Because of the unfortunate stigma still attached to mental health conditions, people should think twice before using their health insurance to pay for visits to a mental health professional, such a marriage and family therapist, a psychologist or psychiatrist.If you do have health insurance coverage, your first reaction might be to think, “Well, if I’ve got insurance, why shouldn’t I use it? That’s what it’s there for.” And, most of the time, that’s true. I know I’m certainly grateful for my health insurance when I go to the doctor or dentist.But it gets more complicated when it comes to mental health care because of negative associations attached to psychological disorders. For example, people probably think differently about an individual who has a physical condition such as a thyroid disorder versus someone who has a psychological condition such as major depression.The reality is, if you want to get your insurance company to pay for your mental health care, the mental health care provider has to give you a serious psychological diagnosis or the insurance company won’t pay for the treatment.For instance, many insurance companies won’t pay for someone seeing a therapist for couples counseling or for “normal bereavement” following a loved one’s death. So your mental health care provider needs to find a serious diagnosis that legitimately describes your situation and that will be acceptable to your insurance company. But, once you have that diagnosis, the big issue becomes confidentiality.Here’s how that works. When you’re seeing a therapist and paying for it yourself, the information you discuss in session stays in the room for the most part. The therapist doesn’t share the information with anyone else, except when they’re required to report child abuse or elder abuse or a handful of other situations covered by law or their profession’s code of ethics. So the vast majority of the time, the information you share with your therapist stays just between the two of you, and you can feel completely free to share all the deep problems that brought you to the therapist’s office in the first place.However, your sessions won’t be so private any more if your insurance company is paying for all or part of your mental health care, because your diagnosis then becomes part of your health record and it’s no longer confidential. That could be detrimental to you in the future.For example, let’s say your therapist diagnoses you with major depressive disorder, which is a very common diagnosis. Think about how people view other people who are seriously depressed. They generally have certain expectations of how depressed people behave.So having that diagnosis in your health record could affect your ability to get a job in the future. It could be an issue in a child custody battle or other legal problems, especially since law enforcement agencies can access your insurance information at any time. A serious mental health diagnosis could cause problems if you tried to obtain other health insurance or life insurance in the future. Those are just a few examples of situations to think about.The other issue with using insurance benefits for mental health care is that the insurance company might place limitations on the number of sessions you can obtain or require that you get pre-approval from your primary care physician. Some insurance companies are very generous and allow weekly sessions until your problem is resolved, and they don’t interfere very much in the therapeutic process. But some companies place a limit on the number of sessions they’ll cover in a given year, and that frankly might not be enough to resolve some serious or longstanding problems.But, to me at least, those pragmatic challenges of trying to get your insurance company to provide adequate mental health coverage pale in comparison to the confidentiality issue I was talking about earlier. Confidentiality really is the Number One thing you should consider when you’re deciding whether you want to use your health insurance to cover mental health care.

There are some immediate changes in health care plans for 2012. As you might imagine, the changes won’t end next year. While the new plans roll out, there are other things you want to keep in mind for the future.Barring the gutting or repeal of Obamacare, we can look forward to more restrictions beginning in 2014. While there are some benefits to the Patient Affordability and Care Act, the down side skews the equation in favor of problems for business owners, difficult decisions for people without health care insurance and the self-employed.On the positive side, insurance companies cannot consider a person’s health status when insuring them. Kaching…that was the sound of your premiums going up to begin paying for coverage of more unhealthy people. Now, for the record, I am all in favor of insuring everyone, regardless of health status. None of us want our families to live without health care coverage. The financial consequences can be devastating for families if someone becomes very ill. But we need a better plan for paying for all this coverage than what we see today and in the near future. In two years almost everyone will be required to have some form of health insurance. In order to force this on people, health insurance “exchanges” will be created to accommodate the varying income levels of people. It is not entirely clear today how these exchanges will actually work to the benefit of the insureds or the insurance companies.One of the criticisms of Obamacare is that it is a thinly disguised plan to force everyone out of private insurance and choice into these exchanges, which will be managed by some federal agency. Trying to understand the deluge of verbiage on this topic is like trying to nail Jello to the wall. The truth is no one seems to know how this would really work. In the breach, we already see companies adhering to new law to be by offering coverage extensions to children up to age 26 who are living at home with their parents. This raises more problems for companies who are trying to peer into the crystal ball to see what they’ll be on the hook for in two years.Many companies admit they might just drop health insurance benefits for their employees. Rising costs, more liability, and confusing laws and rules, guarantee more owners will throw up their hands in disgust and opt out of the system. The owners are also looking at options that help them force more accountability and self-care on their employees. These options include Accountable-care organizations, reference-based pricing and defined contributions.Accountable-care organization reward health providers who cut expenses while maintaining good performance. These organizations can be physician owned, physician and insurance company owned, or some other combination. Reference-based pricing lets the company declare what it is willing to pay for services. Employees are then responsible for finding health care providers willing to work for the amount offered. This price shopping still allows employees to choose a higher-priced provider, but the employee must pay the difference in prices. Defined contributions means the company gives employees a set amount of money to purchase plans where they wish. Any difference in prices must be absorbed by the employee. These plans are available on an exchange, so employees will have more choices in this plan.All this presumes employees will see the benefit in these changes. Most people have gotten used to some form of HMO, PPO, or other network system with predictable premiums, co-pays, deductibles and so forth. This future is the wild west of health care and insurance exchanges. We will have to actually read the information from different companies, plans, and exchanges to decide where and how to best protect our families with health care. Unfortunately, most of us are ill-equipped to do this.We need more information and education in order to make this complicated plan work. Or, better yet, we could scrap the plan before it fully vests and find a better way to insure Americans that allows doctors to practice medicine and keeps us all honest. Can someone please invent a better mousetrap soon?Have a terrific day!Patricia