Fee-for-Service vs. Insurance Reimbursement
In the traditional medical model of treatment a person goes to a doctor to diagnose and treat a specific problem or condition. This is also the model used in today's arena of managed care (MC) for mental/emotional concerns and conditions. Mental and emotional disorders are diagnosed to determine if treatment is "medically" necessary. A diagnosis is given to the patient from a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM). The diagnosis is entered into the client's records, and noted on bills and other documents sent to the insurance company.
Drawbacks of the Medical Model:
- Reduced Confidentiality
- Managed care (MC) insurance plans routinely require information about a patient's family and developmental history, past and current substance use/ abuse, marital and other relationships, a rating of current dysfunction, and other personal information. They do this to assess the extent of a patient's problems and the medical necessity for treatment, and then authorize treatment sessions for a therapist to see you. The amount of detail required varies among insurance companies and authorization procedures.
The contents of your medical and insurance record might be shared with others with whom you do not want it shared. For example, when you agree to disclosure of your medical records, you are allowing access to all of your records, including mental health diagnoses and treatment records. You would typically be asked for such authorization when you apply for health, life, disability, accident, or long term care insurance. Based on your treatment for mental/emotional disorders insurance companies may determine that you are not a good risk. They may refuse coverage altogether, exclude coverage for "pre-existing conditions", or charge you higher premiums. - Reduced Freedom of Choice
- MC insurance plans require that you choose your mental health provider from an approved provider panel - a group of practitioners who have contracted with the company by agreeing to certain allowable fees, reporting requirements, and service standards. On the other hand, people often seek specific practitioners based on recommendations from friends or family, or have otherwise researched a professional who specializes in their specific concerns. Using MC insurance restricts your choice of who you can see for service.
- Session Limits
- All MC insurance plans specify a maximum number of sessions they will allow per year -- often 20. Sessions are authorized in blocks of anywhere from 4 to 9 at a time. A report on your progress must be sent to the company to justify further treatment. Subscribers are not guaranteed the annual maximum number of sessions.
- MC Involvement in Treatment and Agenda Setting
- Obviously, third-party reimbursement also means 3rd party involvement in the patient-therapist relationship, the agenda that is set between them, and the course and limits of treatment.
Fee-For-Service
In response to the drawbacks of third party reimbursement, an increasing number of clients are financing psychotherapy/ counseling services by paying directly for them -- the way you pay for other services you use everyday.
Advantages of Fee-for-Service:
- Privacy and Confidentiality
- Paying directly affords you the privacy of keeping your therapeutic concerns solely between you and your therapist. No paperwork or information needs to be transmitted to anyone else. There are no records over which you have no control.
- Freedom of Choice in Providers
- You are able to research and select the professional that best suits your concerns and your personality. Just as when you choose a lawyer or a car mechanic, the choice is totally up to you.
- Setting the Agenda and Direction of Therapy
- Fee-for-service puts the agenda and direction of the therapeutic relationship into your hands in conjunction with the therapist you've selected. Many life concerns don't fit into medical diagnostic categories. Fee-for-service allows for greater exploration of issues without the constraints imposed by insurance guidelines for "medical necessity".
The choice is yours. Consider the information and decide which alternative best suits your situation and needs.
Fee-for-service rates are $130. per visit.
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