have what you are giving them for premiums and that has to pay for administration costs and personnel, too. You cannot pay them 800 SEK a month and they have to pay the therapist 3200 (800 times 4 weeks) or they cannot pay the 3200 SEK a month for the "whole" time (12 months)? Without administration costs, if you paid the insurance company 800 a month, that would be 9600, about 3 months (3200/month to therapist) or 12 weeks/sessions? It is better than not paying anything at all. You have to decide if you can continue or not and how to do/finance that, private insurance can be a help but is not to take care of you, that is your government "insurance"/public health job.

Perna: I´m not sure I´ve got your point completely but I´m not questioning that I pay for my insurance so they can use mine and other peoples insurance payments in cases like accidents and as in this case, therapeutical treatment. The 10 times in therapy is not calculated from how much money you´ve already put into the insurance, the number of times is the same for every insurance customer.

I´m questioning the unethical as I see it that therapists take clients into treatment being aware that

1. the client don´t have the ability to pay for him- or herself
2. the number of limited sessions are often not enough following that
3. he or she won´t be able to complete the therapy with the client as he or she won´t get paid and the client won´t be able to pay
4. it´s a often hard process to open up and it´s not just to change therapist. In Sweden and surely in many other areas it´s often very hard, nearly impossible to get free therapy with an authorized therapist unless you suffer from very severe issues.

The outcome will then be an unfinished therapy and continued bad health for the client.

Sigh this is what created "brief therapy" in the USA... insurance companies saying take it or leave it...10 sessions of 50 minutes (so that therapists couldn't extend sessions to 2 hours and get paid more also).

It used to be oil companies ruled the world..now I think it's insurance companies.

It's tough for the T because so many do need more than just 10 meetings that would normally suffice for "advice on an issue or two" rather than decent therapy. Now, would you have preferred NO help? (That's the insurance company's side.)

My point is that no one can know your case before you start therapy. Some/many people do well with only 10 sessions. Some, even less. When you start treatment, you are supposed to educate yourself on what you want and what it might be like, etc. what the process is and prepare, the people treating you cannot know what you want/will be like to treat for therapy. Most of us here have had many therapists and many periods of therapy, gaps, etc. it is not a straight, one-time process. There is no money from anyone to pay for that kind of therapy for a person.

JD: The question you ask me, that is "would you have preferred no help" is central to this discussion. My view is that if the therapist knows, which they do, that there is a risk that the client won´t get proper treatment in 10 times, then he or she should recommend the client to seek other types of care. That is public healthcare where you can get the sessions paid for a longer time.

OKay.

I would suspect that in our system here it is the T that has to put in for additional time once they realize they need it...whether for diagnosing or therapy itself.

Are we saying the same thing? Did your T NOT put in for the extra time. If that's so, can you nudge the T? Perhaps T forgot to...or maybe you're beyond their competence level.

In that case (above) it isn't unethical to offer therapy at all, since there is allowance for adjusting the number of sessions needed ongoing.

The T might be new and ignorant of the procedure or just not on the ball.

JD: I´m not sure I understand you but do you mean that in the US the therapist him or herself has to give the client free sessions to be able to diagnose or to fulfill the therapy?

I have a few free sessions left through my insurance and I´ve mentioned for my therapist that I´m seeking ways to finance more sessions with her. But she hasn´t actually given any clear answers, she just showed she was positive into me having more sessions with her.

What do you mean I can nudge the therapist about? She is very experinced, about 30 years in practice to I don´t belive she doesn´t know about this apparent problem.

Perhaps it´s not unethical when you look upon health care policies and so on but I still can´t get how a therapist with a serious business can in some way "lead" patients into a need of therapy that they can´t meet since the patient won´t be able to pay. I can´t understand that at all.

Okay I may have misunderstood.

The last sentence implied to me that rather than go for psychotherapy, OR after the 10 sessions are used, that there is public healthcare where you CAN go and get more sessions. Is that right?

That's why I was suggesting that perhaps your T has to recommend and request the additional sessions. But no, most insurance companies won't budge. That's a big reason why there's such an effort in the US to combat the insurance companies over their acting like psychologists and medical doctors (since they override the experts all the time.) It's bottom line is money and the problem has not been fixed by the bogus "affordable health care act".

But getting back to your original OP... why would it be unethical to offer someone in dire straits looking for support and possibly guidance their expert help, support and guidance? How did you feel during those sessions you had---was nothing conveyed that can help you going forward? (Just asking.)

What would you suggest a T do? Close their offices/practices because of the politics of insurance companies and poor health care plans, or do the best they can with what they are allowed/given?

Anyway... do try not to offend and act out on the T...it's out of their control... except if the T is able to take on a pro-bono case now and then (which means, for those unaware of the term, without charge as a public service (Pro bono publico)).

See if she can offer some free sessions, and perhaps reduced fee ongoing for a while???

It´s partly true but the chance is very small to get into therapy through the public health care system unless you have severe conditions and diagnoses.

It´s perhaps some differences between the US and Sweden. Here most people can afford the health insurance itself but when you want to use it for paying therapy sessions, the insurances are very limited.

The unethical side of this matter is that any therapist with some experience knows about the fact that 10 times of therapy won´t be enough in many cases. That it´s enough in some cases doesn´t make it less unethical in my view.

My point is still that even if the therapy had some positive effects, and also so in my case, you let the client "out in the street" and being aware of the risk of that already before you start working with the client.

As all therapists work for the well-being of their clients I think none of them should take clients into their therapy room unless the insurance conditions tell them they can bill the insurance company as long as the clients need. Not setting up financial boundaries at first, in the therapists case agreeing to them, and then don´t care what happens to the client afterwards.

In my case I feel that even if the therapy also did me some good, the anxiety to be left without having a complete treatment is just causing my damage. In a vulnerable state you have to fight to get care somewhere else, not being sure you´ll get it. From the unfinished therapy you have to deal with emotional wounds, memories that were brought up but not completely dealt with and so on. Why start something you can´t finish when it comes to peoples´ health? That´s to me unethical for sure.

I don´t know if there are pro bono cases in Sweden but I assume the therapist have told me that would be an option if it was. I think asking for free sessions would be like telling her I don´t have respect for her or her occupation

I do understand that the Swede mindset is different from the American. I know how difficult it would be to express your need or private desire for free sessions.

I do not know how the Therapist views it though, in Sweden--so I cannot advise that way.

Here in America, many people feel they are entitled to therapy sessions if they want or need them, and while their mental illness may cause issues often they can and do ask for some pro bono work.

Asking for additional therapy sessions is a compliment here, in a way, because you trust the T and think the T can still help you.

I would have to believe though, in either country, the therapist went into that profession because of their desire to make a difference in other people's lives. If you approach the T professionally it may cause a good conversation and possible good solution to your dilemma. (Here in USA a T will often give a consult over the phone without charge...a few minutes to discuss just such an issue, especially if they had already seen you in session.)

Good wishes.

often if your t appeals to your insurance for you, they will authorize additional sessions (in my experience, anyway.)

Hej Sarah! This is very interesting to me - I had never heard of anybody here in Sweden taking out healthcare insurance, other than for special assistance needs and perhaps medication. Now I googled it and I see that it does exist, but it appears to work a bit differently from the insurance that they have in the US. In any case, depending on where you live, it doesn't have to be difficult to get psychotherapy through the system. I get an unlimited number of therapy sessions, from a therapist in private practice who has an agreement with the county and is paid by them - I only have to pay up to the maximum yearly fee for health care (SEK 1100 in my county) which is about four sessions, and then it's all paid by taxes. If you go to the website for your county council (landsting) there will be information about private practitioners who are paid by the county (I think the phrase you need to look for is "samverkansavtal med landstinget".) I didn't even need a referral.

I really do think that offering a limited number of sessions is slightly unethical. I know that the psychologists who are employed directly by the county are often limited to 20 sessions or something like that. For some people that would be enough, but for others it wouldn't. Me, I've been seeing my therapist twice a week for two years and there's no end in sight yet.

Finally, if you are looking for a sliding scale, I know that St Lukasstiftelsen offers that, though I don't know what their fee scale is. It might be worth contacting them to find out - I do know that they have branches all around the country.

In the US we choose everything and are familiar with having to research what we choose beforehand. We perhaps have more options than Sweden and don't have the state versus private conflict. If individuals are on a government health plan here, they don't have much choice, no other "insurance" and what is offered is what is offered and all the government will pay, it is not about the therapist. If individuals buy insurance they might be offered 10 sessions but they and their therapist can often negotiate for more or do sliding fee, go to a therapist offering more, etc. if they both decide that is a good idea. There isn't anything pre-meditated about it not being enough here and just wanting to collect money. The short-term therapy here is usually designed to be short-term and not go into much detail/history.

InRealLife45: I hope this can apply to Swedish conditions as well, that is the therapist him- or herself can talk to the insurance company to convince them to pay for more sessions for their customers well-being. I haven´t heard of this procedure within Swedish health care though but I hope I will get some solution to the financial issue.

Mastodon: Thanks for your ideas concerning Swedish conditions and health care. Unfortunately, and that´s why my issue was risen in the first place, is that my therapist is not connected to the county council, that is you don´t get any reduction in the therapy fee when getting over the 1100 SEK limit. You have to pay for yourself when you have used the 10 time of free therapy through the insurance company.

I´m unemployed so even therapy through "St Lukas-stiftelsen" would be too expensive and I want to do all I can to stay with the therapist I´m seeing at the moment because therapy itself is much about finding a therapist you have a good chemistry with and whom you can trust.

But I appreciate you writing here and giving me advice in this matter.

Perna: I knew the therapy would be limited to 10 sessions but I didn´t know what it would imply in detail, that is you get in to the hard issue of being left with unsolved but in therapy evoked matters of different kinds. I think the therapy is considered to be short-term here in Sweden as well, when you get those 10 sessions of free therapy but as in my case and certainly many others you realise it isn´t enough.

I hope there can be a solution to this issue, that the therapist perhaps have some suggestions on how to solve the financial matter.

I completely understand not wanting to change therapists once you have found a therapist who is a good match for you. I think the best thing you can do is bring it up with your therapist... after all, it is not exactly rude or offensive to let her know that you think that your work together is meaningful, and that you want to continue seeing her!

Again, I don't know your full situation... but there are clinics here which offer "sliding scale" fees. That means they are adjusted to what you can afford to pay, and sometimes means the sessions are almost free.

Also, if someone believes in God in some fashion, there are most houses of worship that also have a person who does counseling..and it's without charge.

Do you have any organizations that offer free counseling, outside of the usual medical/psychological system?

Mastodon: Yes, I hope I can get some sympathy through expressing this to my therapist. I hestitate bringing the matter up to bluntly because I fear an absolute "no" as an answer. The therapist could perhaps feel a bit cornered if she knows I need more sessions but she can´t provide them and that in a case where it´s hard to get therapy from some other instance. I haven´t heard or read that much about this issue at all in Swedish press or so on so I think it´s hard to know how to bring this forward to my therapist.

JD: Yes, there are some clinics that offer sliding scales here as well but often you have to wait for several months to get through to this kind of health care and I want to keep seeing the therapist I´m at at the moment, I don´t want to change therapist. That´s because so much depends on thrust and personal chemistry. I need not just someone to talk to, there is such services through the Swedish church, but I want to complete my treatment, that already have been entered upon by my therapist. There´s where my largest problem is.

A "no" is just a word. The conversation might open up or help either of you realize another avenue. Don't take this personally (I know, you're personally involved...) but just like here in the USA it isn't personal, it's the way the inadequate system operates.

JD: Yes, that´s what I´m hoping for, that there will be solutions to this matter when talk about it with my therapist. I won´t take this personally, it´s me wanting to continue seeing this particular therapist. If she refuses seeing me I know it will all depend on the money and it´s in such a refusal , which is partly evident from the beginning, where I see the the unethical act.

Sarah, they have the same thing here. Even on an extended benefit plan - one that you would get if you get benefits through a job - they cover up to $500 usually. Which is between 5-6, roughly, and that's a hopeful estimate. I'm really not sure why they bother at all, quite frankly. These are for registered psychologists and private therapists. There are public psychiatrists and counsellors who work through family programs. And the wait lists that accompany them. The system is really not set up for anyone to succeed, regardless of what they are paying into it.
I'm sorry you've had this experience. I would suggest going through a community counsellor. Other than the 10 or so sessions I did while I still actually had a job, it's the only kind of counselling/therapy I've done for 17+ years. In my opinion it's not about the credentials (ie. RCC vs MA, MEd or PhD) so much as it's about the relationship. In fact, I find that the higher up a person is on the food chain, the less I trust them.
My therapist - the one I paid for - was lovely. She suggested to me that if I appealed to disability and got a prescription from my psychiatrist then they might cover the therapy as a necessary expense. But alas, no.
I wish you all the best. Hopefully you can find a beneficial situation for yourself.

I think your therapist or your insurance company should have explained all of this more thoroughly before the therapy began. In that sense I agree with you. So, you were treated unethically. But I don't think was illegal. Most people, including most therapists and most insurance company people, mainly concern themselves with avoiding doing illegal things. Always doing the ethical thing, well, I think it is just a fact that a lot of somewhat unethical things go on constantly in health care, therapy, business, insurance, government. What can we do about it? Nothing. Mostly nothing. We must just accept this as a part of life, the way that animals in the wild must accept that they are going to bit by flies, ticks, fleas, and mosquitoes. Life in this world will always have spots and points and patches of unfairness.

To me, all you can do is take what you've learned and move forward.

I think that the person who is constantly severely disturbed by all the unethical, unfair, hurtful, callous things that people do to each other is a person who is going to have a hard time in life. I have been--perhaps still am--such a person, alas. I'm not saying behavior that is selfish, self-serving, negligent, incompetent, reckless, etc., is something we should approve of or endorse. I'm only saying we shouldn't be so shocked and upset by all this. We should instead take control of our own lives, take responsibility for our own happiness, and stop focusing on the sins and failings of other people.