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  • Lagniappe Counseling

5 Reasons NOT to use Insurance

What you don't know could hurt you

One of the first questions I often get is "do you take my insurance?" It makes sense, really, especially if you are at least as thrifty as the next person and prefer to budget wisely for things. However, after dealing with insurance companies in this field, I have several concerns with using insurance and managed care in general. I wanted to take the time to educate my prospective clients on this topic.

Reason #1

Medical Insurance requires a medical diagnosis

This is one that I am sad to hear that many people haven't heard from their therapists. If you have ever had counseling or therapy paid for by medical insurance, you have a mental health diagnosis on your permanent medical record. Yep, every time insurance pays for therapeutic services it is because the professional provided them with a diagnosis code that is now on your permanent medical record. For some this is not an issue. For others, it could be a big problem.  There are some professions for instance, that will put someone on leave if they are depressed, or anxious. Others that will do polygraph testing before hiring. Imagine being asked if you have ever been diagnosed with a mental illness, answering no because you didn't know you were diagnosed when you went to counseling with your partner a few years back, and then being flagged as lying when they acquired your records later. It has happened. We also have a political climate with changing rules and regulations regarding insurance and pre-existing conditions.

Reason #2

You don't want a diagnosis that doesn't actually fit

Diagnosis can sometimes feel icky to me. I have been part of organizations that, because they bill to insurance, have to diagnose every one of their clients with a disorder to get paid. Ethically, I just don't agree with this practice. An ethical therapist will not diagnose you if you do not fit the criteria. However, I have heard many, many times, someone saying, "well this doesn't quite fit, but it is the best I can find." Imagine going into an ER with stomach pain and being told "Appendicitis doesn't quite fit, but it is the closest to your symptoms, so that is your diagnosis...and oh that means we are going to take out your appendix." That wouldn't sit quite right with you, would it? When you pay for counseling or therapy out of pocket, a therapist does not have to try to fit you and your symptoms into a box. They can look at your whole picture and focus on working toward moving your toward your goals rather than focusing on your diagnosis and symptoms.

Reason #3

When insurance pays, they get a say in your treatment

Just like when you were a kid and asked your parents for money and they asked what for, the insurance company does too. They not only want to know what diagnosis is appropriate, but they want the details of your treatment plan, sometimes details of sessions, and THEY get to decide how many sessions they will pay for, how long the sessions should be, and which modalities they will pay for or not. Many insurance companies don't pay for the newer therapies, or have favorites they want therapists to use for a diagnosis (even if it doesn't fit with the client.) They also get to decide WHO you get to see.

Reason #4

If you are paying out of pocket, you  get to be in control of your own care

The most important questions to ask when trying to find a therapist shouldn't be "do you take my insurance" or "who is the cheapest I can find?" Really you should choose a therapist based on: their expertise with your specific issue, the kind of therapy they practice and the connection you feel with the therapist. Once you have chosen your therapist, you and your therapist should work together to set goals, determine a plan for reaching them, and choose the therapeutic approaches or modalities that will best support you in your goals. The amount of therapy needed should not be based on a chart that someone says that X issue = 8 sessions. The length of therapy can really only be determined over time as progress is evaluated and goals are achieved. So, if you want more choice in the who, what, when, where and how you get the help you desire, paying out of pocket might be a good choice for you.

Reason #5

Clients who pay out of pocket tend to get faster results and notice more significant change in their lives.

I think this is one of the best reasons right here. I am in this field because I want to help people achieve real change in their lives, and I have seen this to be true. When you are paying out of pocket for something, you are investing in it. You see the value and you want to make it worthwhile. Clients who pay out of pocket are more likely to make their therapy a priority. They are more likely to try the homework or suggestions that come up during sessions between sessions.  They are less likely to cancel last minute. They are more likely to come consistently. They are more likely to focus on truly utilizing their sessions to the fullest, and not just distracting from the real issues and talking about the weather. When I worked in agency work and had medicaid clients who didn't pay anything out of pocket, it was the exception not the rule that it took longer, they were less likely to follow through with suggestions and were much more inconsistent in their own treatment. When you invest financially in your treatment, you are more likely to invest in other ways as well and see more growth in the process.


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