Jackie Dotson, LCSW, Sacramento Therapist
4825 J Street, Suite 223, Sacramento, CA 95819, 916-454-1021
Using Insurance - The Risks and Benefits
You may be able to use your health insurance to pay for your therapy or you may decide to pay out of pocket. There are distinct advantages and disadvantages to using your insurance, and I'd like to outline them here:
The Benefits
•Your insurance may pay for a good portion of your therapy.
•Your insurance may pay for all of your therapy, saving you money.
•You pay a lot for your premiums and it's good to be able to use your benefits whenever possible.
The Risks
• If you have mental health benefits, your insurance will pay for therapy. However, this will require me to give you a mental disorder diagnosis, such as major depression or generalized anxiety disorder for example.
• Just because you can receive up to a certain number of therapy sessions per year (usually 20-40 in many cases), this does not mean the insurance company will authorize that many. In order for your therapy to be paid for by insurance, your treatment will have to be deemed "medically necessary". In order for this to happen, I will need to speak with your insurance company to explain why you need continued treatment, which means I will have to discuss your therapy with your insurance company who will then decide whether your therapy should be paid for.
• If, in the future you are trying to apply for life/disability insurance/private health insurance, your company will need to have access to any prior health information and people are often turned down for private insurance/life insurance and/or disability insurance because of a history of mental disorder diagnoses and treatment.
• Sometimes, your insurance company may stop authorizing sessions if you are unable or unwilling to be assessed for medications. Medications are not always necessary for the issues you may be working on.
•If you ever are involved in a court hearing, your medical records could get subpeonaed and your mental health records would be included.
If I am not contracted with your insurance carrier, you may be able to use your "out of network" benefits. This means you would pay me for services provided and I would provide you with a statement that you would submit to your insurance for reimbursement. When you have out of network benefits, your insurance company will usually reimburse a portion of the cost. This amount varies.
The Benefits
•Your insurance may pay for a good portion of your therapy.
•Your insurance may pay for all of your therapy, saving you money.
•You pay a lot for your premiums and it's good to be able to use your benefits whenever possible.
The Risks
• If you have mental health benefits, your insurance will pay for therapy. However, this will require me to give you a mental disorder diagnosis, such as major depression or generalized anxiety disorder for example.
• Just because you can receive up to a certain number of therapy sessions per year (usually 20-40 in many cases), this does not mean the insurance company will authorize that many. In order for your therapy to be paid for by insurance, your treatment will have to be deemed "medically necessary". In order for this to happen, I will need to speak with your insurance company to explain why you need continued treatment, which means I will have to discuss your therapy with your insurance company who will then decide whether your therapy should be paid for.
• If, in the future you are trying to apply for life/disability insurance/private health insurance, your company will need to have access to any prior health information and people are often turned down for private insurance/life insurance and/or disability insurance because of a history of mental disorder diagnoses and treatment.
• Sometimes, your insurance company may stop authorizing sessions if you are unable or unwilling to be assessed for medications. Medications are not always necessary for the issues you may be working on.
•If you ever are involved in a court hearing, your medical records could get subpeonaed and your mental health records would be included.
If I am not contracted with your insurance carrier, you may be able to use your "out of network" benefits. This means you would pay me for services provided and I would provide you with a statement that you would submit to your insurance for reimbursement. When you have out of network benefits, your insurance company will usually reimburse a portion of the cost. This amount varies.