What Insurance Will and Will Not Cover, Part 1
Most people assume that when they need to see a therapist, their health insurance will help pay the bills. This is only true in part. Most health insurance providers have relatively strict guidelines about what “conditions” are covered. Health insurance after all helps to pay medical bills for health problems. The factor that most determines if insurance will cover therapy is the diagnosis. If you are being treated for a mental illness, insurance will usually help. There are several problems therapist routinely help clients with that do warrant counseling, but do not get diagnosed as mental illness. The end all be all of clinical diagnosis is a book called the DSM-IV (Diagnostics and Statistical Manual version 4). Nearly all of the reasons a person might see a mental health professional are discussed and “coded” for the sake of insurance billing and record keeping. Among the various reasons for seeking professional help are a category of diagnoses called “The V Codes”. V code diagnoses are not considered mental illnesses and are seldom covered by any insurance policy. The most common V code that people are surprised to find themselves not covered for by their insurance is marital/couples counseling. Fighting with your spouse or significant other (partner relational problem) is not a mental illness and very few insurance providers are willing to pay for you and your partner’s inability to get a long. Another V code diagnosis clinician’s see often is bereavement. When a person has experienced a profound loss in their life, like a loved one passing away, counseling can be an excellent source of support. Again, being upset after a profound loss is quite normal and as such is not considered mental illness. The third most common is what is generically called a “phase of life problem”. Phase of life problems include all kinds of things that people can have a hard time coping with that are the challenging parts of life we all experience. It includes things like changing jobs, getting divorced, being a better parent, reacclimating to being single, issues of ageing and dealing with financial hardship. Like all the other V codes, people often seek a therapist with good reason for these problems, but they do not rise to the level of mental illness. Other common V codes which therapists see clients for are parent and child relationship / interaction problems, religious / spiritual difficulties, occupational problems, academic problems and acculturation problems that arise from people experiencing alienation in an unfamiliar culture. Many of these problems in very extreme situations can persist long enough and have such dramatic symptoms such as to rise to the level of mental illness, but fortunately that is uncommon. Some therapists are eager to exaggerate the seriousness of a client’s problem such that they can diagnosed them as a mental illness rather than a V code and qualify the client for insurance benefits. Not only is this unethical but it is fraud; motivated by a clinician’s desire to help a client get assistance they may be otherwise unable to afford.
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