Should I pay or file for coverage for therapy?

November 7, 2005 9:22 AM

I'm thinking of seeking counseling for a variety of reasons. Being new to the US however, I have questions about how therapy will have an effect on my future health care coverage. Should I pay out-of-pocket or file for coverage?

I have Blue Cross/Blue Shield in the US, and if I use someone in-network, they cover 80% and if it's out of network, it's 60%. I could just pay out-of-pocket - it would stretch me, but I would be willing to make sacrifices elsewhere to let it happen if it was really worth it. But, I pay enough in health care coverage already, that if it makes sense to use it, I will.

My question is this: how does seeking mental health help effect future a) employment b) health care coverage/prices c) anything else?

I know that the HMO will need a 'code' from the therapist as to a diagnosis for appropriate charges. That doesn't concern me as much as future implications for that diagnosis. Who can access that information? What would they know? Will this matter?

I'm not paranoid of 'ohmigod mental health stigma' but I would just like to make an informed decision based on future possible implications. This is the first time I've ever really dealt with the US health care system, and it's a little overwhelming.

posted by barnone to Health & Fitness (8 answers total)

It should not affect employment, as your medical records are confidential. I am the HR administrator (among other things) for my small company and I don't know anything about the services actually received by my employees.

Regarding coverage-- if you are purchasing the insurance yourself any claim, for mental health services or otherwise, may push up costs. However, in a pool (employer-sponsored or other) it will not.

Also for the record, so many people in this country receive couseling at some point in their lives, there really isn't a stigma. I am in the process of getting life insurance and asked my broker whether being on zoloft would affect my rates or chances of getting approved and he said not at all.
posted by miss tea at 9:33 AM on November 7, 2005

There may not be a stigma, but god help you when you go to apply for Long Term Care insurance or Long Term Disability. Bleh. There might be a time limit, though. I'm not sure. (like if you haven't been receiving treatment for the 10 years before you apply.)
posted by small_ruminant at 9:36 AM on November 7, 2005

as far as employment goes, future possible employer should not reject you due to your medical history unless job requires you to be healthy (mental or physical) which they are required to disclose prior to or during job interview(s). if they do not hire you for medical reasons though you're fit for the job, i'd consider that to be a discrimination.
however all depends on severity - whether you are able to perform the job you're applying for.

as for future health care, i don't see it being an issue either but again, this depends on severity and your age.

i have had treatments before, have changed a job since then (which gave me a different health care coverage) and i have not had any issues with it. but due to personal preference, i did not get prescribed to any medication just so you know.

also, the new job hired an external 3rd-party company for some verifications - they looked into my schooling history, previous work verifications and criminal history. by law, the external company is also supposed to provide me with a copy of their findings - i didn't see anything about my medical history in the copy so they probably don't look at that.
posted by grafholic at 9:39 AM on November 7, 2005

Response by poster: Yeah, a few updates: I'm in a pool (not self-insured). It likely won't involve medication. As for age, I'm in my late 20's.
posted by barnone at 9:55 AM on November 7, 2005

If you're paying for insurance, it is your right to get them to pay for treatments that you need. But the confidentiality thing makes me nervous too. As a therapist, on my consent for treatment forms I tell new clients something to the effect that although insurance companies *say* they keep all data about treatment confidential, that I have no control over how any of that information is secured or used.

Your records *are* covered under federal and state privacy regulations, and I don't mean to scare people, but everytime I read about how careless corporations are with confidential data, I wonder about how many incidents of data theft or inappropriate access aren't reported. It just makes me feel that people should be aware that once information about treatment leaves my office, I have no control over how it's used.
posted by jasper411 at 10:23 AM on November 7, 2005 [1 favorite]

When my daughter tried to get private health insurance, she was denied because she had been treated for ADD and was also taking an antidepressant. If you work for a group, and are covered under a group plan, it makes no difference. If you try to get private insurance outside of a group plan, and have a history of a psychiatric condition or treatment I believe it can adversely affect you, at least in Colorado.
posted by madstop1 at 4:31 PM on November 7, 2005

As madstop1 says, seeking counseling/treatment for mental health can -- though not necessary will -- make it more difficult (or least more expensive) to obtain individual coverage if you lose your group coverage and need to insure yourself for some reason (this was certainly my experience about 5 years ago -- several insurance companies actually seemed less concerned about my previous bout of thryoid cancer than with my being on an antidepressant!). It's less likely to do so if you don't go on medications, though.

However, it should go without saying that this possible future risk should not -- IMO -- prevent you from seeking out mental health care right now! As I said, it might make an individual policy pricier down the road, but that's small potatoes compared to your wellness now.

Good luck with counseling!
posted by scody at 5:06 PM on November 7, 2005

Response by poster: Thanks for the answers everyone. No, it wouldn't prevent me from seeking help, just trying to decide whether or not to pay or file. In the end, the counselor I've decided to use has a few scholarship slots, and paying for that out of pocket is only a few dollars more than my co-pay for the insurance. So, I might just go that route for the moment. Thanks for all the suggestions and warnings!
posted by barnone at 7:55 PM on November 7, 2005