Dr. Robin: Why insurance doesn’t offer assurance in mental health

February 14, 2020

One of the most common questions mental health providers get is whether they accept insurance. When the answer is “no”, the assumption is often related to the complicated nature of insurance payments for practitioners. While that may be true, there are two factors which are more significant to patients in the decision not to accept insurance by mental health practitioners: ethics and confidentiality.

Ethics

A new patient came to our practice a few years back. She had been dealing with a mild eating disorder for about 8 years. She decided to come for therapy when she noticed the eating disorder was getting worse, after the sudden death of her mother. Her health insurance company required pre-authorization for treatment and, when contacted by our office, the patient’s insurance approved a total of 10 visits. Now let’s do a quick math problem. The insurance company was essentially approving 1.25 sessions for each YEAR this young woman had experienced the eating disorder. It doesn’t take a doctoral degree in psychology to understand this is unrealistic for successful treatment.

By not being paneled for insurance, mental health providers can focus on effective and ethical treatment for each patient, whether it takes less or more time than dictated by the algorithms used by insurance companies. Less time is also spent on insurance paperwork, allowing the practitioner more time to determine strategies and approaches that will treat the symptoms and get the patient back to an appropriate level of functioning. The focus stays on data-driven mental health best practices, rather than a “one-size-fits-all” model of cost effectiveness.

Confidentiality

Private pay rather than insurance also allows for a higher level of confidentiality. Let me give you an example. A patient came in with severe depression. When asked how long he had been dealing with the depressive symptoms, he responded, “Nine months.” If you know what severe depression feels like, you can empathize with how hard the past nine months had been for this individual. The patient went on to explain that the depression had built over the nine months, but he had been afraid to get treatment because of his future plans. You see, this patient planned to apply for high-level jobs in the corporate world, and was worried what a psychological diagnosis might do to his acceptance. With insurance, a diagnosis would be required and would be documented in this individual’s records, and potentially discoverable in a future application process. Without insurance involved, however, a diagnosis did not have to be recorded. The patient’s mental health issue and treatment would remain completely confidential. This option for private pay rather than insurance allowed the patient’s stress level and anxiety to decrease, which only increased the successful treatment of his depression.

Without documentation, confidentiality can also be ensured from any potential technology breaches. It seems as if no organization is immune to the threat of data breaches. Target, Facebook, CapitalOne, Equifax, and others have all been hacked, leaving the personal information of their customers and clients exposed. Now imagine if your mental health history was exposed. At the least, this is a personal violation; at the worst, it could have negative ramifications on your professional and personal life. But if no diagnosis is recorded in insurance companies’ databases, there can be no information leak due to security breaches. Mental health information stays out of the hands of individuals who might exploit it.

Options

Of course having an ethical, completely confidential approach to mental health seems like it might be a more expensive approach, but there are two things to consider regarding this aspect. First, many practitioners offer a sliding fee scale for those individuals who can’t meet the private pay costs. Second, individuals do have the option of submitting receipts to insurance companies for reimbursement. While this might be contrary to the discussion we had about confidentiality, it puts the decision on what have documented with insurance companies in the hands of the patient, and this sense of control over your treatment can only benefit the overall process and prognosis of the individual.

Just a little something for your insight. – Dr. Robin