Problems of Using Health Insurance for Mental Health Therapy

Most health insurance plans are expected by default to cover substance abuse services and mental health. However, using health insurance can be interpreted very differently when dealing with care for the body than the treatment for the mind. And this is why many people wonder does Health insurance covers therapy? and if it does, to what extent?


To help you decide whether or not to use mental health care insurance, here are some factors to consider:

1. Reduced costs for prescription drugs
For those diagnosed with mental illness and have prescribed the drug, health insurance often can significantly lower out-of-pocket expenses that you must pay. For those who have diseases that rely on Medicated treatment, but did not have the funds to purchase their own recipes often, aspects of health insurance is very helpful.

Problems of Using Health Insurance for Mental Health Therapy


It is important to note, however, that even if you see a therapist to talk therapy and paying out of pocket, many insurance carriers will still cover your prescribed medication from a psychiatrist.

So for those people with questions like, is therapy covered by insurance? you would agree with me that yes it does, but there is so much to be considered before you go for it.

2. Pre-existing Conditions don’t affect coverage
Currently under the Affordable Care Act, all Marketplace plan should include behavioral health treatment (eg psychotherapy and counseling), mental and behavioral health services, and substance abuse disorders. 

In addition, the Marketplace plan can not legally deny coverage and / or mental health conditions cost more for pre-existing medical diagnosis. Therefore, regardless of the reason you are seeking mental health care, Marketplace plan is required to have a package that can provide services for your needs.

There are two things to note though: changes in legislation and the cap on the number of visits. Already there are proposals to eliminate or restrict the pre-existing condition clause in the new law recently. Health is a field that is constantly changing so it is important to know that these changes to pre-existing conditions that are relatively new and many experts do not consider them to be a permanent change in our health system. 

In addition, many insurance plans limit the number of times you can see a therapist. While some plans allow you to see someone for a year without interruption, other plans may only allow for 10 sessions, while others require you and / or your therapist to file for benefits to extend the number of sessions allowed.

3. Difficulty Finding Therapists Who Receive Insurance
Until you try to take advantage of insurance, most people do not realize that the majority of mental health professionals do not take insurance. It can be frustrating trying to find a therapist who takes your insurance and when you finally do, often times people are not happy with their choices were limited.

The main reason why many therapists choose not to take insurance reflect a poor relationship between the therapist and the insurance company. Usually, working with insurance may cause the therapist to make significantly less money or take a large number of documents which they are not compensated. The therapist requires a master’s degree and enrolled in apprenticeship hours before obtaining their license. But after their charge, which is possible for many people to work more than 50 hours a week making less than $ 50,000 per year.

As a result, the therapist who agrees to work with insurance companies to come few and far between, causing extensive waiting times for clients. Going through your insurance company to see a therapist can have time to wait up to four months before having your first session. Those kind of extended wait times simply not practical when dealing with mental problems.

4. Required Mental Illness Diagnosis
One of the main reasons for therapists and mental health clinics decreased use of insurance is that insurance companies usually only cover services that are expressed as a medical necessity. In other words, your doctor is required to diagnose you with mental illness to be of service to qualify for coverage under the insurance.

With the ups and downs in life that many people go through every day, many people seek mental health care for reasons that are not defined by a specific mental health disorders. If the reason that you are looking for a therapist is not a diagnosed disorder, such as OCD or Bipolar Disorder, it can be very difficult to get your insurance to cover the session ..

Being that many people go into therapy for relationship repair, recover from traumatic experiences or just generally to improve their lives, find a medical diagnosis often do not apply. As frustrating as it can be for the patient, it would be unethical for a therapist to diagnose a person with a mental illness that they do not actually have.

5. Documented Sessions & Lack of Privacy
Another reason that therapists are hesitant to accept the insurance of their patients is due to the fact that each health care is documented submitted through your insurance is required to be recorded on your permanent medical record.

In addition to your treatment being proposed permanently, health insurance companies have access to the type of treatment you receive and what progress you have. The details and personal information that the therapist have, your insurance company will also have. 

If the insurance company decides to conduct an audit of your records in an effort to prevent fraud, they will have access to the details of what happened during any of your therapy sessions and other personal details of the patient normally would prefer to be left confidential. Using health insurance to receive mental health treatment opens the floodgates of your personal information to anyone who has access to your account at your insurance company.

Also, when such a proposed mental health diagnosis on your record, it is considered a preexisting condition. In the future, this could potentially increase your insurance costs or prevent you from getting coverage at all. When thinking about your mental health care in the long term, this is a major factor to be considered.

6. Specialist shortage
Even if you find a therapist through your insurance, often not going to be someone who specializes in the area you need.

When the doctor signs a contract with an insurance company, they are required to provide services for any and all patients that request to order the session. This means that if you want to see a therapist for anxiety, you might instead be stuck with a therapist who specializes in couples and families, simply because that’s what insurance company you have bid.

Contrary to popular belief, many therapists want to take out insurance. The doctor came into the profession with the primary goal of therapy to help improve people’s lives. But the reduced rate, extensive paperwork and rigid restrictions imposed on the therapist by the insurance company has pushed many of the most talented therapists away from work on insurance panels.

In conclusion, insurance benefits must be weighed and examined with caution when considering the use of mental health care. We know that life can be quite complicated and that’s why Betterhelp therapy is providing online, easy and affordable mental therapy for all. 

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