What are the Implications of Using Insurance
for
Mental Health Services?
Most people choose to have their insurance pay for
mental health services if they have a benefit for it. However there are several implications that clients should be
aware of in doing so. Some insurance plans will pay for mental health services with no questions asked other than for
a diagnostic code and a treatment date. Others will pay for 8-12 sessions with no questions asked, after which they
will want some additional information in order to determine if continued treatment is "medically necessary."
When insurers ask providers to submit a "treatment
authorization request" for cointinuing services, typically this will include a disclosure of the following types of information:
- Specific symptoms, their severity and duration.
- Risk
factors such as suicidal/homicidal tendencies or significant substance abuse.
- Level and description of functional
impairment.
- Specific treatment goals and indications of progress made toward those goals.
- Psychotropic
medications taken or reasons why medications are not being considered.
When
information like this is requested by your insurer, I make every effort to minimize the disclosure of sensitive information.
Clients are free to review and participate in the creation of these short reports upon request and to share concerns about
any information they do not want to have disclosed to their insurer.
The only sure way to eliminate any information from being disclosed to an insurance company is
to consider a self-pay arrangement with a therapist.
