Wednesday, October 7, 2009

Counseling: Self Pay pays off again.

"Abused then denied care: 8 states allow practice
Some insurers say victims of domestic violence are too high risk to cover"
Counseling / Psychotherapy is the most efficacious treatment, and/or preferred treatment for a range of problems including depression, sleep problems, anxiety disordes, PTSD, childhood behavioral and defiant disorders, etc.

Talk therapy treatment for these problems can often be "billed" to health insurance. At first blush that sounds great: I pay my $20 co-pay, or whatever, and I receive a session worth $150!! Typically, what is required is 1. meet any health plan requirements such as seeing a licensed provider, seeing someoen in your plan's "panel" of providers, etc., PLUS: you MUST have a diagnosable condition.

There are reasons to choose to pay out-of-pocket, rather than have talk therapy payed for by your health insurance.

This current news story shows how well-intentioned HELP can later HARM you.
The story reports that the woman was denied health insurance coverage:"She says the insurer told her that her medical history made her a high risk, more likely to end up in the mergency room or require additional care."

How did the insurer know?

This domestic abuse victim received medical/counseling care for the abuse through a provider -- could be an emergency room at a hospital -- that filed some kind of reimbursement claim.
The same goes for you seeking counseling for sleep, or behavior problems in your kid, or marital counseling.

Often, in counseling, the provider is assigning a diagnosis, and not telling you. Or, kind-of telling you. They phrase something one way. But on the claim / reimbursment form, they put some fitting, arguable, defensible code that will qualify as a "mental disorder" that is in the range of those that get reimbursed.

"Adjustment Disorder," as you struggle with anxiety adjusting to a new job in a new town in a new home, will not get reimbursed; but if you kind-of fit "generalized anxiety disorder," you will fit into the reimbursement category.

Then, you are "on the grid" as a person with a "mental disorder."

The insurance companies are tricky. THe news story noted here indicates that there are laws against health insurers denying coverage for a domestic abuse victim for the "pre-existing condition" of domestic abuse.

But - folks - let's think about this -- all they need to do is fond a couple emergency room visits for certain types of injuries, plus maybe a valium prescription. They can read between the lines.
Another challenge: some kind of application -job, etc. -- asks if you have ever been diagnosed with a "mental disorder," or received treatment for such.

If you HAVE been diagnosed and treated, you need to answer "yes."

If you go see a talk therapist for some interference from anxiety in your work, or your marriage, or some conflict between you and your child, you do NOT readily qualify to be diagnosed with a mental disorder.

ASk, or tell, the provider to NOT assign a diagnosis - or determine WHICH might be assigned -- as part of the payment-for-services arrangement.

TEll them you NEVER want your PRIVATE business to be on record anywhere. Unless, of course, you become a danger to yourself (imminently suicidal, etc.) or others (imminently homicidal, etc.), in which case the provider may NEED to act: with cops, with 911, whatever.
But otherwise: go self-pay. And arrange to have no formal "mental disorder" diagnosis.

There are a good amount of providers who have given up on the hassle of insurance companies, and now run "self-pay" practices. There is a value in that. They will encourage self-pay, or tell you they only work under self-pay arrangements. For other providers: If you offer to pay something close to what they might hope to get from the increasingly tight-fisted insurance company, WITH NO DELAY, the provider should be excited to accept your cash.

Understand that the provider will, in most all cases, stil be legally and ethically bound to keep records. If you are concerned about what goes into the reocrds, you can negotiate HOW certain things can be entered.

Counselors and therapists almost totally do NOT understand what happens to your medical records once submitted to the insurance company for reimbursement. Or, what happens if they share these records to your next provider in the future, or to court in anty sort of proceedings. What becomes public record?

If it is NEVER written down, it can NEVER be xeroxed, faxed, shared, etc.
Your therapist does NOT NEED to record "sex ual abuse by uncle." Your therapist can record "We discussed the impact of childhood experiences upon current relationships." And can record the same thing week after week, if it is fitting / true.

Your life history of se xual experiences do NOT need to be in ink anywhere in any professional's office.

It is YOUR money. YOU negotiate the terms of therapy. OR you walk. Counselors and psychiatrists NEVER have the authority to tell you what to do. IF there is such a need, it would actually be a legal COURT madating some type of service.

If you cannot find a mental health provider, look for alternatives: a pastoral counselor is an awesome plan - just get informed about training, etc. Depending upon circumstances, they may accept you as a client even if you are not in their denomination - but don't be surprised if they invite you to attend Sunday morn. And would it hurt so much to hear a good sermon?

Other alternatives, at least until you can find a decent provider who will work with you, are self-help books, self-help groups, and things of that nature.

Work your budget, and negotiate. Good talk therapy can make amazing changes in your life. It can be WORTH giving up cable and caffe latte.

Especially if the therapy does not later lead to a DENIAL of a job or of health insurance.
I am sad to say, but most all counselors / therapists do NOT know what happens to your billing records on the other end. They end up in a data base and future insurers "might" look at that data base to figure out coverage. In this news story, this vulnerable woman, and the counselor, had no idea.

Unless Universal health care gets approved: then the govt WILL have all info.

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