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Dawn J. Lipthrott, LCSW
Relationship Learning Ctr.
1177 Louisiana Ave. Ste. 109
Winter Park, FL 32789

(part of Orlando area)

Tel & Fax: 407-740-7763




My Position on Using Insurance to Pay for Marriage or Relationship Counseling Sessions
By Dawn J. Lipthrott, LCSW

In order to receive insurance benefits, insurance companies require that you have a diagnosis of a mental disorder on your claim and that treatment is medically necessary.

The truth of the matter is that my clients who come for marriage counseling or relationship counseling are nearly always normal people who tend to be stuck in their relationship, who want to learn how to create a happy marriage or partnership. Some have a good relationship they want to deepen. Others have a growing or major rupture in their relationship. Some might come as an individual because they are grieving the loss of an important relationship or want to avoid mistakes in future relationships..

We do have some people who think their partner is 'crazy', but that's a different story! I do not view most of my clients as having a disorder and I do not want them viewing themselves or their partner that way. Most often it is not true and that view of self or other only promotes feelings of helplessness. It is also illegal and unethical for me to report to insurance that you have a mental disorder when I do not believe you do..

. . . .therefore I do not participate in HMO / PPO plans and do not accept insurance. I will not give you a diagnosis of a mental disorder when I really believe you do not have one!

(Occasionally, a couple will come to me where one or both have been working with an individual therapist who has given them a diagnosis and wants them to get couples' therapy as a supplement to that work. In that case we would use whatever diagnosis code your therapist is using, but you would have to submit your own insurance.)

(If you choose to go to a different marriage counselor who will take insurance, click here to go to the bottom of the page for important information you need to know and discuss that with any potential counselor.)

I believe that it is unethical to make up a diagnosis that will loosely fit a client in order to collect insurance. Doing that is a disservice to the client and a violation of the ethics of our profession.

My clients seek help here to take their next steps toward increasing success. They might need support, direction, information or skills to change patterns of behaviors that hold them back. And yes, probably 95% of humanity have some 'issues'. Certainly some of my clients experience stress, anxiety or mild depression because of circumstances in their life or relationship, but I believe that the clients with whom I work can successfully move forward and find ways of significantly reducing or eliminating most of the causes of distress in their marriage or other relationships.

I expect my clients to value their life, their relationship, as much as I do. My clients view their work with me as an investment in themselves and their future.

I believe that people pay for what they value and for what they really want. People will spend $50 or more for a round of golf, or $1500 or more for a new or additional computer with little, if any, hesitation. If they do not value their marriage or relationship enough to spend the time, money, and energy to invest in positive change, they do not meet my profile of the clients with whom I prefer to work. Too often insurance becomes a way for people to avoid making the necessary commitment to put energy, time, resources, and effort toward achieving their personal, professional or relationship goals. However, I do understand that many people who want to work on their marriage or relationship who truly do not have the financial means to pay for counseling. They can find counseling at local agencies or with someone who does take their insurance. For those who need discounted services, there are counseling centers, usually associated with Christian, Jewish, or Islamic communities, that see clients on a sliding scale basis. (They do not usually require people to be a member of their religion and they don't usually 'push' religion. It is most often a community service that they provide.) There are also a few private therapists who will see people based on a sliding scale (payment is based on income).

IF YOU CHOOSE TO USE INSURANCE WITH SOMEONE ELSE, READ THIS and discuss it with your counselor before you meet or within the first visit:

For you or your counselor to make an insurance claim:

You must be given a diagnosis of some type of mental disorder.
Any counselor who accepts your insurance must give you a diagnosis of a mental disorder as specified in the book called the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders). Otherwise the insurance company usually will not pay.

Your 'treatment' must be considered medically necessary:
Insurance pays for conditions and treatment that meet their qualifications for being medically necessary. This means at a minimum that it is significantly impairing your ability to function. This becomes part of your medical record.

Parts of your medical record may not be as private as you think:

This diagnosis, nature of treatment, lifestyle and other pertinent information (from the insurance company records, not from your counselor) is often fed into a national medical information database (MIB) that centralizes information for approximately 700 or more insurance companies. MIB states that it was designed to prevent fraud on insurance applications. At the very least, they would have on record that you saw a counselor for some type of mental disorder. This database information is accessed if you subsequently apply for any individual health, life or disability insurance for 7 years. And, since you have signed a general release, the insurance company can get more detailed information from the previous insurance company that paid for the treatment. That can include more details about specifics of plans, goals, treatment information or more. ( For $9.00 you can obtain a copy of your record at MIB. It is worthwhile to check for accuracy in all your medical records.)

How can this affect you negatively, when you are not trying to defraud your insurance? A typical example is someone who attended two session of counseling for stress, grief counseling--even marriage counseling. Five years later, they apply for disability insurance or life insurance. Whether directly or indirectly, the information coded at MIB can influence whether or not the insurance company rejects the application or charges a higher rate. I know someone personally who went to counseling through her EAP program for 3-4 sessions after a major traumatic event in her life. Years later, she applied through her work for long term disability insurance as one of her benefits. They almost rejected her and ended up charging a higher rate saying that records had shown she was 'depressed' when she sought counseling. Even a letter from her therapist did not help. MIB says it is illegal to reject insurance based solely on the MIB report. However, because of the red flag codes at MIB, additional information is easily obtained since you signed the general release.

In addition, frequently, a counselor has to talk with a case manager (who may not be a counselor) at an insurance company paying for your counseling (especially if you are using an HMO) to justify sessions. This often means that more detailed information is given about you and your concerns and remains on file with your insurance company.

General releases for medical records are typically found on applications for employment, health, life or disability insurance, background checks for employment, adoptions, security clearances and seeing a new healthcare provider. These may or may not reveal your diagnosis and number of sessions.

I value my clients' confidentiality and do everything possible to protect it. Once your information goes to an insurance company, we cannot guarantee the information will remain confidential by others who may have record of your visits.

Think twice before you automatically jump to take the 'easy road' with insurance when you seek counseling! Then, if you DO choose to use it, you will be making an informed choice.

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