Five Hidden Truths Everyone Should Know Before Using Insurance

"I think the biggest problem with healthcare today is not its cost – which is a big problem – but for all that money, it’s not an expression of our humanity."

-Jonathan Bush

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Finding the right therapist can be a daunting process. Will my therapist be able to help me? What skill set best matches needs? So many important questions.

Those seeking therapy or counseling in Seattle, where the cost of living is stratospheric, are also mindful of the therapy price tag. This is why so many Seattle therapy clients hope to work with providers who accept insurance. This is understandable: clients pay the monthly insurance premium so, naturally, they want use their benefits.

While skill set and cost are certainly an integral part of therapy, the best predictor of treatment outcomes is the strength of the alliance between client and therapist. In other words, clients do better when they feel a deep connection with their therapist. This was the primary reason I stopped taking insurance.  I'll explain why.

Many clients assume that utilizing their mental health benefits will be simple: schedule the appointment, bring the insurance card to the first session, pay a nominal co-pay, and leave. Sounds pretty straight-forward, right?  Actually, it's anything but.

Just as an email makes its way through a complex series of invisible gatekeepers before it lands in a recipient’s inbox, so too does a mental health claim after it's been filed. And what goes on behind the scenes may cause you to think twice about pulling that insurance card out of your wallet.

Here are the top five hidden truths every client deserves to know before deploying their mental health coverage:

1. It doesn’t matter what you want.  Your therapy should be for and about you. Ideally, you and your therapist would decide together the frequency and duration of your counseling.  When you use insurance, all of that is determined by your insurance company, which is staffed by strangers (often with little or no mental health training) whose primary mission is to maximize profits by limiting care. One of the ways they do this is by requiring clients to meet the criteria for serious conditions they often don’t have, like major mood and anxiety disorders. The fancy insurance term for this is “medical necessity.” Insurance companies are always looking to deem therapy unnecessary, even when it is benefitting you, the client. You may be struggling with job loss, for example, but if you are still able to function reasonably well, your insurance company may decide you are “not sick enough" and stop paying for your therapy.  That’s if they’ve even bothered to review your information before denying coverage (click here if would want to know more about this). As a therapist and counselor, I work with people, not diagnoses. Insurance companies foster the opposite. Which brings me to the next truth.
2. Your diagnosis will become part of your permanent record and may be used against you in the future. In order to be reimbursed for service, your provider must assign a diagnosis that satisfies the insurance company's medical necessity requirement, even if that means diagnosing you with a condition you don't have. (Sidebar: if this sounds like insurance fraud to you, that’s because it is. Therapists are incentivized to commit fraud in order to get paid. They do it all the time.). Your diagnosis will then become a part of your permanent medical record, which is discoverable by present and future entities such as employers (especially when they are furnishing your health insurance), disability insurance companies, labor and industries, divorce attorneys, and/or anyone else who gains access to your protected health information. All of these entities will have their own agenda, which may or may not align with yours. In other words, you are at risk for being stigmatized or penalized for seeking help. If you choose to cover your own therapy, you will not have to worry about diagnoses coming back to haunt you in the future. 
3. Your therapy will not be confidential.  Confidentiality and privacy are integral to an effective and meaningful therapy relationship. When you pay for your own therapy, you are the sole determinant of who gets to know that you are in counseling and what is discussed within the safety of your counselor's office. Most clients do not realize that, when they use insurance, they are agreeing to allow their insurance company (again, strangers with little to no mental health training), at any time for any reason, to access to their private information. This can include diagnoses, treatment plan, and even session notes. Remember, the sole intention of gaining access to your file is to limit your coverage.
4. Resentful therapists. This one is particularly tricky to acknowledge because, as a former contracted provider, I've been there. One of the most widely-known and infrequently admitted truths in the industry is that every contracted provider resents third-party payers. This happens because the per-session amount we receive from insurance companies is anywhere from thirty to fifty percent less than our service fee. Reimbursement rates are never adjusted for cost of living. In fact, they tend to decrease, year after year, despite the rising cost of overhead. Aside from discontinuing their contracts, there is nothing providers can do to change this. What’s more, to make ends meet, many therapists over-fill their schedules. More appointments mean more insurance red tape and greater risk for burnout. Imagine if your employer systematically increased your work load while reducing your wages, when you were already paid less than the going rate for your expertise. How would you feel about showing up for work every day? Therapists and counselors are innately caring, considerate people. But they are still human beings. When any human is asked to do more for less, over time, it is only natural to feel resentment. Even the most seasoned therapist will bring this resentment into the therapy room, whether he or she intends to or not. And this has the potential to hinder your therapy. Which brings me to the fifth and final truth.
5. Slower treatment progress. When a third-party payer is involved, there is always confusion, whether it is conscious or not, about who is responsible for the therapy. Removing third-party payers from the therapeutic relationship empowers both therapist and client by clarifying ownership of the work. Just as you are more likely to take better care of a car you own than one you are merely renting, so too will you invest more in therapy that clearly belongs to you. Add to this the fact that humans automatically perceive greater value in what they pay for and you've got a recipe for getting better--faster!

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At this point, you might be wondering if it’s even possible to get good therapy with a contracted insurance provider. I think it is.  At least I hope so—I was a contracted provider for the majority of my professional career and I was committed to helping my clients! 

It is important to acknowledge that, when third party payers are involved, the therapy will be impacted by forces that cannot be found on any insurance website or glossy-paged benefits booklet. Knowing what these forces are ahead of time can help prevent unwanted or unpleasant surprises from popping up down the road.  

The decision to begin therapy or counseling may be one of the most important ones you make. Regardless of whether you choose to seek services in or out-of-network, what matters most is that you have as much (accurate) information as possible before deciding which path is right for you.  If you've read this, you are on your way to making a well-informed decision about the future of your mental health care.

If you’ve got anything to add to the discussion, feel free to speak your mind in the comment section below. 


​Dr. Jill Gross is a licensed psychologist, therapist, and counselor. She offers grief therapy, divorce support, and other counseling services in the Phinney Greenwood area of Seattle, WA.  Interested in finding out more about how counseling and therapy can benefit you?

Schedule Your Free Consultation Now

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