Is this ethical?

My husband and I saw a marriage counselor this morning. He finally agreed to go so I researched and found a woman who specializes in marriage and parenting issues.

So, she explained how out of network insurance works at the end of the session.

After we left, I ran to the restroom and when I came out of the stall (yes the stall) the T was there washing her hands.

She immediately asked me if it was okay if she put a diagnosis of depression since my insurance doesn't pay for relational issues.

I was taken aback and said that I already have my individual T as I told her earlier and his diagnosis is similar to that. She said for insurance purposes she could use NOS (not otherwise specified).

I didn't know what to say so I said well alright as long as it doesn't interfere with my individual sessions.

Once I got back to work, I was thinking that how would this not impact my individual sessions. Wouldn't insurance say which T is treating depression??

I called T's office and left a message, I see him tomorrow anyway. I called my insurance and asked if they get two claims for depression by different T's what happens and the woman said I could see as many people as I want for depression.

This sounded ridiculous to me. But really, she is doing marriage therapy, not depression therapy...isn't this unethical? or am I overreacting? I tend to do that.

over-reacting in my opinion

insurance companies are not your friends and no matter what they put down as a diagnosis they will find some excuse to raise rates or
deny a claim or etc....

almedafan, I have experience with getting reimbursement from 3 different insurance plans (different companies) for mental health issues and counseling. None of them will reimburse for marriage or couples counseling or any type of family therapy. Basically, if there is more than one person in the room, it is not covered. Are you sure your insurance covers family therapy?

If it turns out you are lucky and your insurance will reimburse for family/couples therapy, if it were me, I would not "double dip" and submit claims from 2 different therapists for depression. Ask her for a different diagnosis, perhaps the NOS. Or better yet, have your husband take the diagnosis and submit the claim. He could use NOS and submit to his insurance (or yours) but it is from a different person on the plan so it shouldn't impinge on your claims at all.

As for the therapist "choosing" the diagnosis to put down from among several choices just to get reimbursement--yes, they play the game. For individual psychotherapy, usually a mood disorder such as depression is one of the least serious diagnosis codes they can write down and get reimbursed, so they are doing clients a favor to write down something so benign (when maybe it could be more serious). I've looked into this for my daughter and what would be the least serious diagnosis they could give her and still get reimbursed. I think it is something like "mood disorder, unspecified". As of yet we haven't submitted claims for her, but it is really nice her therapist is willing to work with us on this because I am sensitive to the fact she is a minor and I don't want stuff going into her permanent record that might impact her future options.

When my husband and I go for couples sessions with T we go under his name for individual. They won't pay for couples counseling either.

I wouldn't worry about it, but maybe you could put it in his name so that your # of sessions per year is not compromised by the couples sessions.

I think the ethics issue gets fuzzy sometimes and this is one of them.

If she persuades the insurance company to cover her counselling, will that affect your regular therapy coverage by your insurance? If they cover a limited number of visits then both therapies would be counting toward that maximum.

If you don't want your insurance company involved, tell her that you don't and that going out of network is fine with you.

Okay it seems I overreacted that is good then. Family therapy is not covered so she is doing individual under me with depression NOS.

My husband said he should have unlimited visits for mental health outpatient so maybe it'll be okay. If it isn't I'll have her switch it.

I think you should be ok. When my H and I went to couples my insurance wouldn't pay for it unless T put it under an individual diagnosis. In addition to couples, I was seeing her for individual and my H (now ex-H) was seeing a different T for individual. All of it was covered.

Actually, my insurance company allows for family counseling under its plan. I don't use that, but I would assume that if I did, it would be processed differently, because it has a different code number than "individual therapy."