Insurance is commonly used to cover mental health therapy sessions, but have you ever considered the drawbacks? While insurance may help offset costs, it can also limit the quality and flexibility of your care. Here are some disadvantages to consider, including the need for a diagnosis, restrictions on treatment, and potential impacts on the quality of care in Northern Virginia.

The Issue with Required Diagnoses

To have therapy sessions covered by insurance, a formal diagnosis from the DSM-5 is often required. This presents several challenges:

• Diagnosis Requirements: Many people in Northern Virginia seek therapy for personal growth, anxiety, or life challenges that don’t meet the clinical criteria for a diagnosis. For example, those interested in weekly talk therapy or improving their day-to-day life might not qualify.

• Treatment Limitations: Some insurance companies require specific diagnoses for certain therapies. For instance, clients in NOVA seeking EMDR therapy may need a PTSD diagnosis, even if they would benefit from EMDR for anxiety or complex trauma.

• Permanent Records: Mental health diagnoses become part of your permanent medical record, which can affect future opportunities, such as employment or certain health treatments. The stigma surrounding mental health diagnoses can also be a concern for some clients in the Northern Virginia area.

Insurance Controls Your Treatment

Insurance companies often dictate the type, frequency, and duration of therapy sessions, which can compromise your care. Here’s how:

• Limited Sessions: Some plans cap therapy sessions at a set number (e.g., 6 or 12), which might not be enough to achieve meaningful progress.

• Session Length Restrictions: Therapists often recommend longer than 50-minute sessions for EMDR therapy to allow for deep processing and grounding. However, most insurance companies only cover 50- to 60-minute sessions.

• Frequency of Sessions: Insurance companies may limit how often you can schedule therapy, even if your therapist recommends twice-weekly sessions for effective treatment.

In an article published by ProPublica, a therapist was interviewed and stated that a client of theirs with bipolar disorder was forced to stop treatment because insurance decided the client no longer needed treatment. This is unfortunate because insurance companies are not in the room during therapy sessions and do not know the clients case.

Impact on Therapist Burnout and Quality of Care

Using insurance for therapy can also affect the quality of care due to therapist burnout:

• Low Reimbursement Rates: Insurance companies often reimburse therapists at low rates, forcing them to take on heavy caseloads to make a living. This can lead to long workdays and burnout.

• Fewer Openings: Therapists in Northern Virginia who accept insurance may have full caseloads, making it harder for new clients to find availability.

• Higher Quality with Private Pay: Therapists in NOVA who don’t accept insurance may have lighter caseloads and more time to focus on each client, resulting in better care. Private pay also allows therapists to set rates that reflect the value of their services and maintain their well-being.

How to See a Therapist Without Insurance

If you’re concerned about the drawbacks of using insurance, there are alternative ways to access affordable therapy in Northern Virginia:

• Out-of-Network Benefits: Many insurance plans offer out-of-network coverage. Therapists can provide a superbill for you to submit to your insurance for partial reimbursement, sometimes covering up to 80% of the session cost.

• Flexible Scheduling: Consider biweekly sessions instead of weekly ones to reduce costs. For example, scheduling 90-minute sessions every other week can provide meaningful progress while saving money.

• Reimbursement Services: Some therapists in Northern Virginia work with services like Mentaya, which handle superbill submissions and send clients reimbursement checks. This simplifies the process and helps you get reimbursed with minimal effort.

Insurance vs. Private Pay: What’s Right for You?

Deciding whether to use insurance or pay privately for therapy is a personal choice. It’s essential to weigh the potential drawbacks of insurance—such as limited sessions, required diagnoses, and therapist burnout—against your financial situation and needs.

Talk with your therapist about your options or call your insurance provider to learn more about in-network and out-of-network benefits. Choosing the right path ensures you receive the care you deserve for your mental health journey in Northern Virginia.

Hi! I’m Kate.

I’m Kate Regnier, owner and therapist at Regnier Restorative Counseling, and I’m an EMDR Therapist and LCSW who works with adults who are stuck people pleasing and are looking to break the cycle. I’m a fully virtual therapist who sees clients in NOVA and the following states: MD, DC, VA, MI & IN. 

Contact me through my website or by email at rrcounseling.info@gmail.com

Waldman, A., Miller, M., Eldeib, D., Blau, M., Luong, T., & Mukulu, Z. (2024, August 25). Why I left the Network. ProPublica. https://projects.propublica.org/why-i-left-the-network/

Disclaimer* The content provided in this blog is intended for educational purposes only and is not a substitute for professional therapy or medical advice. While I strive to ensure the accuracy of the information shared, I cannot guarantee that all information is current or correct. Readers are advised to consult with a qualified healthcare professional before making any decisions based on this post.