Many people start their search for a mental health therapist by asking friends or their family doctor for recommendations. After that — understandably concerned about costs — they typically cross-reference with their insurance company’s preferred provider list. Finding a preferred provider is often an exercise in frustration in the DC area, though. It can be hard to locate a therapist who is close to your area, has hours that are convenient to you, and who is also on your plan. Why is that?
As a mental health provider, I can tell you that the decision to register (or not) with insurance is not one therapists make lightly. Insurance can help a broader swath of clients to obtain counseling services, which is important. At the same time, counselors must weigh what they are required to give up in paneling with insurance, both for themselves and for their clients.
Insurance companies require a few things when their members seek counseling:
1) A diagnosis. Your counselor is required to diagnose you with a mental health disorder in order for your treatment to be covered. This is also true if you seek reimbursement for out-of-network services, which is important to know. Informed clients should discuss this with their therapists; you have a right to know what diagnosis code your counselor is using for you and why.
2) Involvement in client care. Insurance companies offer limited approval for sessions, many times setting a cap on the number of sessions you can have. Therapists, in order to ask for approval for more sessions, have to share information about your treatment. The insurance company may ask your prognosis, why the counselor thinks you need more sessions, and may ask for your treatment records. This may compromise your privacy.
Other Potential Pitfalls
Clients who are looking for mental health providers on their insurance plans can encounter problems in finding someone convenient. Other pitfalls include not being able to find a practitioner with a lot of experience or who specialize in an area of therapy that is in high demand.
Suggestions for Clients
One of the most important considerations in counseling is good fit with your therapist. It is also important to consider your therapist’s credentials and experience. A seasoned, knowledgeable therapist — while their services may be more expensive — may more than make up for the extra expense with helping you efficiently and effectively with your mental health issues.