U.S. Guys - do you regret using company insurance for counseling on gay issues

[NCDogGuy]

This is mainly for guys in the states who've done this in the past few years as this question pertains to insurance procedures.

When you sought counseling for gay related issues, did you use your company insurance or pay out of pocket? If the former, did you later regret that?

I know they have to put a diagnosis code. I have a depression diagnosis on my record, so if they use that, it won't be any worse. But were there any other issues? My understanding is "homosexuality" is no longer a diagnosis in the DSM-IV, but it does have "302.9 Sexual Disorder Not Otherwise Specified."

Yes - I'll ask them what they are coding it before having them file, if I have them file.

I'm extremely fortunate to have great mental health insurance through my employer that just has a copay and a generous appointment limit. And the employer has strict non-discrimination policies regarding orientation. But will I later regret using the insurance for this?

Thanks!

 

[looseliam]

Your employer does not have access to your medical records. HIPAA protects even your billing information.

 

[KaraBulut]

You can ask what DSM-IV-TR they're going to use (assuming that your insurance company actually accepts DSM instead of ICD-9). If so, they're more likely to use something like 309.28 since you're not seeking treatment for a sexual disorder as much as you are there for adjustment disorder.

 

[NCDogGuy]

looseliam - That's what I think too. But several of the websites for counselors listed on the LGBT Support Center for my area warn of risks in filing. It is mostly from the "this could hurt your chances of getting insurance in the future, and insurance companies will have copies of our session notes and sometimes micromanage treatment because they only pay for what is medically necessary."

So I figured I'd ask if anyone reading this acutally experienced that.

Those of us in this journey desperately need so much help, so I was surprised that some very good sounding therapists effectively say "Danger - getting help through insurance could cause problems." The costs without insurance are quite high.

The cynic in me says they get more if clients pay than if they use the negotiated rate with insurance groups. If so, why don't they prominently say that on the non-LGBT info pages as well? Something seems to make LGBT different for them.

I'll definitely talk to the provider I choose about this. Just wanted as much helpful feedback from this amazing community as I can get.

 

[JayQueer]

NCDogGuy,


I would recommend paying out of pocket (as long as you can afford to do so) for two reasons.

1) You won't have any anxiety about your company accidentally finding out that you are receiving any form of counseling or medical care. Yes, there is HIPAA, but as we all know, we are human and security breaches do occur -- and more often than you think. If you don't use your company insurance, you have the peace of mind knowing that your company can't find out about your counseling.

2) The compensation for most mental health services in most insurance plans is very low. Which is really unfortunate. So unless you incur some exorbitant charges, such as an inpatient stay in a psychiatric ward, you will likely have to pay out-of-pocket for the majority of the cost, even with insurance.

Furthermore, almost all of the most trained & highly rated mental health professionals (PhD or MD) in my area only accept payment upfront for their services. Even in the Raleigh-Durham-Cary area, I suspect that is the case as well.

 

[evanrick]

I wouldnt feel guilty, im guessing some people use health insurance for fertility treatment or obesity surgery, so i dont see identity health counseling as different since culture does play a part in our mental as well as physical health.

 

[KaraBulut]

Not to get too far in the weeds but HIPAA Sec. 164.530 does allow for your insurance company to obtain your medical records.

Pay attention to the disclosure forms that you will be asked to sign by the therapist. You will receive a HIPAA Privacy Notice- read it.

You may also receive something called an "authorization to release medical information" or a release of information form. This form authorizes the provider to provide any information that an insurance company requires in order to make payment to the provider. It is perfectly legal for the therapist to provide medical records to the insurance company if they request it in order to process a claim for payment. The one thing that is excluded is psychotherapy notes (HIPAA Sec. 164.508) but all claims do have a diagnosis code and a treatment plan may not be covered under the psychotherapy notes exclusion.

 

[NCDogGuy]

KaraBulut - yes - that is what the therapists are saying. And they point out that once they release the info, the insurance company controls it. I did not know session notes were exempted.

I'm not sure what I'll do. My insurance is amazing ($30 copays!) But having insurance involved in this stage of my journey makes me nervous. Is reducing the risk worth paying $100-130 more each session? Can I even afford it?

Lots of good info here as usual.

If anyone did use the insurance and got burned by it, I'd love even a PM.

 

[neditesjamais]

I never would have thought about this, but it's clearly worth considering. My own counseling was not covered under medical but rather under a sort of "blanket" mental health benefit available to employees and their families as well. It was provided by a private practice that had a standing contract with several large employers to provide service. They merely reported the number of contacts they had with each employer's employee/family. I know this because I asked--not out of worry, just interest.

Have you considered or looked for a public mental health agency (I know . . . there aren't enough and they're not the best, etc.)? Maybe just to get a start and perhaps to discuss this very issue? Many of them use a sliding scale, as well.

But, yeah, it's worth it to pay out-of-pocket for the help you need. I had over $12K in uncovered/unreimbursed medical expenses last year. Reduced my taxes a bit, but more important, kept me alive!

good luck

ned

 

[KaraBulut]

I'm not sure what I'll do. My insurance is amazing ($30 copays!) But having insurance involved in this stage of my journey makes me nervous. Is reducing the risk worth paying $100-130 more each session? Can I even afford it?

Membership in a group plan usually entitles you to the contract rate even if you pay cash for the services. In other words, if the provider would bill $100/hr but your insurance has negotiated a contract rate of $50/hr, you are entitled to pay $50/hr even if you pay cash and don't bill your insurance. The provide would only get paid the $50 rate if they billed the insurance company, so it makes sense that they would accept $50 if you pay in cash.