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Some
thoughts about insurance ...
Insurance is a
financial tool used by many people to help manage their
resources. For some it is a necessity, and for others a
luxury. As insurance costs skyrocket many people are taking
their own cost cutting measures, like installing huge
deductibles or catastrophic only for hospital emergencies.
Everything else is out of pocket. On the other side,
insurance companies are taking similar cost cutting
measures. By raising premiums, cutting allowable amounts and
reducing reimbursement percentages, insurance companies are
able to contain outflow. But undeniably the consumer is
paying more and receiving less than they did one year ago,
and much less than five years ago.
Conversely, I
have not raised my fees since August of 2004, while
simultaneously enhancing all my services. In many ways I am
like a client-funded missionary; though I provide immeasurable
services to the faith community, my practice is directly
funded by the clients I serve. Some of those dollars come
from insurance, but just as much from clients who choose to pay out of
pocket and skip the insurance complexities altogether.
I also provide
reduced fees when necessary and donate hundreds of hours
without pay to help people facing difficult life challenges.
Believing that all things come from God, I see my work as
giving back to Him.
The Apostle John wrote, "Through Him all things
were made; and without Him nothing was made that has been
made" (Jn 1:3). In
spiritual terms, nothing really belongs to us. It is all a
gift from God. So our money is as well. A good friend once said, "Tom, I've never seen a
U-Haul behind a hearse!" Not surprisingly, he and his wife invest heavily
into the lives of people.
So how we spend our money counts, and where we spend our
money counts. When a client comes to me seeking mental or
emotional health, or spiritual consultation, he or she is
investing directly into the kingdom of God. That alone has
intrinsic spiritual value, and might be considered a
tithe because those funds allow me to help those less
fortunate. Jesus tells us that even a cup of cool water
given to one of His little ones will certainly be rewarded,
and to store our treasures in heaven, not
on earth. This means investing in people, not in things. And
sometimes we must invest in ourselves to be the whole person
(spirit, soul and body) that God intends us to be.
So when deciding when and
where to go for counseling, it is more than strictly a
financial decision regarding insurance. It is also a matter of
investing into your personal well-being and the kingdom
work of God.
As for insurance, to
their credit
most
companies still recognize the value and quality of out-of-network
providers and continue to reimburse for services.
My clients
typically see reimbursement at 60, 80 or
even 100 percent in some cases. However, in this era of
rapidly changing laws, some opportunistic insurance
companies have decided to categorically slash reimbursement
to out-of-network providers. In January 2010 one client
reported that her new policy "flipped" the
reimbursement from 60/40 to 40/60.
I seriously question the moral and ethical foundation of
mining such "legal" loopholes to deprive clients of needed services.
Marriage Therapy –
Insurance
companies categorically deny benefits for marital therapy.
There are no
primary diagnostic codes
for marital or couples therapy. And insurance
companies will not process a claim without
a diagnostic code. Simply said, if you can't diagnose it, it doesn't exist. So in the case of
marital or couples therapy, there is no
benefit to using insurance at all.
However, when providing
individual therapy, I can and do integrate occasional
conjoint sessions on behalf of the individual client. Social
impairments do matter, and insurance models usually approve
some
family therapy with the client present, because it does not inherently alter the focus of individual
therapy. In these cases the individual retains the diagnosis
and it is appropriate to use insurance.
Unfortunately, I realize that
unethical strategies are being used to avert this insurance
dilemma altogether. For example, diagnosing one person of the couple,
then going straightaway into marital therapy. Although
commonly practiced by many counselors, I
will not engage this unethical behavior. If marital
therapy is needed I cannot ethically diagnose one person
and then assume to treat the marriage relationship.
Furthermore, it is impossible to diagnose one individual and
somehow expect to keep the focus of therapy on the
marriage relationship. It will inevitably turn toward the
diagnosed individual, which can easily divide the
couple at the onset:
"He / she has the problem ... not me!" And it ultimately
destroys the fabric of reciprocity in marriage therapy.
On the bright side of this insurance
dilemma:
Since insurance will not recognize or pay for marital
or couples therapy, you are free to choose any
provider or services you like. So don't be forced into thinking you are obligated
to a specific insurance network. Also, don't be afraid to
ask questions of your prospective counselor. If he or she says that
insurance will cover your marriage therapy, they are either
willfully ignorant or choosing to use deceptive billing
practices.
What
many clients are choosing to do ... and why.
Rather than having their healthcare dictated by their insurance policy, a growing number of clients are
simply choosing to see whom they want, when they want,
and where they want. They make their choices based upon compatible client-therapist values, spiritual
worldview, and the reality of their circumstances. They see the value in regaining their
personal autonomy and directing control over where and how
their money is spent.
Another tangible benefit of
bypassing insurance is that your mental
health record remains confidential according to law, and
your personal, private and confidential treatment record is not
disclosed to (or demanded by) third party agencies like your insurance company
or their TPA (third party administrator), or their
"independent auditors," or by your employer, or by the
medical records bureau. Yes, there are assurances of
electronic privacy, yet having one's mental health record
rocketing around in cyberspace can be unnerving; and to
believe these electronic records will remain perpetually
confidential is questionable. This may be a minor concern,
yet protection of one's personal privacy and electronic
identity ultimately belongs to the client, not to the
insurance company.
Further options
for the client ...
Shrewdly investing your time, energy and money into your own
healthcare can be empowering. With the advent of
medical savings accounts and other financial strategies,
clients are taking control of their resources and
directing their own policies to meet their own needs. Increased
privacy, autonomy and
control over your personal health and well-being is desirable.
How to
get the process going ...
If you are
choosing to bypass your insurance altogether, simply call me
and schedule an appointment. I will mail you an Intake Packet
and we will plan your services accordingly.
If you choose to
use insurance, I would be happy to consult with you about
the next step. In general, clients pay me directly, and I provide a receipt with all the
necessary diagnostic and service codes. This is faxed to the
insurance company and you receive reimbursement according to
your own unique insurance policy.
I hope this
information brings some clarity to a typically confusing
topic. Remember, this is your life and it doesn't belong to
the insurance company. Ultimately,
you prayerfully decide the best choices for your personal well-being and
that of your marriage and family.
(C) Thomas Isaac
Berscheid, MA, LMFT, LPC, Ordained Minister
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