The FAQs and Not The FAQs About Psychotherapy: Part 1

The FAQs and Not The FAQs About Psychotherapy: Part 1

Most often, a caller in search of a psychotherapist leaves voicemail asking, “Are you taking new patients?” and “Do you take my insurance?” They rarely say, “I’d like to speak with you before making an appointment.”

Usually, callers have been turned away by several therapists. Prospective clients often get names of therapists from their insurance company which has limited the number of providers in their network. Clients also get names from the internet which does not filter providers based on insurance coverage. Insurance company approved therapists can quickly get an overwhelming number of clients and may not have room in their practice for another. Callers may be very upset, but they aren’t stupid. Their experience tells them they ought to save time by first asking if the provider is taking new clients. 

Asking if the therapist is taking new clients is an okay question. It is quick, easy and can save time. Colleagues not on insurance company panels will probably be taking new clients because potential clients are being directed away from them and therefore, such therapists are harder to find. The more common problem with therapists not affiliated with an insurance company is finding a mutually convenient time to meet with the client. Most people have busy lives and complicated schedules.

The second question, “Do you take my insurance?”, is practical and a good question. If the therapist is in the insurance company network, they have agreed to a predetermined low fee. All that is due from the client is a co-pay, and a co-pay is far less money than a full fee. Most people must sacrifice choice of practitioner for less costly treatment. With respect to physicians and medical practices, this is not generally an issue. Most top-level physician groups and hospitals accept most insurances. The opposite is true for out-patient psychotherapists. 

There is a group who can choose between a low-cost co-pay insurance panel provider, and having the choice of any provider. That group is the one with an out-of-network benefit. That is, after you have paid from your own pocket enough to fulfill the deductible amount, the insurance company then reimburses you a significant percentage of the full fee. It still costs more for the therapy than offered by an in-network provider, but the overall cost is far less. The reality is that most people have to be practical and cannot afford to have complete choice and control over who will be their therapist and the nature of their treatment.

If the cost of treatment has to take priority over the choice of who will provide that treatment, asking if the therapist is in the insurance company network is a good question.

Almost never do people question what they might be sacrificing for lower costs or gaining from higher costs. Those would be  good questions, too. I’ll address that fully in a little bit. Read on. The answer will be evident.

If a caller can get passed the first two questions, they are likely to ask about the therapist’s methods, techniques, and relevant experience. These can be very good questions because sometimes they yield information about a therapist who has the right kind of experience. More importantly, a brief conversation may offer a sense of being able to work together. The therapist and client connection is the most powerful predictor for achieving a good therapeutic outcome.

As I promised to explain, what justifies paying more? The first benefit is privacy. When you pay directly out of your own pocket, only you and your therapist have to know you are in psychotherapy. Your insurance company won’t know and so they can’t tell anyone. You remain in complete control of your information. Given the use and misuse of personal information, this becomes a significant benefit. Nobody has to know unless you share the information. The therapist can’t tell anyone unless you either give permission or you do something to trigger the legal threshold for mandated reporting such as threatening your own life or another’s life. Violating confidentiality laws and ethical standards have severe penalties for the private psychotherapist.

You thought that insurance companies were bound by law to keep your information secret? There are lots of rules that they must comply with that restrict but also allow your information to be shared. Once you apply for benefits from the insurance company, you are giving them all the rights that the law allows them. Did you know that insurance companies can share some information you thought was private through industry sanctioned clearinghouses and partnership agreements? These days, having a pre-existing condition recorded in an insurance company database can be costly to future insurability. Additionally, in a legal dispute that involves your mental state, your adversary’s opposing attorneys could access any of your records that they know about, and use your personal information for their own purposes.

The second benefit of paying completely out of your own pocket is treatment can be customized for your personality and unique personal circumstances. There is no external pressure to restrict your psychotherapy to an issue defined by the insurance company’s limitations, and employ only methods approved by that corporation, regardless of what research says about its effectiveness. You don’t lose protection against poor treatment because the therapist still must obey all the laws and ethics of their profession. It is my opinion that you actually have more protection with a private psychotherapist because the insurance company can place limits on the number, frequency and type of treatment by saying the policy itself has limitations. For example, they can say that the problem in your marital relationship is not covered by the policy you purchased.

Let’s say you and your spouse need marriage counseling because you remember loving your spouse, don’t want to break up your family and possibly go through an ugly divorce. Many policies do not cover marital therapy. They would only cover individual therapy which could include having your spouse present in the room, but you would have to be identified as the patient. Being labeled as “the patient” suggests you are the one with the problem, not your spouse who may be abusing you, or be a hoarder, or chronically depressed, or whatever that might be stressing the marriage. You would get the diagnosis and have the pre-existing condition on your record, and your spouse could say they didn’t have a mental disorder. Their claim of being free from having a mental disorder would be confirmed because you got the diagnosis and you made the claim to the insurance company. It can make for unpleasant complications should the marriage turn into an ugly divorce.

If you care about real choice in selecting your psychotherapist, having treatment that is customized specifically for you, delivered in a truly confidential, private setting, and have the finances, paying out of your own pocket has important benefits.

The best question you can ask your potential psychotherapist, whether in- or out-of-network, is about their experience with the problem you are presenting. The first problem you discuss may not be the most important one or the one you spend the most time on, but it is a good place to start a meaningful conversation. Ultimately, the only way to know if the therapist is right for you is for you to go to a session. A face-to-face meeting will give you the most information. What you feel in that first meeting should dictate your next action, whether to set up another appointment or go back to finding the right therapist. More than one session is often needed before selecting the right therapist and making a true commitment to change via psychotherapy. 

I hope this information helps you. Your comments are appreciated.