Foresight's Policy On Acceptance Of Insurance for Services
When Foresight Counseling was established, the aim was to provide effective low cost counseling in an old fashioned unhurried manner. The points for and against accepting insurance were weighed in the light of that objective and of our desire to treat clients with the utmost professional care and respect while protecting the confidentiality of their sessions. When the Federal Government changed the Health Insurance Portability Protection Act (HIPPA), April 15, 2003, the issue was revisited to be certain that our position was still valid in light of the changes in that law. The new HIPPA law only confirmed our position.
Employees who have counseling insurance benefits are understandably disappointed when a counselor they prefer to use is not on their provider list. And, if their insurance covers counseling by professionals not on the provider's list, the employee can be disappointed when he or she finds out that the counseling firm will not bill their insurance company. Being an approved provider for insurance companies has the immediate benefit of expanding the base of potential clients who might not seek a counselor other than those on their provider list. This has been a major concern and weighed heavily in our decision. However, the down side also had to be considered and it is our hope that as you read the following points you will agree with our decision.
Because the insurance carrier controls the purse strings, it can easily become "the client" in the sense that its financial demands take precedence over the actual client's interests. This can negatively impact both the relationship between client and counselor, and counseling outcomes.
More insurance companies are increasing their deductible to the point that the client is essentially paying for services out-of-pocket. We are now regularly seeing clients with $1500 deductibles. It is rare for us to have a client run up fees that high, so most would never meet their deductible.
Most insurance companies limit the number of covered sessions, some as few as one visit. If a client's interest in, and commitment to, counseling are dependent on insurance benefits, he or she is likely to discontinue counseling when the benefits expire rather than when therapy goals are realized.
Tracking and collecting fees from insurance companies can easily require the services of an additional full- time employee. Payments are delayed for months when submitted bills are rejected due to unannounced changes in claims forms or procedures, forms not filled in quite right, authorizations being lost or not provided properly, and numerous other glitches.
In order to receive payment, most insurance companies require that the therapist's diagnosis of the client's issue be one which the carrier covers, and often these do not include therapy for marital, premarital, "sex addiction," pornography, religious, and career issues. This puts a therapist in an awkward ethical situation. In order for the client to get any help at all, and the counseling office to get paid, the temptation is strong to submit a diagnosis that will qualify the sessions for payments. This diagnosis becomes a part of the client's medical history and, despite all the claims of confidentiality of records, history shows us that such information has been used for job hiring, placement, promotions, layoffs, future insurance coverage, court ordered child custody, early retirement, and other life changing decisions by courts and employers.
Changes to the Federal Government's Health Insurance Portability and Protection Act (HIPPA) in 2003 heavily impacted mental health providers who receive payment from insurance carriers. Although this regulation was advertised as offering more protection for clients by requiring such things as locking file cabinets and sliding sound proof windows at the reception desk in counseling offices, it effectively reduces the client's confidentiality by enabling even more entities to have access to those records without the client's permission, or even notification. When clients are advised who all can legally look into their personal file for such poorly defined and broad reasons as "national security," they might be reluctant to see a counselor at all, let alone say much of anything in session.
Our experience shows that clients who pay out of pocket for their therapy tend to be more invested in the counseling process and are more likely to continue with counseling until they are satisfied with their results than those whose insurance runs out beforehand.
In short, we believe that our decision to be the best alternative to assure lower costs and better outcomes for all concerned. Thank you.