For more information:

Tuesday, February 21, 2017

Using Insurance for Couples Therapy? Here are 4 Considerations

In terms of mental health, the Affordable Care Act provided individuals one really important benefit: coverage. And not just coverage, but benefits that were on par with the benefits one could receive for medical health issues. In other words, the ACA finally allowed people with mental illness to a) get insurance (because they couldn't be denied for a pre-existing condition), b) pay reasonable charges for services, and c) not be charged more in premiums because of a mental health condition (see this page for more info).

 That was all excellent news for people who needed to seek therapy or medication to help with mental, behavioral, or mood disorders.

However, by equating mental health services with medical services, the system became a little sticky for couples. After all, how do you diagnose a couple who is having problems, say, communicating? 

There are four considerations a couple should take into account before they use their insurance for therapy.

1) One of you has to get diagnosed with something. That's the way insurance works. For a provider to get reimbursed by your insurance company, they have to "prove" that there's a need for their services. This is done by submitting a diagnosis to insurance. Currently, the medical codes that pertain to relationship work are not generally reimbursable. Hmmm. That means that one of you has to get diagnosed with a mental disorder in order for your provider to get paid.

2) The partner who is most distressed is more likely to get diagnosed. It may be that you're losing your marbles because you just found out your partner has been cheating on you. It could be that you're angry beyond belief that you your partner has drained your bank account to fund a friend's business. In many couples who seek therapy, one partner is considerably more distressed than the other, thereby looking more disordered. Despite the fact that one partner is reacting to the conflict created by the other partner, the reactor is usually going to get the diagnosis.

3) If you break up, the diagnosis doesn't go away. Although mental illness diagnoses can be temporary, they often aren't treated that way. So, if you're upset and anxious because of your relationship AND get diagnosed with depression or anxiety, that diagnosis is in your medical history forever. Of course, so are the two UTIs and spells of bronchitis you had in the last five years, but there's an understanding that those were cured. "Curing" a mental illness is not as measurable as checking a urine sample or reporting that your cough has gone away, so its presence isn't discounted as easily.

4) A diagnosis can be used against you, intentionally or not. There are a few ways this can happen. a) In the most horrible, worst-case scenario, your and your partner break up and your partner wants...custody, the house, your IRA, etc. and uses your diagnosis of depression or anxiety (or whatever else) to pressure you or the courts to grant them something. 

b) In a lesser worst-case scenario, your diagnosis can limit your ability to get life insurance at a later date. True story: a woman I know had to pay extra in life insurance premiums because she was diagnosed with depression while going through her divorce. In order to petition to have her rates lowered, she had to not mention any sort of emotional distress to her doctor for at least a year.

c) In just a who-woulda-thunk scenario, you and your partner stay together after therapy (which is great!), but there is a shift in the power differential between you because one of you has been labeled less fit to handle the stress of conflict in the relationship.

Many couples who seek therapy just want good help--at a good price--as soon as possible. Usually "at a good price" seems, on the surface, like the same thing as "using insurance", but it may not be. If you or someone you know is thinking about seeking therapy for a relationship issue, you might want to think about the non-monetary costs of incurring a diagnosis.

Things to ask a therapist about insurance:

1) How will you determine who gets diagnosed?
2) Will you take a cash payment (or even a discounted cash payment) instead of submitting to my insurance?
3) In your experience, does my insurance company manage treatment in terms of number of sessions, type of therapy, etc?

No comments:

Post a Comment