6 Reasons NOT to use Insurance for Counseling


You likely pay Hundreds, even thousands, a month for medical insurance, so why wouldn't you want to use it to help you pay for counseling or therapy?

One of the first questions that therapists and counselors often get is "do you take my insurance?" It makes sense, really. Before I knew what I know now, I would have asked the same question. I am at least as thrifty as the next person and prefer to budget wisely for things. I get it. However, after working in this field for as long as I have, I have several concerns with using insurance and that is why I have chosen not to get on insurance panels. I often take the time to educate my prospective clients on this topic, as I think it is so important, so why not share it with anyone who might care?


Reason #1

Medical Insurance requires a medical diagnosis

This is one that I am sad to hear that many people haven't heard from their therapists. If you have ever had counseling or therapy paid for by medical insurance, you have a mental health diagnosis on your permanent medical record. I hope you aren't one of the people that this comes as a shock to, but it is true. This might not sound too shocking if you are going to a therapist for something clearly clinical, such as Major Depressive Disorder or Generalized Anxiety Disorder. BUT, what if you are seeking counseling because you need support in dealing with a struggling child? Or what if your marriage is struggling and you need a professional to guide you through the landmines of that? What if you are struggling to figure out where to go next in life, in your career, personal life, etc? What if you need help to recover from a painful relationship end? Yep, every time insurance pays for therapeutic services it is because the professional provided them with a diagnosis code that is now on your permanent medical record. For some this is not an issue. If you are on anti-depressants, anti-anxiety meds or anything else in that realm, it is already on your record.  For others, it could be a big problem.  There are some professions for instance, that will put someone on leave if they are depressed, or anxious. Others that will do polygraph testing before hiring. Imagine being asked if you have ever been diagnosed with a mental illness, answering no because you didn't know you were diagnosed when you went to counseling with your wife a few years back, and then being flagged as lying when they acquired your records later. It has happened. We also have a political climate with changing rules and regulations regarding insurance and pre-existing conditions. You likely don't want a permanent record of a diagnosis just to get some help with a temporary situation at a better price. Now, I am not suggesting that you avoid getting a diagnosis if you actually fit the criteria. But that would be for #2...


Reason #2

You don't want a diagnosis that doesn't actually fit

This part feels kind of icky to me. I have been part of organizations that, because they bill to insurance, have to diagnose every one of their clients with a disorder to get paid. Ethically, I just don't agree with this practice. I am kind of a stickler for details and rules, to be honest, and I wouldn't want a therapist who wasn't. An ethical therapist will not diagnose you if you do not fit the criteria. However, I have heard many, many times, someone saying, "well this doesn't quite fit, but it is the best I can find." Imagine going into an ER with stomach pain and being told "Appendicitis doesn't quite fit, but it is the closest to your symptoms, so that is your diagnosis...and oh that means we are going to take out your appendix." That wouldn't sit quite right with you, would it? You also don't want to be diagnosed with "adjustment disorder" just because nothing else quite fits. When you pay for counseling or therapy out of pocket, a therapist does not have to try to fit you and your symptoms into a box. They can look at your whole picture and focus on working toward moving your toward your goals rather than focusing on your diagnosis and symptoms.


money in hand

Reason #3

When insurance pays, they get a say in your treatment

Just like when you were a kid and asked your parents for money and they asked what for, the insurance company does too. They not only want to know what diagnosis is appropriate, but they want the details of your treatment plan, sometimes details of sessions, and THEY get to decide how many sessions they will pay for, how long the sessions should be, and which modalities they will pay for or not. Many insurance companies don't pay for the newer therapies, or have favorites they want therapists to use for a diagnosis (even if it doesn't fit with the client.) They also get to decide WHO you get to see. See the next reason...


Reason #4

Insurance dictates WHO you get to see

As mentioned above, your insurance company will dictate which therapists you can see to be covered in your policy. Now, in areas densely populated with therapists, like the Denver-Metro area I am in, you can likely find quite a few therapists that chose to become "in-network" with your insurance. However, it is anyone's guess whether they are the right person for the job. Studies have shown that the most predictive factor of improvement through therapy, is not based on the modality, education, background etc, but rather based on the therapist themselves and the relationship between the therapist and the client. So, if you do choose to use your insurance, please still engage therapists before choosing one, so you know if it is a good fit. Then...hope your insurance doesn't change, because most therapists don't take all insurances. So just when you are making progress and your insurance changes...you will be faced with the same problem, pay out of pocket, or find a new therapist and start all over.


Reason #5

If you are paying out of pocket, you  get to be in control of your own care

The most important questions to ask when trying to find a therapist shouldn't be "do you take my insurance" or "who is the cheapest I can find?" It may be a topic for a later blog to expand on, but really you should choose a therapist based on: their expertise with your specific issue, the kind of therapy they practice and the connection you feel with the therapist. Once you have chosen your therapist, you and your therapist should work together to set goals, determine a plan for reaching them, and choose the therapeutic approaches or modalities that will best support you in your goals. The amount of therapy needed should not be based on a chart that someone says that X issue = 8 sessions. The length of therapy can really only be determined over time as progress is evaluated and goals are achieved. So, if you want more choice in the who, what, when, where and how you get the help you desire, paying out of pocket might be a good choice for you.


Reason #6

Clients who pay out of pocket tend to get faster results and notice more significant change in their lives.

I think this is one of the best reasons right here. I am in this field because I want to help people achieve real change in their lives, and I have seen this to be true. I remember the first time I read an article about this feeling skeptical but then it really makes sense. When you are paying out of pocket for something, you are investing in it. You see the value and you want to make it worthwhile. Clients who pay out of pocket are more likely to make their therapy a priority. They are more likely to try the homework or suggestions that come up during sessions between sessions.  They are less likely to cancel last minute. They are more likely to come consistently. They are more likely to focus on truly utilizing their sessions to the fullest, and not just distracting from the real issues and talking about the weather. When I worked in agency work and had medicaid clients who didn't pay anything out of pocket, it was the exception not the rule that it took longer, they were less likely to follow through with suggestions and were much more inconsistent in their own treatment. When you invest financially in your treatment, you are more likely to invest in other ways as well and see more growth in the process.

In conclusion....

If you read all of this and you still want to use your insurance, it can still be a good option, especially if cost would be prohibitive otherwise. I would rather a client get the help they need, by utilizing their resources, than avoid it altogether. If that's the case, there are many great therapists out there who might take your insurance. Ask great questions, find someone who specializes in your issues and find someone you gel with. If someone calls me and wants to use their insurance, my answer will still be "I'm sorry, I don't take insurance, but if your issue meets criteria for a diagnosis, I can always provide you with the information you need to submit it to your insurance for partial reimbursement after you have paid for your sessions."

May you always find the therapist who meets your needs, and the means to achieve your goals.