Surely, it is no surprise that millions of Americans today are perfectly fed-up with the health care insurance industry, and the reasons are simple. The insurance industry is profit-driven ~ period. This means that insurance billing and claims systems are carefully designed and managed to do two things very well to best ensure high profits; (1) collect hefty premiums. (2) avoid or delay paying claims. Insurance companies don’t care the slightest about your health and wellbeing, they care only about their own bottom line. This may sound cold and heartless, but the truth is that the business of insurance is all about sustained profitability. This is precisely why the insurance industry is not user-friendly or user-attractive. In fact, insurance companies are hoping that you will become confused, frustrated, and overwhelmed in navigating your way through the maze of these complex systems that are set-up to capture revenue, and then pay little or none of it back out in the form of benefits and coverage. They want you to give up at claiming what is right and fair and just accept the system as it is.
Here are some very important points concerning mental health care and health care insurance services.
1. Health care insurance may be good for providing coverage and benefits for your physical health, but the same cannot always be said for your mental health. Many insurances don’t cover mental health therapy, or they will have a high deductible, or require a high co-pay for mental health treatment. Furthermore, the insurance product may only cover a few visits, and have significant limitations concerning what kinds of mental health concerns and conditions they will cover. Most insurance products are very narrow concerning mental health.
2. Mental health care providers who are billing insurance for treatment(s) are “required” by the insurance carrier to designate a mental health diagnosis (a medically-coded mental health disorder) to the patient’s clinical record. Truly, this information can then be used against the patient in the form of future denied claims or limitations and restrictions in accessing benefits and certain types of health care that they would allow or pay for. This system builds insurance profit.
3. The mental health diagnosis or disorder thus applied to treatment might not be completely accurate or fully relevant to the patient’s actual presenting needs or problems. Many practitioners feel as though they are forced into stretching and modifying assessments and evaluations so that the clinical diagnosis will fit-into the insurance carrier’s specific system of approved and qualified claims and coverage for services.
4. These “stretched” or otherwise “interpretive” diagnostics can cause patients to feel stigmatized, and categorized by a given diagnostic label. A patient may begin to believe that his or her life is more disordered than it really is, and begin to think that without critical treatment, things could remain problematic or get worse. This can create an inflated dependency on treatment and insurance use.
5. The patient’s diagnosis, no matter how accurate or inaccurate, then becomes a part of their unretractable medical record. This can have disadvantageous consequences. For example; certain disorders can completely disqualify individuals from accessing opportunities into various kinds of vocations and employment, such as the U.S. military and certain kinds of public service. These diagnoses and conditions will become a part of the patient’s medical record, and insurance carriers can then later find there to be “pre-existing conditions”. This is a built-in metric to raise premiums, deny coverage, or limit benefits and claims.
6. Of great importance is confidentiality! Since insurance companies always look for ways to deny claims and limit or otherwise control benefits, they will surely find ways to do it. And since they are paying for at least some of the patient’s treatment, they can access patient records. Here they will scrutinize treatment methods and objectives, question improvements made or not made (all very subjective), and challenge recovery or overall progress. They may ask the practitioner to prove that the prescribed treatment is “medically necessary”. And know this: An average insurance claim may pass-through more than a dozen different people who are trained to “evaluate and challenge” the merit of, or the necessity of the given treatment. This evaluation of the patient’s treatment is equally subjective and is purposely set-up to reject billing reimbursements to the health care providers and coverage for the insurance users.
7. Insurance fine print and hidden provisos within insurance policies are common in insurance plans. Remember, the goal of insurance companies is to collect money, but then not pay much or any of it back out. The “fine print” will contain listed exceptions and disqualifying language which can be difficult to understand.
Taking control or your mental health care and protecting your money, your very personal and confidential mental health information, and your dignity may best be accomplished by accessing mental health counseling services independent of an insurance carrier. Consider carefully the costs, risks, benefits, and alternatives before deciding how you are going to pay for your mental health care. Ask your mental health provider to explain the pro’s and cons of using insurance and the same in paying “out-of-pocket” for clinical services. Advocate for your own best interests and needs.
Dr. Ray Smith is the most sought-after counselor and relationship coach for physicians in Spokane. After graduating with a Doctor of Ministry from Austin Presbyterian Theological Seminary, he worked with doctors in Galveston, Houston, San Antonio, Spokane, and Memphis, where he earned a second doctorate, in counseling. His background in parish ministry led to pastoral counseling and coaching for Christian MDs and the creation of physicianscoaching.com to help G.P.s and specialists deal with their unique stresses in medicine.
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