When telling people about the counseling services I offer, I am often asked if I accept health insurance as a means of payment for my services. In short, I do not.
There are a number of reasons for which I do not directly accept and bill insurance. First and foremost, when a mental health provider directly bills an insurance company for counseling or psychotherapy services, a significant amount of personal information is required to ensure “medical necessity” and support the need for counseling services. Medical necessity means that you have a mental health diagnosis that is severe enough to be impacting your daily functioning, namely your ability to accomplish your day to day tasks (eg. work, school, social interactions, activities of daily living such as bathing, eating, etc). Direct billing through your insurance provider is a rigid process that requires a diagnosis, as well as strong justification of how this diagnosis it impairs you from being a functional individual.
Most insurance companies also require treatment plans which itemize the issues we are working on in therapy and the goals we have set to help you resolve these issues. Further, some insurance carriers only approve a certain number of visits and require reauthorization, by asking the therapist to share more of your personal information with the health insurance provider, each time you need more sessions. This can be extremely invasive and detrimental to progress in other areas of life.
I am dedicated to protectecting my clients’ privacy as much as possible. I also avoid labeling with a medical diagnosis which your health insurance will then keep on file permanently. The diagnosis given to you stays on your permanent health record, and can affect your future. For example, if you would want a job that requires a security clearance, or you would like to adopt a child, mental health diagnoses are taken into account.
Therefore, I offer a monthly superbill to clients who request them for reimbursement purposes. A superbillitemizes the services rendered, how much you paid for your services, and a diagnosis that is sufficient enough for the insurance carrier to pay you back a portion of the fees you paid for your services. As an “Out of Network” provider, I am classified as outside of your insurance company’s preferred provider network, but some of the fees for services might be reimbursable to you directly. This is typically only applicable to people who have PPO type insurance plans. Please note, it is ultimately your responsibility to understand your insurance benefits and to make sure what percentage of the therapist’s fees will be reimbursable.