ABOUT INSURANCE AND COUNSELING


Mental health benefits are different from medical and dental benefits. Medical and dental benefits almost always allow for preventive check ups. Unfortunately, this is not the case with behavioral health or mental health benefits.

 

At the present time, most insurance companies will not reimburse you for counseling services unless a diagnosis is made. Generally this means I have to determine a “disorder” is present and list it. This will be the listed as the “ICD Code” or "DSM IV Code".

 

Doing this could possibly impact your insurance in the future in the form of perceived risk, rates, or -up until very recently- denial of insurance. Please note, many other medical diagnoses can possibly impact your insurance as well. Please do not put off counseling due to this, I only mention the need to diagnose because insurances do not reimburse for preventative MH care yet, and I believe it's important for people to be informed consumers. (UPDATE:  The implementation of ACA -also known as Obamacare- should lower the risks to consumers around their rates going up due to accessing services- but how much of a lower risk is not clear yet). 

 

If I don't accept your insurance, you can see if Out Of Network benefits will reimburse you for sessions.  Out of Network benefits vary quite a bit depending on your insurance and coverage levels, but are often they can be very helpful in helping to cover the costs of my fees. 

 

NEW: Confidentially paying out of pocket if you are insured is now protected by law.  If you wish to avoid using your insurance (to avoid possible increases in rates or perceived risk) you are now entitled to do so, and it can remain confidential.

 

As a clinician, I feel obligated to do my best to ensure clients are not harmed by diagnoses in the present or the future and will not diagnose anyone with disorders I believe may seriously hurt their ability to access services in the future. Having said that, giving “less serious” diagnoses might impact the number of sessions your insurance will authorize. In the rare event I need to give a serious diagnosis in order for you to access certain resources (e.g. hospitalization or other inpatient treatment), I will do my best to speak with you about it beforehand. 

 

In a very few lucky cases, insurance companies will pay out for what are called “V Code” diagnoses, which are “areas of clinical focus” and not “disorders”. If your insurance company will pay out for V Codes, in general it is better for me to list that (if applicable). But most companies do not pay out for V Codes.

 

Please feel free to talk to me about any of this if you have questions or want more information.

 

 

 

Additional information