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Health Insurance Guide

As a health professional, it is my responsibility to inform you that when you use health insurnace to pay for counseling services, your mental health diagnosis becomes a part of your permanent health record. Many people have questions about whether or not counseling services are reimbursable by their health insurance. These questions are best answered by a representative of your health insurance company, because benefits and coverage varies widely between health insurance companies and insurance policies.

Following are some frequently asked questions that are related to health insurance reimbursement for counseling services.

What is a mental health diagnosis?
A mental health diagnosis is required for insurance to pay for counseling. If you were to have a sports injury, you might go to the doctor to determine exactly what the issue is. The doctor would do the examination and any other necessary tests, and give you the name of the issue - the diagnosis. A mental health diagnosis is a set of symptoms and criteria that characterizes a specific condition. In mental health, diagnoses we use include such things as Major Depressive Disorder, Panic Disorder, Generalized Anxiety Disorder, Bipolar Disorder, Schizophrenia, Oppositional Defiant Disorder, Attention Deficit Hyperactivity Disorder, Post Traumatic Stress Disorder, etc. There are also substance-related diagnoses such as Cannabis Use Disorder, Cocaine Use Disorder, Opioid Use Disorders, etc. Counselors use the Diagnostic and Statistical Manuel (DSM-5) to assess for mental health and substance use diagnoses.

Why is a mental health diagnosis required for insurance to pay for counseling?
This is a requirement of the insurance company, not the counselor. Insurance companies require that counseling services are treating a specific condition (the diagnosis). For example, if a person is diagnosed with Major Depressive Disorder, the counseling services would need to be focused on reducing the symptoms of depression in order for insurance to reimburse for counseling.

Which diagnoses will insurance pay for?
For counseling, insurance companies will only provide reimbursement to treat certain diagnoses. Often these are called "billable diagnoses."  These billable diagnoses vary among different insurance companies. For example, some insurance companies will not reimburse for "attitudinal" diagnoses or diagnosis of a personality disorder, while others will. Generally, insurance companies do not reimburse for Z-codes in the DSM-5, because these codes are not classified as mental health disorders. An example of a Z-code is "Z63.0: Problems in relationship with spouse or partner."

What if I don't have a mental health diagnosis?
If counseling services are not focused on a diagnosed mental health disorder, they are not generally reimbursable by private health insurance companies.

How does this work for the intake counseling session?
If there is no mental health diagnosis discovered during the intake session, generally this session will not be covered by health insurance.

Why doesn't insurance generally cover marriage counseling?
Marriage counseling is designed to focus on the relationship between spouses or partners, and not on a clinical mental health diagnosis.

What are my payment options?
At Lewisville Family Counseling, all of our counselors are currently credentialed with Blue Cross Blue Shield and we are happy to file your insurance claim for you. Often, when clients call their insurance company, they find that they have a deductable, co-insurance, or co-payment; that payment can be made at the time of your session by cash, check, or credit card. Many people do not realize that they also have the option to pay for counseling privately. When people pay privately, Lewisville Family Counseling offers the option of providing a superbill, which you can in turn submit to your insurance company for reimbursement. Your insurance company can tell you what your out of network benefits and eligibility for reimbursement would be. If you choose to submit a superbill, please be aware that any diagnosis that has been assessed will appear on your superbill and will become a part of your permanent health record. If you choose to pay privately and not submit a superbill, that will not be the case. We can also provide receipts which may be tax-deductable (without the need for a diagnosis!).

Why do people choose to pay privately for counseling?
There are many reasons why people choose to pay privately for counseling:

  • They do not have a mental health diagnosis
  • They have a high deductable
  • They want counseling to focus on an issue that is not related to their diagnosis
  • They do not want to be assessed for a mental health diagnosis which would become part of their permanent health record
  • They want to work with a specific counselor who is the best fit for them
  • They want to be seen more frequently than insurance would allow
  • They want to be seen for a longer duration than insurance would allow
  • They want to work with a counselor who has a specialization
  • They want an alternative form of therapy that may not be covered by their insurance
  • Marriage and Couples Counseling, Premarital Counseling
  • Other personal reasons

When you pay for counseling privately, you can be seen as often as you need to be, whether it is more often to quickly meet your goals, or less often to meet your budget.

Counseling is an investment - in yourself, your children, your family, your community.