I have a sliding scale with a broad range that I hope most people are able to afford. I do this because I do not accept insurance, and I am increasingly unlikely to ever do so. This isn’t a decision born of laziness or a desire to limit my clientele to people who can afford private pay, but one of ethical imperative and concern for my clients.

There are a few things you may not be aware of when using your insurance for mental health care. The first, and most problematic for me, is that being reimbursed for therapy will often require a diagnosis in order for it to be viewed as “medically necessary”. This may not seem like an issue, but it can cause difficulty if you ever lose coverage and need to re-apply somewhere else. It becomes a part of your permanent medical record and therefore may lead to other people having access to your mental health diagnosis without your explicit consent. Further, not just any diagnosis will do, so finding one that fulfills your insurance company’s requirements, while also being appropriate for you can be difficult. It is unethical for counselors to offer diagnoses for the sake of billing insurance that do not fit the client’s particular situation. None of this even touches on the inherent problems diagnoses carry in and of themselves, which is an entire blog in itself (forthcoming).

The second issue pertains to confidentiality. Your insurance will, most likely, require access to session records, many of which may have things that you do not want other people knowing. Confidentiality and trust are key in the counseling relationship, and they deteriorate for every outside party that has a hand in the process. As counselors, we work hard to maintain your confidentiality, and hate to see it violated, no matter the reason.

Lastly, when billing insurance, your treatment – everything from how many sessions to what interventions are used – can be dictated by someone with no actual training in mental health. As a counselor, I work with you to choose interventions and goals according to what is best for your unique situation. I am able to do this through years of experience, constant reading, additional education and consultation with people wiser and more experienced than me. With insurance, interventions may be chosen based on what is most cost effective for your provider. Period.

None of this is intended to demonize insurance companies – from a business perspective their policies make very good sense. It is troubling that this is the state of our healthcare, and that a service you pay so much money for is not useful when it comes to finding a counselor unless you consent to multiple conditions that may not be good for you or your treatment. As counselors, we understand this, and every counselor I know tries to find ways to help their clients despite these limitations and restrictions.

Personally, apart from the sliding scale, I keep a certain number of spots reserved for much lower rates and pro-bono clients, as well as offering a Mindfulness Meditation group once per week that people can attend for a small donation, or for free. I am also working to compile a list of affordable counseling services in my area, which I will turn into a page on my website. Whatever you do, look into the requirements your insurance company may have before choosing to use it for mental health and make an informed choice rather than assuming that it is the best way to find the help you need.