Paying for Treatment

Therapy Within the Medical Model of Health

Therapy through insurance is within the frame of the medical model of mental health. Similar to how you would see your primary care doctor for a medical illness or complaint, insurance companies view psychotherapy in the same way. Insurance companies see treatment as a way to quickly resolve the immediate symptoms. When the symptoms appear to be resolved then treatment is considered completed.

 

Impairment Focus and Insurance Limitations

Insurance companies focus on the impairment that an individual is suffering from. The impairment has to be significant enough that the individuals work, personal life and hobbies have been negatively impacted causing significant distress. This focus on the severity of impairment can sometimes lead to limitations on the duration or frequency of sessions, as insurers often impose restrictions to control costs. On top of this, insurance companies will only cover treatment that is directly related to interventions addressing an ongoing impairment. For example, if a client's depression or anxiety reduce to a manageable state treatment should be terminated. Self discovery or deepening your interpersonal relationsips outside of the context of a diagnostic disorder, is not covered by insurance. These constraints can disrupt the natural flow of therapy and hinder progress for some who desire longer-term therapy working deeper change and self discovery when the symptoms related to the DSM diagnosis might have gone into remission.

Diagnostic Pressure and Therapeutic Process

Insurance companies require therapists to diagnose clients with a mental health disorder in order to justify reimbursement. While diagnostic assessments are a standard part of therapy, insurance companies only accept diagnosis from the DSM (Diagnostic and Statistical Manual of Mental Health). DSM diagnosis can be limited in scope and driven by external pressures such as pharmaceutical companies. For therapists, there may be  pressure to assign a diagnosis for insurance purposes can potentially influence the therapeutic process. Therapists may feel compelled to focus primarily on symptom management rather than exploring underlying issues or providing holistic support. A focus on treating the diagnosis can limit the available modalities used as well. Insurance companies will typically only reimburse specific evidence based treatments which can impact they ways that therapists approach treatment with insurance.

Reimbursement Challenges

Have you ever wondered why you are having a hard time finding therapists that take your insurance? The reimbursement rates set by insurance companies is typically much lower than that standard private pay rate. As a result, many therapists decide to forego taking insurance as it often is more time intensive with documentation, claims filing and communication with insurance companies. Some therapists that do take insurance may be forced to prioritize volume over quality, squeezing in more clients to offset lower fees. This can lead to shorter sessions or less personalized care, detracting from the therapeutic experience.

Importance of Accessibility

Despite these challenges, accepting insurance remains a vital means of making mental health care accessible to a broader population which is the reason I do have a portion of my caseload for insurance clients. However, it is important for clients to understand the pressures that insurance places on treating providers and the limitations of the therapeutic space when insurance is invited into it.

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I am happy to discuss during a consultation call if using your insurance would be the best option for us to work together.

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