Can I Use My Insurance For Therapy?

Health Insurance Spelled on Scrabble Blocks on Top of a Notebook Planner

July 19, 2022

I'm Alana
I'm a Couples and Sex Therapist. For over a decade I have been working with partners and individuals, just like you, on their journey to a stronger relationship, a more fulfilling sex life, and finding their true sexual selves.
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When a client comes to see me for a free consultation, inevitably the question gets asked:

Do you take my insurance?

I understand why I get asked the question, only paying a co-pay and having your insurance foot the rest of the bill sounds like an amazing deal, like it’s too good to be true!

The truth is, ​sometimes it is too good to be true and there are a couple of reasons why my answer to the question is “no.”

Diagnosis Disasters

​Many people don’t realize that in order to use your mental health insurance benefits you have to be diagnosed with an illness. Insurance companies call this “medical necessity” and if you and I can’t prove to the insurance company that you need the treatment you are seeking, they can deny your request to use your insurance.

Even if you made it past the initial request, I would have to consistently prove to your insurance company that it was important for me to continue to see you, otherwise they may deny you further sessions.

In addition, all diagnoses go on your medical record and could be considered pre-existing conditions in the years to come.

Pre-existing conditions can have a significant impact on your ability to secure any health insurance coverage in the future.

Even if you are able to obtain insurance with a diagnosis on your record, your premiums, deductibles, and co-pays are likely to be much higher, as protections for pre-existing conditions have been, to say the least, scaled back.

​I don’t want to take that kind of risk with your well-being.

Say Goodbye to Privacy

Did you know the average insurance claim passes through fourteen people on its way to being approved?

Fourteen people…

Now remember, in order to use your insurance, I have to diagnose you with a condition relevant to the treatment you would receive from me. That means upwards of fourteen people could find out that you’re suffering from a sexual dysfunction, are struggling with a sexual concern, or have a problem in your marriage or partnership.

It’s embarrassing enough to have to reach out and talk to someone about your concerns, and the last thing I want is for everyone at your insurance company to know your problems and be the judge of when you should stop seeing me.

And ultimately, if I take your insurance directly, that’s what they would do.

Talk about a lack of control over your own situation.

Couples Consequences

More often than not, couples and relationship counseling is not covered on health insurance plans.

I know a lot of insurance companies say they cover couples or relationship therapy, but there is no such thing as a couple’s therapy code for insurance claims, nor is there a diagnosis I could give a couple that would qualify for mental health treatment.

What insurance companies really mean is the person who gets a diagnosis for an individual mental health concern can have their partner present in session while we work on their diagnosis.

But sometimes, even if you meet all the criteria to have your partner present while we work on your depression, low libido, or erectile dysfunction, having your partner in session may not be considered “medically necessary” and so your claim for couples therapy would be denied.

Alana, You Are Killing Me…

image of a couple stressed and turned away from each other

I get that you’re frustrated. Until I feel that the insurance companies I might contract with are safeguarding your mental health and allowing us to do the work we need to do, I won’t be taking your insurance directly.

But let’s look at the positives! Not a lot of people realize that, because I don’t take insurance right now, I can do a lot of amazing things like:

  • Give every one of my clients personalized attention
  • Offer 80-minute sessions (seriously, your insurance would never cover that)
  • Go to cool trainings regularly to become a better and more experienced therapist

And it’s all because I don’t have to spend my off hours talking to insurance companies and seeing people who aren’t committed to doing the hard work of therapy.

Ok, So What Are My Options For Seeing You?

​Right now, I do not take insurance plans directly, but you have options if you want to see me and possibly use your insurance benefits:

  • I take cash, cards and checks for all services.
  • I am able to take Flexible Spending Account cards and Health Savings Account cards.
  • While being an out-of-network provider for all insurance plans means I do not file with your insurance directly, I can provide you with what is called a superbill, which you can submit to your insurance for potential out-of-network reimbursement.

But fair warning:

  • There are times where couples therapy is not eligible for reimbursement
  • HMO plans do not provide out-of-network coverage
  • If you have a high deductible, you will need to meet it before you are eligible to receive reimbursement.
  • Sometimes, longer sessions are not covered by health insurance (if that’s something you’re interested in.

If you want to try to use some of your insurance benefits for my services, the best thing you can do is call your health insurance company and ask about reimbursement for outpatient mental health services with out-of-network therapists.

I hope that spending some time explaining why I do not take insurance right now was helpful and informative. If you have any questions about it, please feel free to email or call me with further questions. I would also recommend checking out my Fees & Insurance page for my current rates.

If you think you may be ready to take the leap into therapy with me, head on over to my Contact page. I would love to hear from you!

Alana Ogilvie, LMFT, CST Portland Sex Therapy

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