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Should I use my health insurance or pay for myself?

Many people want their insurance companies to pay for their mental health care. On the surface, this desire is logical. People pay a health insurance premium that, according to the Affordable Care Act (commonly known as Obamacare), requires insurers to cover a portion of mental health and substance abuse services. While the intention of this is ostensibly positive there are reasons to consider not using your insurance coverage for mental health services.


Here are some reasons to consider before choosing to use insurance coverage:

Health insurance requires that you are given a mental health diagnosis so that your therapist

can be reimbursed.


This is helpful in certain circumstances because it creates a paper trail that could lead to other services.  All diagnoses are derived from The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) which uses pathologizing categories for official coding that legitimizes the use of insurance coverage. It gives professionals a language for speaking with one another, thus assuring they are speaking about the same condition. It also provides a way to determine medications for treatment.


You may wish to opt out of using your insurance for counseling if you do not wish to have a mental health diagnosis in your permanent healthcare record. Not using insurance means you do not have a potentially stigmatizing and enduring statement about your health.

Health insurance carriers have access to your private information, including provider case notes

as well as and your diagnosis.


Your personal issues can be viewed by health insurance company employees.


Though highly unlikely, your private information could be hacked.


Electronic Medical Records require  stringent HIPAA compliance and are stored in the "cloud." If you choose to pay privately there is no requirement for an electronic record.

Mental health diagnoses have the potential to make it difficult for you to obtain life insurance.


Most insurer view hints of a problem as riskier than well-documented and successfully treated mental health disorders. You might wish to wait several months following a diagnosis and treatment before applying for life insurance. Insurers will want to know when you were diagnosed, who is treating you, what type of treatment you are receiving, length of treatment and how well you are responding. Life insurers will ask for access to your medical records as part of their underwriting process.


Health insurance can be very hard to process, understand, and receive payment from for

both the provider and patient.

It takes a substantial amount of work on both your part and the part of your provider to participate in the insurance system. Sometimes payments are denied for services that have already been provided meaning you will have to pay out-of-pocket for the service. Though not all health insurers are like this, they do periodically deny claims, limit care, dictate care, and intrude on your personal health-care  records.  For example, Bosque Mental Health has received notices from insurers that certain diagnoses are not eligible for reimbursement, though they have paid for the same service with the same patient in the recent past.

If you have used your insurance for doctor or hospital visits, you understand the value as well as the complications that can arise.  Please consider carefully if using your insurance is right for you. We are happy to talk with you about private pay options if you decide to opt out of using your insurance.