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.
Shopping for a Therapist
Most therapists are quite proficient in their profession and can help practically every client they work with. Just because all therapists share the same fundamental skills, this does not mean that all therapists are the same or that all therapists and clients are guaranteed to be a good match for each other. Most of the time, it is the client who chooses which therapist they will be working with. A prospective client has the right to shop around for a clinician that they think will best suit their needs. When a client decides that it is time to see a counselor, it’s tempting to just look on the internet or in the phone book and choose the one they find who is closest to home or cheapest. Though cost and location are clearly considerations, other things are important too. Therapy is a substantial investment in time, money and interpersonal commitment. Don’t feel compelled to latch onto the first therapist you find. It’s unfortunate but true that the same difficulties that compel a person to seek a therapist in the first place are those that can make even looking for one a challenge. Even making the first telephone call to a therapist is a huge step for many facing mental illness. It can feel intimidating to some. Often when clients do make a first call, they want to get it over and done with as soon as possible. Most people are reluctant to try new things and procrastinate. Looking for a therapist is even harder because it involves telling a stranger some of your most embarrassing difficulties and admitting you have problems with things “normal people” seem to handle just fine. Something good you can tell yourself when you are looking for help is that…You are a customer and therapists want to offer you their services. Remind yourself that a therapist is not there to judge, intimidate or make you feel inferior. They are there to help you. They are competing for your business. If you have ever had the misfortune of trying to get yourself an appointment squeezed into a medical doctor’s busy schedule, you will be pleasantly surprised to find that most therapists will have plenty of availability. With medical doctors, supply and demand often works in the doctor’s favor because there are so few doctors and so many that need their help. In mental health, the supply and demand equation works more in the favor of the client. As a prospective client, you are hiring somebody who wants to work for you; don’t be afraid to interview them a bit. Don’t be afraid to interview several and pick your favorite. In a true therapeutic relationship neither the therapist nor the client has power over the other; both work cooperatively for the benefit of the client. This is collaboration. Choose a therapist as a partner who you think you can have a cooperative and collaborative relationship with. Perhaps the first thing you should look for in a therapist is their personality. In most places there are plenty of therapists who have ample experience working with most common problems. Looking for one that you seem to feel a good rapport with can be a better start than considering their various licenses, degrees, schools and stated specialties. If you have particularly strong religious, political or cultural beliefs, don’t be afraid to ask a potential therapist about things that are important to you. Don’t be afraid to ask a therapist about what types of clients they seem to have the best experiences with. Even though therapists are trained to work effectively with people from very diverse backgrounds, they do have some types of people they just relate to better. Don’t be afraid to ask about past times or personal interests. Many times a client can feel much better understood by his therapist when he knows that therapist has had some similar experiences. More and more, psychotherapy is becoming a niche industry with various therapists catering to specific types of clientel. Why sell yourself short and work with the therapist down the street when there very well could be a clinician who better suits you in the next town?