therapists and insurance

I thought this blurb, found here, was interesting and reflected what I have experienced with my family's own mental health care providers:
http://www.hrobbinsphd.com/psychothe...html#insurance

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Many successful, established psychologists do not join insurance panels for three reasons. First, there is a great deal of paperwork to submit for in-network benefits, making it an impractical use of the clinician's time. Second, the in-network filing process usually requires a significant breach of client confidentiality. To meet the requirements for in-network reimbursement, the psychologist must submit an official client diagnosis and an ongoing progress report, treatment plan, etc. Such information requires that the therapist divulge a good deal of personal information about the client, which then becomes part of his or her permanent medical record (potentially driving up client insurance rates). Third, insurance panel fee schedules are well below national averages, and are therefore not ideal for established psychologists. Because of these considerations, the vast majority of mental health professionals who choose to join insurance panels and become in-network providers are either just beginning their clinical practice, or find it difficult to sustain their target client load.

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I am finding that to be true. My former counselor was an "in network preferred provider." I can't say she was great. She usually had openings readily available each week. I think she did have trouble sustaining her client load. There was a lot of paperwork she had to do for each client. It was great for me, because my insurance reimbursed me for 90% of her fee. Her fee was determined by the insurance and was below the rate of my current therapist, who is not network.

My current therapist is highly sought after and fantastic. He is the guy to go to for my particular presenting problem. Back when I first started with him, I didn't realize how lucky I was to get onto his client roster. He is not part of any insurance networks, and in fact is not reimbursable even as an "out of network provider", as some people are. I tried with 2 different insurance companies to get reimbursement for him as an out of network provider, but both companies did not like his particular licensure. He does no insurance paperwork at all, but reserves his time for working with clients.

My daughter's new therapist is very similar. She is part of no networks and leaves it up to you to try to get out of network reimbursement for her services. Luckily, her fee is lower than my T and she has a licensure that the insurance companies like, so I should be able to get reimbursed for her at 60%. I'm still trying to decide if I want to seek reimbursement, though, as I'm weighing the negatives of having a mental health diagnosis associated with my daughter's medical record.

Does anyone think there are significant negatives to having a mental health diagnosis attached to a minor's record? Would this limit her opportunities in school and future jobs in some way? I'm not sure what the downside is.

I don't know, but that's what I'm afriad of. I'm 16 and I have ADD and I don't have my license yet and thats' why I was fired by my last job But if you happen to find any answers please let me know.

Here's some good information from a good source:

http://www.oregoncounseling.org/Cons...dentiality.htm

Thank you, Perna. That link has lots of great (and scary!) information.

Wow this is very scary!

Have you talked to your daughter's therapist about this sunrise? Maybe you could get some reassurance that way.

We all know that some people have prejudices about mental health diagnoses and treatment(s), it is so subjective. I don't know if there are professions that a person would be excluded from because of a mental health treatment history. It is so common and so much more accepted now days so I would hope unless a person has a very serious disorder that it would not be significant. To me it would say that the person was wise to pay attention to their mental health and intelligent to seek treatment.

It is a good question you raise and I have had professional friends who have wanted and needed treatment but would not risk it because of this very worry. So sad!

wait ..im lost and just wondering...does that mean someone who does not go through the whole in network thing wont give a client an offical diagnosis? Or do you mean those who do the in network thing are more thorough in their examinations of their client as well as with the diagnosis while the therapists and such who are not in network just listen to you but dont tell you whats wrong with you or keep their own profile of how you are progressing? Do i make any sense whatsoever lol ?
thanks, Inny

Inny, just means those in network HAVE to give their clients a diagnosis, sometimes exaggerated (wrong in degree/how serious it is) so it's serious enough so the insurance will accept it. So, some anxiety or depression and you end up with a "paper" diagnosis (not necessarily what the T's tell you) of panic attacks or major depression. Even out of network, in order to get the insurance to pay, have to do that.

But it doesn't have anything to do with why you went to the T or what they tell you, etc. However, it's possible that some, especially beginning T's might "believe" what they write so then you can get at cross purposes with what you actually may want or need or be convinced you've got a serious, hard-to-cure illness when it doesn't have to be that way.

That's not necessarily what happens, but it can happen and it seems like everybody's looking the other way. But that's what sunrise is saying, why therapists aren't signing up for or clients aren't using insurance anymore, the whole system for using mental health insurance isn't very good. I used insurance back in the 70's but it was before managed care and was a whole different ball of wax.

But what your T does and why, one has to talk to one's T about. We know what happens to politicians whose treatment for depression (or drugs) gets out. I remember being asked on school forms if I'd had "mental illness," etc. There can be insurance risks for schools with troubled students or companies hiring people who might have a problem and no one wants to take on those risks; doesn't matter so much about personal stigma. I notice everyone always waits in a news broadcast where something really bizarre or horrific happened to see if the person "had a history of mental illness." Like that "explains" anything!

I think I've decided I'm going to let my daughter go to 10 sessions or so before deciding if I should seek reimbursement from insurance or not. So far she's had 2 sessions. My insurance lets you submit claims for up to a year after the date of service so we have quite some time to decide. I guess I don't want her getting a mental health diagnosis attached to her medical records at this stage in her life. If the therapy proves to be longterm and I need financial assistance on this, I'll re-evaluate.

I'm kind of bummed also I tried to get reimbursement from my own insurance for my own current therapist (months ago). It turns out he is not reimbursable by either of my insurance plans, but I didn't know that and submitted claims to both of them with his diagnosis. Now they got the information but didn't do their part (pay). Well, I guess for all they know, I only went for 2 visits, since that was the claim I submitted to them.

When I told my T some time ago that I was having trouble getting reimbursed for his services, he asked, what's the matter, didn't they like my diagnosis? And I had the sense he would change it if I wanted to make it more reimbursable (but the diagnosis was not the problem). It all seems like a game to me, and possibly a game with negative consequences.

Now it all makes sense to me why my first counselor (preferred provider) spent ages during our first session taking a detailed history full of irrelevant details. Whereas my current T asked very little of that stuff and we got right to the important issues that brought me to his office. Hmmmmm.

InACorner, if you want a diagnosis from your T, just ask him/her. He can give you a diagnosis even if you don't seek insurance reimbursement, but it will stay between him and you. I have never asked my T to tell me what is wrong with me, although I know what "official diagnosis" he gave when I tried to submit the claim (it was the same one my first preferred provider counselor gave). My sense is he prefers to operate from a position of health rather than pathology, and if I asked him "what is wrong with me?" he would talk about healing and what he can provide in his office that can allow a person to heal.

Thank you Perna for clearing that up for me..i have no insurance and i was worried how i would be treated when i do get therapy with out any insurance...

inny, I agree with sunny. some therapists (and some patients/clients too!) think that a diagnosis is not necessary. I can think of many reasons: it is just a label for the symptoms presented; sometimes a person can change their thinking or behavior based on the diagnosis they're given--you hear so many people say "I'm this or that diagnosis" as if they have allowed the diagnosis to define them and then they expect certain thinking and behaviors from themselves. I would not want to do that, although I'm sure I have at times; most of us have symptoms of several of the many diagnostic classifications used.

I could be borderline personality. I could be avoidant personality. Probably a lot of things. I only know I feel depressed and anxious a lot and have traumas in my past. Those are my symptoms. I want the details on how my mind works and what old patterns i am still using that are unhelpful/harmful to me. For example, I'm lonely but don't risk getting close to people. See that viscious cycle? There's a lot in between the feeling lonely and the unwillingness to risk. That's what I want to learn about. A label/diagnosis wouldn't be very helpful with that, so it doesn't matter to me and I don't ask.

Sorry if that was more than what you were looking for!

About being accepted by the T... it does feel so good and that we mutually agree we can work well together feels like a solid foundation to start with... and I like that too.

xoxo

That sounds like a good decision, to wait and see for now.

Crap I wish we'd just all win the stinking lottery so we could not have to deal with the gate-keepers.

My work recently helped solve the insurance issue some. They took it away. Not entirely, but in a month we will switch from a nice PPO plan (network providers, copays, Rx coverage) to a catastrophic plan with a $3000 individual/$6000 family deductible. After that if you stay in network the insurance kicks in. Now I have to have $$ for every doctor visit, lab, Rx. I had Whiple surgery last summer (part of my pancreas and small intestine removed) and getting sick again is something that worries me a lot. It makes me so mad that they took away the peace of mind that comes with having good insurance. It's like a $3000 salary reduction. For the families it is worse because no one in the family gets reimbursed until that entire $6000 deductible is met. Look out, as this is a major insurance company (UHC) and this is the plan their own employees are on!!! I sincerely hope this is not a trend. It is devastating.

ECHOES

ECHOES, that's absolutely horrible. It's absurd for an employer to expect people to only need catastrophic coverage. After all, everyone should go in for checkups etc. even if they're perfectly healthy.

But back to the original question (what was it again?).

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Does anyone think there are significant negatives to having a mental health diagnosis attached to a minor's record?

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I think it depends on what field you're in. In my particular line of work, I don't think anyone would think negatively of me (or anyone) for seeking that type of help. In fact, several of my co-workers know I go to a therapist and they all think it's a good thing that I'm interested in taking care of my mental health. It might be more of a problem if I were incapable of good job performance as a result of it though. But then it would be the job performance, rather than a mental health issue, that would be to blame there.

On the other hand, my brother is in the medical field (he's a surgeon). He once went to a therapist when he was having trouble with making some serious decisions. That therapist wanted him to seek a psychiatric evaluation (perhaps for depression or something), and my brother refused. He refused because he was afraid it would get attached to his medical records and hurt him in finding a job later on. I thought he was being paranoid, but another friend of mine (who works in public health policy) told me he was right and that it'd be safer for him not to let that onto his record. So for him, if he wants to seek a psychiatrist, he'd have to seek one without ever letting the insurance companies know (which would be too costly for him as he's still in training and doesn't make much money yet).

It's sad that there's such a stigma attached to trying to stay healthy.

Sidony

ECHOES, I am shocked about your insurance. You work for a major health insurance company and they only provide their own employees with catastrophic health insurance? Grrrrrrrrrrrr. I hope their best employees quit (you included!) and go work for a competitor and run UHC out of business. That is just unconscionable. I would like to see an expose written up about UHC in the press.

That's interesting, sidony, and makes me go Grrrrrrrrrrr again! Your brother was worried about having a psychiatric visit on his record but not a therapist. visit. So at least maybe having the therapist was not detrimental to his career. I wish ALL the bias against mental health treatment would just go away.

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sunrise said:That's interesting, sidony, and makes me go Grrrrrrrrrrr again! Your brother was worried about having a psychiatric visit on his record but not a therapist. visit. So at least maybe having the therapist was not detrimental to his career.

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Yeah I didn't totally understand that part. It may be because he only went to the therapist a few times and could say that it was for help with career decision-making (or something like that) that wouldn't be a serious issue on his record. But he wasn't going to risk having a diagnosis / prescribed medication for depression on his record (my guess as to what might have happened if he'd gone for a psychiatric evaluation). And yet it might have helped him. Working as a surgeon is a hard field on anybody, and some depressing things happen in a hospital environment. And yet it'd be negative on his record to seek any sort of psychiatric help. I think that really sucks.

Sidony