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September 10, 2012 7:08 PM   Subscribe

Major depressive episodes and individual (USA) insurance repercussions. Should I let my psychologist submit this?

California, USA. I've just been to see a new psychologist for a first visit today. My initial impressions are quite positive; I could see myself developing a very fruitful and trusting relationship with him over time.

At the end of the session, he offered a diagnosis of mild clinical depression. He asked my psychiatrist to revisit my existing citalopram prescription (from 10mg) and said that he wished to see me twice a week on an open-ended basis. He doesn't see me as having a lifelong (chronic) depression problem, but it is presently very significant and he wants to get me stable in order to achieve longer-term health.

Because my insurance only covers 20 visits a year for outpatient therapy, he asked if he could submit a diagnosis of a Major Depressive Episode in order to qualify me for unlimited sessions under the Mental Health Parity Act. He said it was ultimately up to me if I wanted to pay out-of-pocket after the 20 sessions if I didn't want that on my record.

At the moment, I'm covered under an HMO, but my company isn't doing well, and I can conceive of a future date where I might have to pay for individual insurance. Shall I allow him to process that diagnosis (thus gaining access to more therapy for free), or pay out-of-pocket and keep my record clean for the future?

(I don't know how my psychiatrist classified our prior sessions to my insurance company, but I went in with a panic/anxiety disorder two years ago and I've been on my citalopram regimen ever since. I have nothing else on my record.)
posted by anonymous to Health & Fitness (4 answers total) 2 users marked this as a favorite
That sounds skeevy to me. I have some experience with mental health pros having to force square-peg clients into round-hole diagnoses just to justify treating them at all, but what you describe is more like saying you have a head cold but wanting to diagnose you with pneumonia anyway so he can treat you more.

Is your insurance on a calendar year? Considering it's September already, why not max out (or get near the max) for this year under the 20/year limit, and start over at zero in January? By then you'll have a good idea as to whether this guy's open-ended approach is helping you enough to sign up for the long haul.
posted by headnsouth at 7:31 PM on September 10, 2012 [2 favorites]

I think it's wise to think about how an official diagnosis of a Major Depressive Episode might affect your future ability to qualify for individual insurance. I once naïvely checked a box indicating that I had "moderate" depression as part of an application for individual insurance, and was denied coverage as a result. Subsequently, I was able to convince my therapist to submit a letter attesting to my actual diagnosis of "mild" depression (sure didn't feel mild to me!) and eventually obtained coverage, but it was an important lesson in how much insurance companies may not act in what you and I might think are reasonable ways.
posted by I love to count at 9:22 PM on September 10, 2012 [1 favorite]

Your psychologist wants to submit a trumped-up diagnosis to get you coverage you are not entitled to under your insurance plan. This is more than skeevy; it's insurance fraud. Don't do it.
posted by commander biscuit at 9:29 PM on September 10, 2012 [3 favorites]

Don't do it. Fraud aside, getting a diagnosis of depression definitely affects you in future when optaining insurance.
posted by St. Alia of the Bunnies at 4:59 AM on September 11, 2012 [1 favorite]

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