Why You May NOT Want to Use Your Health Insurance for Counseling

Why not use your health insurance for counseling? Isn’t that what it is for?


But using health insurance for mental health services is a little different than other medical issues. Sometimes mental health issues are not covered by your health insurance. Once you use your health insurance for mental health, you will have a mental health diagnosis on file – a mental health disorder/mental health illness must be on the insurance claim in order for insurance to pay for treatment. This will be in your permanent medical record.

Of course you want to consider using your health insurance for counseling, but there are some good reasons for you to consider why you may not want to use your insurance for counseling services.

Why doesn’t my counselor accept my health insurance?

Many counselors choose not to accept health insurance for very good reasons. They want to focus 100% of their time in treating you. If they accept health insurance, there is a lot of extra work involved in accepting insurance, in addition to agreeing to work for a discounted fee. The counselor may spend hours on the phone getting benefit information, authorizations, or following up on claims payments. The counselor has to wait a month for payment from the insurance company. The counselor has to file progress reports with the insurance company. The counselor is required to submit treatment reports and other details about your medical history with the insurance company.

It’s not that counselors don’t like insurance companies, or don’t want you to use your insurance (we have health insurance too!), but many counselors prefer to focus 100% of their time and energy in helping clients, rather than doing paperwork for insurance companies.

But this isn’t the only reason counselors may not be in network with your health insurance company.

The other reasons are more compelling, and you need to consider them BEFORE you decide to use your health insurance.

Many counselors prefer not to work in network with health insurance companies so that they can better protect your confidentiality. Any information (claims, reports, or treatment plans) filed with health insurance leaves the protection of their office and their locked files and your personal, private, emotional information is outside of your counselor’s office. In order for any insurance company to reimburse or pay for counseling (both in network and out of network), you must be considered “ill”. You must be diagnosed with a mental health illness or disorder. If you are not ill enough to warrant a diagnosis, then insurance will not pay for counseling services. If you do qualify for a mental health diagnosis, your illness will be listed in your permanent medical record. Many counselors don’t like this “medical model” of declaring someone ill, so they choose not to accept insurance because they want to focus on their client’s strengths, and not label them as mentally ill.

Do you want to be considered mentally ill? If you have a mental health diagnosis already, because you have been to counseling or psychiatric appointments in the past, find out what your diagnosis on file is. If you already have a mental health diagnosis, this may not be a concern to you, but if not, you may not want this in your medical record.

Counselors also do not like releasing information to others to protect your confidentiality. Once a claim is submitted to the insurance company, who knows how many people take a look at it and rubber stamp it while it travels through the system? If insurance pays for any counseling sessions (in network or out of network), then the insurance company has the right to audit your complete file. They can request copies of counseling notes, assessments, and other personal emotional information to determine if you really are “sick enough” to warrant their payment. They can deny services to you if they think you aren’t sick enough or if they think your counseling is not “medically necessary”.

Additionally, there are many counseling issues that are not even covered by insurance at all. Stress management and anger management are usually not covered. Marriage counseling is usually not covered. Certain medical conditions/mental health conditions may be excluded (such as attention deficit disorder or adjustment disorder). Even if your illness or disorder is covered by your insurance plan, they may limit the number of visits they will cover (sometimes only 20 per year), and they will set a maximum amount they will pay per calendar year or in your lifetime.

Additionally, counselors prefer not to have someone in the insurance company telling them how to treat their clients. Insurance companies can decide what type of counseling is covered, what diagnoses are allowed, and how many times the client needs to come before they are cured. Many counselors prefer to work directly with clients to serve their needs, without interference from an insurance company.

Using your health insurance for counseling services can also affect your security clearance, life insurance rate, employment, or future health insurance coverage.

For the above reasons, I recommend that you be informed about using health insurance for counseling. You may choose to file anyway, but be an informed consumer.

  • Be an informed consumer.
  • Know your mental health diagnosis.
  • Talk to your counselor about the diagnosis.
  • Ask your counselor about your treatment reports.
  • Decide if you have, or want to have, a psychiatric illness.

If you have clinical, severe depression, anxiety, or other issues, then you probably already have a diagnosis.

But if you are stressed, having relationship problems, or trying to figure out your purpose in life, your symptoms may be minor, and you may not want to have a mental health diagnosis in your records.

Once an insurance claim is submitted to your health insurance company, your diagnosis becomes part of your permanent medical record, and can affect future life insurance, preexisting conditions, or the cost of private health insurance.

The Powers of Professionalism in Partnerships: Health and Social Care?

The NHS and Social care reforms is a forum to intensify competition as well as collaboration within the sectors. Competition is not a new phrase rather; it should be welcomed with open hearts. We can draw our reference from the NHS and Community Care Act (1990), which introduced “Internal Market and GP Fundholding”. Despite all the changes that had occurred in the organisations, competition has not been destabilised but remains every day practice in different forms and shapes. On reflection, delivery of services would synchronise with policies on resource availabilities and this would continue to do so in the present economic climate. By contrast, the powers of professionalism in partnerships; in a modernised sector would recreate opportunities to reformulate strategies capable enough to manage competition in the organisations.

Competition within the organisation should not be interpreted as a “fight between one department and another” rather is a market opportunity that promotes negotiations along specialist services delivery. In conforming to the new approaches of delivering health and social care, the GPs, whether alone or in partnership with local authorities and others will compete for; hospitals services/treatments, mental health services, community clinics and other willing contracts. In practice, the health bill will help to seal the endeavours, giving assurance and legality to quality services delivery and maximisation of resources. Nonetheless, competition has been in practice in the private sectors for a long time and has maximised quality of services delivery and flexibility in the wider consumer markets.

By contrast, why should the professionals and related support staff within the organisations are ambivalent about competition and partnership working, which has become the buzz words of recent years? Professional opinion suggests that integrated care produces; economy of scale, efficiency and effective utilisation of skills mix, maximisation of resources and a reduction of services’ duplications between agencies. This is an indication for savings in the sectors. Critics could argue that competition means a casualty of the health and social care; as patients become commodities that is passed or snatched from one profit centre to another. This could be correct however, in any business whether it is a welfare service or profit-making organisation, the key objectives are to minimise waste, delegate responsibilities to specialists and establish a cost centre that is capable enough to monitor spending in line with budgets.

In the current economic climate, competition could be seen as the antithesis of collaboration between agencies, ensuring maximisation of financial resources and labour capital facilities. Conversely, in the private sector, cooperation is strengthened by government legislation, regulations and the courts intervenes if they think companies are ‘collaborating’ over price fixing or practicing monopoly. We can draw our references from the superstores who are regulated and monitored by the “Trading Standards”.This means they can not fix prices or over charge the consumers. In practice, none of the superstores would monopolise the entire grocery market. In parallel to health and social care organisations, there is no formula by which the public sector can have its cake and eat it. There is a number of legislation and policies restraining monopoly in the sectors therefore, the agencies can enjoy the cost-cutting pressures of competition without atomising services, and neglecting the interests of the public.

In retrospect, the opportunities within the agencies are its professionalism. Doctors, social workers, occupational therapists and nurses will say their training and ethical commitment means putting the interests of the patient and service users first. However, other interests matter, including their own pay, health and safety as well as maintaining their own standard of living. Another way of putting it is to say clinicians internalise the conflicts that inevitably arise and we are happy to let them get on with the reconciliation. In recent times, services and care are prioritised within eligibility matrix, but professionals are able to put side by side to their principles and their practice.

The fundholders (GP, Social Workers, and Commissioners) could compete, but their shared professional identity prevents competition leading to anarchy. Both the NHS and social services relies on staffs that are not professionalised such as the managers and support services staff including the commercial departments, facilities management teams and financial services to manage their budgets. In hindsight, as long as the GP, the chief executive of the local government, the physiotherapist and the receptionist in the sectors think they are part of the organisations and have the common interest then, competition can be accommodated.

Professionalism and organisational behaviours are restraints of reckless trade, according to the legislation and policies governing the welfare institutions. However, in restraining economic principles and markets within modernised services would not offer protection to service users and patients, who otherwise would be treated as consumers that have no opportunities to make choices in the market. In practice, the GPs, hospital consultants and social services works as partners in care, and this is because of their professionalism and a common sense of belonging to the wider welfare service. To support the agreements and legality, drawing up a contract seems to be the only way, which by its very nature is going to supervise and regulate health and social care delivery. This is to ensure service users and patients who might be at risk by the nature of their ailment are not exploited.

Partnership has become a popular word to use within the public service especially when the spending taps are gushing. In health and social care, in particular for children services, the previous government spent time and energy in trying to align the interests of councils, the NHS and other service providers. By contrast, the coalition government should give details of what is working well, and support good policies that were implemented by the previous New Labour administration.

Earn a Better Standard of Living Through a Health Career

Due to the economic crunch that has overwhelmed the world; you may discover that jobs are not too easy to come by. Furthermore, you may also realize that many people are losing their jobs and consequently their homes. A recent survey was done which revealed that there are a few lucrative careers that have not been affected by the global recession. For example, jobs in the health career field are not impacted negatively by the recession. In fact, researches actually confirm a rise in the number of jobs available in the health career path.

There are numerous professions available in health and medicine. Since recently many persons are realizing the need to ensure that they are living healthy and maintaining healthy eating habits and practices. This is because many people are beginning to understand the importance of living healthy. Others are trying to live longer without any sickness or ailment in their body. Pursuing a health career is of utmost importance due to the dramatic increases in the number of diseases plaguing man and the need to effectively treat persons suffering from these diseases.

Specialists within the health career play a vital role in ensuring that health services is provided effectively and efficiently throughout all the phases of life. For example, if you have a newborn baby, you will notice that before the conception of the child there is a need for health care, at the point of conception of the child, and even after the conception of the child. In all the phases of child’s birth and development, there will be a heavy dependence upon people who have a health career, such as nurses, doctors, special medical practitioners and even nursing assistants. As a result of this dependence, you will find that medical personnel will benefit tremendously, as there will always be a demand for their services.

Another area of health career is the health services that specialists provide. In the medical arena, you may realize that not all doctors are general practitioners; you will have doctors who are specialist or experts in their specific area. They will specialize in different parts of the body like the brain, heart, kidneys or the lungs, while other doctors will specialize in treating a particular disease. Many doctors are general practitioners; however, a few doctors are specialists. You will find that these specialist doctors, in their field will make a lot of cash, due to the high demand for their technical health services.

There is an area of health career that deals with the mental health of people. Due to the increase in stress levels, you will find that many people are becoming mentally ill. These persons will need people who are in the mental health career aspect to assist and nurture them back to mental health and wellness.

The truth is the longer you live, the more prone you will become to disease and sickness, as your immune system will gradually decline, especially if you have not been practicing healthy living during your former years. Again, you will need persons who have a health career, as they would provide the necessary health care services to help you in that particular stage of your life.