Non-fiduciary costs to using insurance for therapy?

September 26, 2006 8:08 AM

What's the real story with using health insurance for mental health services, related privacy issues, and how it affects one's ability to get insurance coverage in the future?

After an extended period of consideration, I've decided to seek counselling for what I think are relatively minor issues, and for what I hope will be a relatively short time. (In my rich fantasy life, this means 10-12 sessions over a few months, but I know that may not be realistic.)

Naturally, I'd like to avail myself of the generous health insurance benefits supplied by my employer, but I've known many, many people who choose to keep therapy "off the books" due to concerns about privacy and future coverage. What's the real story? Is it worth it to keep counselling records out of your insurance company's hands? What are the potential repurcussions of using insurance for therapy?

(And one more potentially relevant note: I'm employed full-time, but in the past I've sometimes been self-employed. It's entirely possible that one day I'll want to be self-employed again, in which case I'll have to secure my own insurance.)

Thanks.

posted by anonymous to human relations (13 answers total)

I have seen a therapist under my health insurance policy. I haven't experienced any negative consequences from it, and I don't expect to, but perhaps others have had bad experiences with it.

You say 10-12 sessions over a few months. Make sure your provider covers this much. I think I could get something like 2-3 sessions per month but it's been a while so I don't remember for sure. I think I went once a week but I also think I paid for some of the sessions myself.

I wish therapy were not such a big deal, I think most people could benefit from talking to an impartial observer from time to time, especially one trained to listen, comment, and guide you. Unfortunately a lot of people think there has to be something really "wrong" with you to see a psychologist, but I disagree.

Anyway, in short, if you're covered, I think it's a good deal. Therapy can be expensive if you're paying for it.
posted by RustyBrooks at 8:38 AM on September 26, 2006

I have seen therapists at 3-4 different times in my life for stresses of varying levels. I used insurance for at least three of those periods of time, beginning about 12 years ago. Since then, I've never seen my use of that health benefit referenced or heard it mentioned by anyone else in any medical or employment setting. I don't think my primary care doctor can even tell I've ever seen a psychologist.

There would probably be precedent for divulging your mental health records if you hurt yourself or others. And note that I'm not saying the information could never be used inapproprirately, just that it doesn't seem to have been in my case.
posted by cocoagirl at 9:07 AM on September 26, 2006

I have had to secure my own health insurance a couple of times. Both times during the "pre existing screen" I was asked if I had seen a counselor or been in therapy. I believe the time frame they wanted was for the past 10 yrs..

It is something to think about. They seemed (the insurance companies) fixed on any services I had done in the past 10 yrs., including medical.

I hear your concern. You may want to consider paying cash (if this is a possibility).
posted by 6:1 at 9:35 AM on September 26, 2006

I sought out a psychiatrist in Feb. of 2005 because I was having some pretty awful panic attacks and other anxiety related issues. I had never seen a shrink before, but had been on an anti-anxiety medication that had been prescribed to me by my primary care physician (what happens when you go onto a psychiatric med without psychiatric care is a tale for another thread.) I saw my shrink 1-2 times a week for the next year.

In December of 2005 I left my full-time staff position to go freelance. As I was on my way out, I called the company's insurance broker with whom I was pretty friendly.

I asked for his advice about where I should go to get insurance for myself -- even if he would be able to arrange for something for me. I volunteered my health information so he could work up a quote.

He said "Listen, we're friends so I'll give it to you straight. Because you have used your insurance for mental health, you will likely not be insurable for a while. My son has ADHD and we pay for all of his stuff out-of-pocket -- and I'm an insurance guy! -- because using the mental health policies sets up all sorts of red flags. It absolutely sucks, but it's what happens." He also mentioned that my back problems -- for which I had surgery in 1999 and which had caused at least 1 emergency room trip since then -- weren't as much of a hindrance to my insurability as my mental health claims.

I thanked him for his candor and continued checking around. I went through the application process with Blue Cross Blue Shield, my insurer while I was with my previous employer, to see if I could be added to my husband's policy. He was also freelance at the time and had a policy with BCBS. BCBS denied me coverage. Another company actually hung up on me while I was in the middle of giving them my health history during the application process!

The BCBS insurance I had at my full-time job covered 80% of 12 sessions of therapy for my lifetime, which meant I ended up paying for a shitload of sessions out of pocket anyway. It also covered a portion of my medication -- I believe about 80%. Without insurance, my meds were about $175/month.

Luckily enough my husband was offered a full-time position with a company in May, and I was able to be covered on his policy through his employer as his spouse. However, I will not be able to make any claims for therapy or meds related to my anxiety stuff for one year. At present I am no longer taking medication and haven't seen a shrink since January.

In hindsight, I am ambivalent. If I didn't have the insurance to cover me, I would not have been able to afford the treatment I needed at the time, so I am glad that I did use it, but I am also now pretty much uninsurable. And I can't see a shrink until at least June of next year unless I pay for it entirely out of pocket. And, yes, it's in part because I have voluntarily disclosed my own health status when applying for coverage. I suppose I could have lied, but would probably have been caught, especially when I was applying to BCBS which had already been covering me so they'd have me and my claims in their files.

If I had been more informed of what would happen by making mental health claims, as well as in less of a crisis state requiring immediate help, I would have sought out a therpeutic option that I could have afforded out of pocket.

I hope relating my experience has been helpful for you. Good luck in reaching your desicion.
posted by macadamiaranch at 9:58 AM on September 26, 2006

What insurance plan?

Kaiser -- Kaiser only lets you get therapy in their offices with their psychologists, and I hear you have to really be hard-up for them to take you. With Kaiser, anything you tell anyone at Kaiser will get to everyone in their system. A friend seeking therapy for some temporary thing (a breakup) got turned down for that therapy over the phone, but was then asked about it months later by a medical doctor when she went in to discuss going off birth control (it was because of other side effects, and the doctor said -- "maybe the OTHER reason you want to is..."). I guess I can understand putting a note in someone's record, but it sounded pretty tactless. As a new Kaiser member, I've decided to be pretty reticent about personal issues I might otherwise ask about.

Blue Cross -- The way Blue Cross works as I understand it is that they let you have a certain number of visits with a very minor diagnosis (Situational Anxiety and Depression, something like that). But after a certain number of visits, the psychologist has to shift you to a more major diagnosis. This is relevent, eg, if you try to join the Peace Corps -- they ask if you have ever been diagnosed with a "major" condition (not sure I'm getting the lingo right here). So, a middle-of-the-road course might be to use your insurance and go, but to ration your visits so you can stay in that "situational" diagnosis, then switch to cash after that.
posted by salvia at 10:01 AM on September 26, 2006

Just a note, I think some people keep therapy "off the books" because the only good therapists they can find don't take insurance. For me it's merely an issue of access; if my doctor took my insurance I would absolutely do it. I think therapy and drugs are just too expensive to pass up the opportunity of insurance covering it.

But that's my experience, I know Heather Armstrong has been denied healthcare because of her Prozac. She's detailed this extensively in her blog.
posted by scazza at 10:51 AM on September 26, 2006

My understanding is that it may become more expensive in the future to get individual health insurance if you show evidence of any pre-existing or prior condition that could recur, including mental health issues. However, if you're just going through a tough time, you may not be diagnosed with any specific mental health condition, and having talked to a therapist about breaking up with your boyfriend or your dog dying probably won't count against you the way that a diagnosis of major depression would.

The bad news is that in order to be covered by your current insurance, your therapist will likely have to diagnose you with something in order to code the invoice. It's that diagnosis that could work against you, and so you may want to go outside of your insurance to avoid being diagnosed with any particular condition.

The problem is that most individual insurance companies will ask you whether you've been diagnosed with or treated for any medical conditions within the last X period of time, and you're required under the terms of your contract with them to reveal your therapy sessions, even if they're not in your medical records anywhere. If they find out that you lied on your application, you've breached your contract with them, and they have the right to refuse to cover the costs of your medical expenses. So basically, you sort of have to tell the truth about whether you’ve been seen by a therapist, even if you didn't go through insurance to pay for it.

If you are diagnosed with a mental condition, you may still be able to get health insurance that doesn't cover mental health issues in the future, but if you have ever taken a prescription drug for a mental health condition or have ever been diagnosed with a condition that could require hospitalization, the insurance company will (in many cases rightly) conclude that you could be more expensive than their average customer and charge you more or deny you outright.

My (completely non-expert) advice would be to call up a community health organization or university mental health clinic in your area and ask them what to do. They've more than likely dealt with this before and can give you some more specific advice about how to proceed. I know that all of this sounds daunting, but I hope that it won't prevent you from seeking treatment.
posted by decathecting at 11:02 AM on September 26, 2006

In my unemployed period between graduating from college and finding my first fulltime job w/ benefits, I was denied individual coverage by Blue Cross / Blue Shield in Illinois solely because of my depression/anxiety history. It is literally the only medical problem I have on record, I've never been hospitalized, seriously ill, broken a bone, anything, and yet I couldn't even get catastrophic coverage. I could have understood no coverage on treating the pre-existing condition, but I couldn't get coverage at all, probably because they view depression as a risk factor for other problems(which it is, statistically, over the lifetime of a patient, but at 22 and with no history of suicidal ideation or self-harm, I thought I was in quite a different situation.)

I'd sure love to be able to freelance and work solely for myself someday, but due to my insurability situation, I'm afraid I'll have a hard time pulling it off beyond the period that Cobra would cover. So, I'd say if you can keep it off the books, do so, just to preserve the option of being individually insured. That wasn't an option for me, as I really needed long-term and thorough treatment, but if it is for you, I'd say eat the costs and stay insurable.
posted by jdunn_entropy at 12:11 PM on September 26, 2006

I had the same exprience as jdunn_entropy - no major health problems beyond being treated for depression/anxiety and, after extensive back-and-forth paperwork, was denied healthcare by BCBS.
posted by Zosia Blue at 3:21 PM on September 26, 2006

My sister has a weird situation at her job. Before you can get any mental health benefits, you must talk with one of the councelors there (it's a K-12 school). This is a total joke because they are not even close to qualified for this task. My sister is friendly with one of the councelors who has a big mouth and now she can name every employee who ever applied for mental health benefits. It wouldn't be on your permanant record (but teachers at neighboring districts all know each other so it could get outside your district), but I can't imagine this wouldn't hurt you if you applied for another position within that district.

This info came in handy when my sister decided to see a therapist last year. She just paid for it out of pocket since she knew the score. So, I guess it depends on the company.
posted by bda1972 at 4:29 PM on September 26, 2006

If you have the means, I would keep it off the books. Look closely at the real financial benefits of coverage -- will they pay a meaningful percentage of your costs (especially if treament lasts longer than you expect)?

As another has mentioned above... if you don't have the means to pay for yourself you might do better to bite the bullet: have insurance help pay, get the benefits of better mental health, and suffer the insurance consequences (if any, depending on where life takes you) for X years.

Yes, it's a breach of contract to omit your treatment and any medications in a future insurance application. However, you're unfairly penalized for dealing with issues that many others never deal with. You decide what you think is right, and if you can get away with it. My understanding is that if you never make a claim, insurance companies can't find the info.

Perhaps someday the stigma of actually seeking help and improving your situation will go away. Until then, it makes it hard for the self-employed. Your health claim info is stored and shared by insurance companies, at the Medical Information Bureau (MIB) for example. If you think there'll still be a social stigma when you apply for individual coverage, then do your best to keep your issues out of the database.
posted by powpow at 7:53 PM on September 26, 2006

I asked this very similar question earlier this year.
posted by echo0720 at 1:16 PM on September 27, 2006

I just wanted to pop back in and add my recent experience. I was completely denied cataclysmic coverage (it has a $10,000 deductible and only covers major hospital emergencies) because I had been diagnosed with "cyclothymia." That was over a year ago and I was not currently being treated or medicated in any fashion. Blue Cross/Blue Shield felt that was enough to reject my application. Not just attach a rider that would keep me from being covered for psychiatric conditions, but flat out rejected any health insurance whatsoever. Be careful what you report and claim on health insurance.
posted by iurodivii at 6:35 PM on December 18, 2006