[eeyorestail]

I just ran across this article on one of the Psych Central blogs and was wondering what everyone thought:


Should I NOT Use Insurance for Therapy?


Honestly, I thought it was pretty tone deaf. I don't disagree with the author's list of disadvantages of using insurance for therapy. I don't have much love for insurance companies as I have struggled with them over the years. But in the end it comes down to this: I need insurance in order to afford therapy.


The author says that it is "nice" to have financial assistance for therapy, but that the hassles outweigh the benefits. I would say that for many, financial assistance isn't just "nice," it is vital. He briefly mentions sliding scale, but other than that, he seems pretty oblivious to the fact that affording good therapy without insurance is pretty hard to do.


Honestly? I think insurance is more difficult to deal with for the therapist than the client, and because of that, many therapists would prefer to be paid out of pocket. That's fine, but it bothers me that these therapists will then turn around and make paying out of pocket sound like an advantage for the client so that they don't have to deal with it. "Sure, you'll probably have to pay me more and I won't have to do as much paperwork, but I'm only thinking of you!" seems to be the message.


The author's final (and bizarre, in my opinion) argument is that paying out-of-pocket will increase the client's self-esteem because they will feel more self-reliant: "Many have even acknowledged that it’s increased their self-worth and self-esteem to see that they can actually do this without the outside help — increased independence and being the master of their own self-care."


Huh? Why would my self-esteem be lower because I use health insurance for my health? That's the whole purpose of insurance. Should a cancer patient pay for chemo out of pocket to give their self-worth a boost? Maybe I should rethink my car insurance. Next time I'm in an accident, I wouldn't want to have to face the shame of my policy paying out for the repairs.

[stopdog]

Thoughts of a jungian on it:
Interesting question | Jung At Heart

[Petra5ed]

It bothers me that using insurance (which is paid for) can be seen as "dependence" by anyone. I pay so much for medical insurance and it is horrible and covers next to nothing after my huge deductible. Anyways, either way I'm going out of pocket for therapy because almost no one takes my insurance because they reimburse at a super super low rate AND require extra hours of paper work and notes to be filed.

My guess is a therapist might resent me on some level if I went through insurance vs paying out I pocket. Other than that I don't think it makes a difference.

[CameraObscura]

I pay out of pocket for my therapy, at considerable personal cost. It does increase my sense of self-esteem in therapy, in a very real way. I beg no one for a diagnosis, for my need to be real enough for a company to pay for, I don't have to worry about my therapist being frustrated with my insurance company or not being paid what he is worth. I like walking in feeling like I am on equal footing - every relationship has to be reciprocal or it cannot be healthy, and the only need my therapist brings into our relationship is the agreed-upon fee. I'm doing my part to keep the relationship a mutually beneficial one. I do feel more self-reliant. I don't think my therapy has the same dynamic that using my insurance does for my physical health care, as it is an emotional relationship and emotional undertaking.

I do think the author is a bit tone-deaf in acknowledging that many people simply cannot afford not to use their insurance. I make significant sacrifices to do so, not everyone should be expected to be comfortable doing the same. I have to remind myself of why I choose not to use my insurance when I'm flat broke (and I am right now, after a separation, expensive move, and loss of a partner's combined income). Beans and rice? Not going out at all unless it's free? Juggling utility bills? Sketchier apartment than I could otherwise afford? It's okay with me for now. I am single and have no children, so no one has to give anything up with me.

I also know that my dissociative disorder is not going to end up on an employment background check. I know that I have considerable trust equity (for lack of a better term) built up with my therapist after being a weekly cash-pay client for two years; he knows exactly how seriously I take my work in there.

Just my experience, of course. Everyone's mileage will vary.

[vonmoxie]

Pretty sure the percentage of people in a position to make a decision whether to involve any insurance benefits based on preference alone is quite small. I don't like being dependent on anyone or anything, but unfortunately material reality dictates that my health insurance benefits are utilized to their full extent. Unless I'm to start living in a van by the river.

[NowhereUSA]

If my insurance didn't pay for part of my therapy I wouldn't be in therapy and I wouldn't be here typing this. The fact is, at least in the U.S, insurance is stupidly expensive. Sure, if therapy was the only thing insurance was paying for, I'd be like "Well out of pocket is cheaper!" but it's not. Without my health insurance which costs about the same as a mid-size car (annually), we'd be seriously screwed because of the health costs.

I mean... how is not using insurance "more self reliant" - does this author not realize that most people *pay* for their insurance? If you want to know why I feel entitled to utilizing my insurance, maybe ask me how much it costs me in premiums in a year. How ignorant can this person be?

[krisakira]

Sounds like upper class privilege to me.

[krisakira]

The author is assuming that going to therapy should be a shameful experience, and that paying yourself makes it less demeaning. It is like any other doctor visit, in my opinion.

[ruh roh]

I pay close to $600 mo for health insurance premiums for myself, but as along as I can make private payments for therapy, I will do that instead. I am not rolling in money, but I do have an income. There have been long stretches of years when I could not even afford insurance to pay for therapy, so I went without anything. I guess I make sacrifices (I don't eat out, go on vacations, or even save for retirement) but it's more important to me to pay for my own therapy so it doesn't feel like I'm giving up anything big.

Saying that it gives people more self esteem is offensive to me, though. My self esteem sucks. I do think it affects intangibles, though, by not presenting a hassle for therapists when it comes to paying up. Only the therapist would know for sure if they regard people differently based on insurance headaches or not. But as far as making me feel good about myself? Yeah...not so much.

There is absolutely no way therapy would happen for me without insurance coverage. I find it odd that the writer ties self-esteem to money.

I understand why people choose to pay out-of-pocket, but I just don't share those concerns about the use of insurance. Personally I've always used insurance for my mental health services and have never had problems with it. Insurance has always paid well and promptly; privacy has not ever been an issue; I have never found that insurance was dictating the rules for my therapy and psychiatric needs. I know others have had those issues though, so I get their concerns.

With a very seriously ill husband and children, life is expensive on many fronts. Cutting back any further to afford therapy would not be possible. We live pretty bare bones as it is. So, I thank my lucky stars that we have decent insurance and good providers who accept that insurance.

[missbella]

My self serving former therapist-from-hell web-published a nearly identical article and no longer takes insurance. The article was his contribution to mental health literature.

[AllHeart]

I pay my T out-of-pocket 100% because she is not in my insurance network. I sure wish she was in my insurance network though.

Paying her does not affect my self esteem either way. Or maybe it would if insurance covered her. I'd have more money to spend on me and that would definitely help my self esteem.

[divine1966]

My self-esteem has nothing to do with how I pay for therapy. I pay for my insurance not only with my premium and deductible but also with many hours of work and work related stress! It's not like my insurance is free for me! And in fact we are only able to keep our good insurance because we agree to take major pay cut!

Having health insurance doesn't make me less self-reliant! Should I then pay insurance premium but continue to pay for all of my doctors out if pocket in order to be more self-reliant?

What a joke!

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[doyoutrustme]

My insurance company used to be a pain to deal with, and I see someone who does not take insurance. I don't blame him at all as he'd never get what he's worth and would have to sacrifice the quality of his care to get it.
Once I learned how to navigate the insurance company, I'm now fully reimbursed, and fine with it.

[Salmon77]

I use insurance and do have some of the negative feelings about it mentioned inthe article: I wonder if I'm "sick enough", have to deal with paperwork, etc. But my job does not pay well, and there is no way I could afford to pay out of pocket. Even if I got a 50% discount it would be too much.

[Lauliza]

I honestly feel like this blog is slightly manipulative and self serving. He is trying to convince readers that it is in the best interest of the client to pay privately for therapy when in reality, the only one who really benefits is the therapist. If a client chooses not to use insurance that is their perogative. However, if you pay for benefits and choose to use them, it isn't something to be ashamed of. If all therapists were private pay then fewer people would seek out treatment. I fail to see how that is a good thing.

[Leah123]

Originally Posted by AllHeart

I pay my T out-of-pocket 100% because she is not in my insurance network. I sure wish she was in my insurance network though.

Paying her does not affect my self esteem either way. Or maybe it would if insurance covered her. I'd have more money to spend on me and that would definitely help my self esteem.

Same for me: when I began therapy, I didn't even have mental health insurance and after developing the unique and close relationship I have I can hardly imagine switching to someone brand new with more limitations to boot. Still... it is a real balancing act to determine the best blend of financial health and mental health investment, ha.

[atisketatasket]

I read somewhere online once, before starting therapy, that therapists believe that clients who pay out of pocket tend to improve more quickly in therapy, i.e., it hits them in their wallet, so they don't waste time? Can't find it again.

Even at the time it struck me as a stereotypical statement that I wanted to see more evidence for. After several months of exposure to PC, I definitely think it can't be true.

[eeyorestail]

Originally Posted by Lauliza

I honestly feel like this blog is slightly manipulative and self serving. He is trying to convince readers that it is in the best interest of the client to pay privately for therapy when in reality, the only one who really benefits is the therapist. If a client chooses not to use insurance that is their perogative. However, if you pay for benefits and choose to use them, it isn't something to be ashamed of. If all therapists were private pay then fewer people would seek out treatment. I fail to see how that is a good thing.

I had this feeling as well and I think it's what bothered me the most. "No, really! It will be therapeutic for you! Obviously I'm not thinking of myself." And telling a bunch of psychiatric patients who probably already struggle with self-esteem (I know I do) that shelling out more cash will make them feel better about themselves is a pretty low blow.

I was also wondering about his claim that not having your psych diagnosis on health insurance file will make it easier to get life insurance. I know when I got my life insurance they simply asked me, "Have you received treatment for x disorders?" They don't care if my health insurance has paid or not. Since it wouldn't be recorded on my health insurance files, I suppose he is right in that paying out of pocket would make make it easier for me to lie and say I have not. But it would still be a lie and I could get in trouble for fraud or if something happens to me the company may not pay out. So unless he is encouraging insurance fraud I don't see how that is helpful.

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[atisketatasket]

Originally Posted by krminnj

.

I was also wondering about his claim that not having your psych diagnosis on health insurance file will make it easier to get life insurance. I know when I got my life insurance they simply asked me, "Have you received treatment for x disorders?" They don't care if my health insurance has paid or not. Since it wouldn't be recorded on my health insurance files, I suppose he is right in that paying out of pocket would make make it easier for me to lie and say I have not. But it would still be a lie and I could get in trouble for fraud or if something happens to me the company may not pay out. So unless he is encouraging insurance fraud I don't see how that is helpful.

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He might mean that your diagnosis is on file with your insurance company and that's what the life insurance company checks, not payment information?

I don't see why most psychological diagnoses would be a problem, though. I see which ones would be, of course.

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[Lauliza]

Originally Posted by atisketatasket

He might mean that your diagnosis is on file with your insurance company and that's what the life insurance company checks, not payment information?

I don't see why most psychological diagnoses would be a problem, though. I see which ones would be, of course.

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I agree. I know there are certain medical diagnoses that can affect your life insurance policy but would be surprised if there were many psychiatric ones.

[Patsfan]

Mental illness can affect your ability to get life insurance. Back 20+ years ago I applied for life insurance, I answered all the questions including mental illness. The company gave me the policy but reported to the Medical Insurance Board. When I tried to get a 50k term policy I was denied. Now I get my insurance from work.

I did pay out of pocket when my Pdoc didn't accept my insurance, now she does. We pay premiums plus deductible so I am not getting anything for free!