Will my health insurance pay for counseling?
Although most providers require you to take ultimate responsibility for paying your bill, health insurance may reimburse you or your healthcare provider for medically necessary treatment for covered, diagnosed conditions that impair your ability to function. They do not generally pay for counseling to relieve stress, enhance or maintain wellbeing or prevent problems down the road.
The exception to this rule is that some employers provide employee assistance programs which offer limited counseling for short term problems or crisis. Often these programs are limited to three sessions and then they refer you on to another provider for further treatment, which, if it is medically necessary may be covered by insurance.
That means you must
- Be diagnosed with a condition that meets the standard diagnostic criteria (these conditions are described in detail in a manual: (DSM V).
- Be unable to function normally without treatment.
- Receive treatment intended to relieve that condition.
Finally, you must be willing to release that information about yourself to your insurance company and willing to have that information in your permanent medical record.
Whoa!What about confidentiality?
You should have complete confidentiality (assuming you do not present a threat to yourself or others) if you are paying for your own care. If you ask your insurer to pick up the tab, legally, they gain complete access to your record. Once you grant your therapist permission to contact them, you have given up confidentiality regarding them. Of course, insurers are also required to keep your records private (HIPAA). However, your information may end up being part of a database (MIB) that collects health records from insurance companies.
Practically speaking, the amount of information required by insurers varies considerably. Some only ever ask for a diagnosis and billing information. Others want a lot of specific personal information about your condition and the treatment plan and expect to dictate the level of and length of care needed. Many experienced therapists avoid dealing with insurance companies like this. That’s why you may find the counselors recommended to you may not take your insurance.
My problems aren’t serious medical problems. Should I hold off on counseling until they are?
If that is the case, it is often a very good idea to spend some money out of your own pocket to get counseling for stress, for relationship problems, or to prevent more serious problems. Most healthy people find themselves depressed or anxious at some point. Getting help early can prevent a whole lot of suffering later, and it can help you avoid losing your ability to function at work or home. Short-term counseling is no more expensive than, for instance, the 15,000-mile service to your car, a vacation, or a new laptop.
I already have a therapist. Can my counseling there be covered by insurance?
You should check with your health insurance plan and with your therapist to see if your treatment can be covered by insurance. Rules about mental health coverage have changed in the past few years. In Illinois insurance companies are required to provide coverage for mental health just as any other disease. Check your plan and your state requirements.
Is Telehealth covered by insurance?
Rules shifted quickly to provide coverage for telehealth in early 2020 in response to the COVID 19 pandemic. These changes mean telehealth is covered just like an in-office visit. Sometimes copays are waived depending on the plan. These changes temporary but have been extended twice. Ultimately it will remain the decision of insurers to extend these benefits or change them each time the extension of telehealth benefits expires.
Elizabeth Ritzman, LCPC is in-network and will direct bill Blue Cross Blue Shield PPO only.