“Why don’t you take insurance?”
I was on many insurance panels for many years. Then, gradually, I was only on one insurance panel, finally stopping to take all the insurance.
Medical insurance reimbursed for the medical necessity. So what’s a medical necessity? It means that the patient suffered from a condition that fits the diagnostic criteria of a mental disorder. Accepting insurance works very well for most of my clients with depression, anxiety, or PTSD diagnoses.
As a licensed marriage and family therapist, accepting insurance doesn’t work with many of my other clients who are seeking assistance for their relationship issues. Insurance reimbursed medical necessity by including the identified patient’s family member in the session. However, many couples’ issues are not individual issues but relationship issues.
Unfortunately, when I am on the insurance penal, I can’t refuse to take a couple when they have the insurance where I was on the panel. As a mental health provider who works with individuals and couples, taking insurance creates a bind for me. I don’t want to make insurance fraud by diagnosing someone without mental illness or creating treatment goals and documentation that don’t fit with the couple’s therapy. So in the meantime, not on any insurance panel, I can’t file insurance on behave of the clients who request individual treatment.
There is no better solution than asking my clients to do some work for themselves so that I can offer psychotherapy the best I can to help as many people as possible based on the resource I have. That means getting off the insurance panel so I can work with clients seeking individual or couple therapy without choosing either.
I encouraged you to determine if you have out-of-network benefits through your insurance. If this is the case, I can offer you the receipt of services, which would include information your insurance company would need. You would then submit the receipt and collect reimbursement from your insurance company.
I encourage you to call your insurance company to understand your mental health insurance benefit, whether using insurance or not. These are the steps you can take to determine if you have out-of-network benefits.
