Insurance, Couples Counseling & the Affordable Care Act
There was a time where insurance companies and your employer knew a lot less about what you did in your health provider’s office. Now with the Affordance Care Act more and more people will get insurance and more mental health services are being covered. Sometimes couples counseling is covered as such, sometimes one of the people in the couples session must be the “identified patient” for insurance billing purposes. Many clients do not know this. If you use your insurance to covers your mental health services one of you probably will get a diagnostic code in order for you or the mental health care provider to be able to get reimbursement from the insurance company. No diagnosis code, no reimbursement. You may or may not be told or know what your diagnosis that you are being billed for.
Depending on the diagnostic code that might determine how many sessions you will be allowed, sometimes it can vary depending on your needs. Often time’s insurance company or employer will need an update as to your progress on your diagnosis, in order to determine if more sessions will be given. All this information about you and your diagnosis is given to the insurance company and sometimes as to your employer.
In the past health care information would be kept for five or seven years. In the paper days, this information would be kept by your health care provider, perhaps shared if referrals were made and then later destroyed. These days it is being most likely stored in the cloud for ever. This information will follow you along with the rest of your medical records, probably for life. This should clearly be explained to you.
This is one reason why many people still prefer to keep their mental health care outside of the insurance providers reach. Having to meet insurance deductibles, having a high co pay and needing an “identified patient” for diagnosis makes using insurance less than appealing for some people.
A more attractive alternative model for many is to have an affordable, non diagnosis model as far as their mental health care. Many people thus prefer to keep their mental health information out of their employers or insurance company’s hands by not using their health insurance.
Remember that if you do use your insurance, be sure to inquire about the following contract details to make a better informed decision as a consumer as to which choice is best for you:
- Is outpatient mental health covered? Is Couple’s counseling specifically covered? Or only individual?
- Any preauthorization requirements before you begin?
- What is your co-pay?
- Is there a deductible that must be met yearly, before benefits will begin? What is it?
- What credentials are required of the therapist? There are many types of mental health credentials; will my particular therapists be covered?
- Will it be in either in network or out of network?
- How many visits will be given per year?
Ask your therapists to explain your diagnostic code that they are using for insurance billing purposes, it could be one or several codes. If you have any questions or need clarification ask. It is important to be fully informed and protect your confidentiality. You have a right to know and make an informed decision.