Insurance and Mental Health Care: Cash pay Vs. Using Insurance

In the world of counseling and therapy, there is a lot of discussion and debate surrounding the use of insurance to cover mental health counseling services. We feel these are meaningful discussions in order for both providers and clients to make informed decisions before entering a counseling relationship. A counseling relationship is a sort of dance between client and counselor, and adding a third party into that dance (insurance) can complicate the steps. At our practice, we have experience in taking insurance, and feel there is some essential information that may be helpful to you to know when deciding whether or not you are going to use your health insurance to cover your therapy sessions. 

Requirements of Using Insurance for Mental Health Care

One of the values of the therapeutic relationship is the flexibility of the relationship to help you navigate many different aspects of your life. Our therapists are equipped to help you navigate a transition to a new job, relationship issues in your marriage, parenting concerns, etc. We believe that counseling is extremely beneficial in situations like these, but most insurance companies only reimburse for significant mental health diagnoses. For example, the transitions listed above may result in a client meeting diagnostic criteria for F43.30 Adjustment Disorder – Unspecified, but sometimes, individuals can benefit from therapy due to the aforenamed transitions and a diagnosis just simply doesn’t fit. For example, one of the requirements for an adjustment disorder diagnosis is that the distress is out of proportion to the severity or intensity of the stressor; it could be possible that one could benefit from therapy due to anxiety about a transition, but the anxiety is completely reasonable. This would be a case in which diagnosing an individual, so that the individual can use their insurance for counseling sessions, would be insurance fraud. Our clinicians at Luxx Therapy consistently reevaluate treatment plans, the efficacy of our interventions, and even diagnoses, to ensure that we deliver the best possible services, avoid over-treating our clients, and maintain ethical assessments. 

Continuation of Care

Naturally, if you develop a meaningful and safe relationship with your counselor, and make progress in therapy, it is possible that you may no longer meet the diagnostic criteria for a disorder that you previously met. However, it could also be true that you could still benefit from continued therapeutic services to help you meet personal growth goals or explore other parts of yourself. In that case, we invite you to continue in counseling services, and pay out of pocket for your services rather than using your insurance plan. We provide Superbills to all clients paying out of pocket for services upon request, which you can submit to your insurance plan for potential reimbursement, however, reimbursement is dependent upon many different factors, which can include diagnosis. 

What is a Superbill?

A Superbill is a detailed document created for insurance companies that detail the services provided by your therapist. The Superbill is submitted by you to your insurer, and sometimes, they will reimburse you all or some of what you paid Luxx Therapy, directly.  When a therapist does not work directly with your health care plan, submitting a Superbill can be a great way to still work with the provider of your choice, while still taking advantage of your out-of-network benefits. 

The Double-Edged Sword of Diagnosis

As you can deduce, if you are a client of Luxx Therapy, and are using your insurance to pay for your counseling sessions, this means that your clinician has determined that you meet the diagnostic criteria for a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM). Diagnosing clients as counselors can be as controversial of a topic as taking insurance itself; in fact, many clinics that do not take insurance name the desire to avoid diagnosis as one of the main reasons. At Luxx Therapy, however, we understand both the positive and risk factors associated with diagnosis. For some, learning that they have a diagnosis that other individuals in the world experience create a sort of comradery and awareness that “I am not alone” and “I am not the only one”. However, for others, a diagnosis can completely cloud their worldview and could result in an over-identification with the diagnosis, which can be a significant detriment to treatment. If you are curious about any part of your treatment plan or diagnosis, please bring it up with your clinician at your next session!

A Comment on Finances 

Here at Luxx Therapy, we know that health insurance in the United States is extremely expensive. We consistently hear individuals say, “I already pay so much for this insurance, I want to find someone who accepts my insurance for counseling sessions.” We want this to, which is why we continue to accept insurance for counseling services. However, it is widely well-known in the world of mental health that insurance policies reimburse a fraction of our hourly rate, which is difficult to understand considering the following: the financial details of one of the largest insurers in Texas, Blue Cross Blue Shield self-reported, “In 2021, HCSC increased revenues by 4.1% to $47.2 billion” and described anticipated growth and continued financial prosperity. Based on this self-report, it seems reasonable and necessary that large insurers should increase reimbursement rates to more fair rates for clinicians. Clinicians set hourly rates based on important personal and professional needs, training, experience, etc., and when insurance companies arbitrarily determine to reimburse a faction on the dollar, it can become discouraging for the clinician, leading many making the decision to move away from accepting insurance at all.

Luxx Therapy Cares, Which is Why We Offer Both Insurance and Cash Pay In North Richland Hills, TX.

With all of the potential concerns that taking insurance creates, why do we continue to work with insurance companies? According to the US Census Bureau, in 2022, 92.1% of people, or 304.0 million, had health insurance at some point in the year. To us, this means that the vast majority of our community pays for private or public insurance, and has the reasonable expectation to be able to use that insurance on all of their healthcare needs. We believe mental healthcare is as important as physical healthcare and are devoted to the accessibility of services. Our mission statement is Luxx CARES: Compassion, Accountability, Relationships, and Expertise. Therefore, we believe an instrumental and practical way we can fulfill our mission statement of CARE is to provide and offer financially accessible services. And in today’s society, one way we can do that is by accepting insurance. 

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OTHER MENTAL HEALTH SERVICES AVAILABLE AT LUXX THERAPY

At Luxx Therapy, we offer a wide range of services geared towards meeting you where you are in your mental health journey including Depression Therapy, Anxiety Therapy, Trauma Therapy and Couples Therapy. We will walk the path to understanding and healing with you whether you are in need of Individual Counseling, Couples Counseling, or Family Therapy! Reach out to us today.