Text Box: Insurance, Diagnosis and Your Rights

A mental illness that primarily requires medication to treat, also requires a diagnosis to justify why a prescription is needed.  If you need medication this can help!


A mental illness that requires hospitalization to treat, might also require a diagnosis to justify admission into psychiatric center.


A mental illness diagnosis is needed in order for an insurance company to justify payments to treatment providers.


A mental illness diagnosis is made based upon standard criteria that can be found and cross checked via credible sources: the American Psychiatric Association’s Diagnostic and Statistical Manual2, the US government’s Department of Health and Human Services website1, and other reliable sources.


A mental illness diagnosis provides mental health professionals with a basis on which to develop a treatment plan that includes methods to decrease symptoms.


A mental illness diagnosis can provide clients with explanations for behaviors, thoughts, and feelings that otherwise seem odd, unique or strange. 


Universality, the feeling of having something in common with others, reduces the feeling of loneliness and it  may facilitate speedier recoveries26.


Mental health providers are licensed to assess, diagnose and treat mental illness.  Licensure ensures that minimal standards are met for insurance carriers to approve claims.

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A mental illness diagnosis can cause people to feel like something is wrong with them that cannot be changed.


A mental illness diagnosis could affect a child’s classification in the school setting, and lead the educational system to place youth into Exceptional Education Classes (or to recommend school counseling services).


A mental illness might require the use of medications that include serious risks and side effects.


A mental illness diagnosis could affect a person’s ability to get certain jobs—with the military, law enforcement, and some government entities for example.


A mental illness diagnosis could be wrong; sometimes many illnesses have symptoms that are common in several disorders; a second opinion might be needed.


If insurance is paying for mental health services, a diagnosis will be provided to the insurance company, and your treatment provider may have to release some of your mental health medical records to the company in order to obtain payment or to continue seeing you.


A mental illness diagnosis might be perceived as the justification for  many unacceptable behaviors—enabling someone to continue in certain patterns which may not necessarily be a part of the disorder.


Because the process of diagnosis is subjective, biased by cultural, social and gender differences, it is “phallocentric” (man-centered) and inherently erroneous much of the time 25.  In short, it might simply be wrong.

   If you are using health insurance (other than EAP services) coverage is approved with diagnosis codes that indicate a mental illness and policy terms, as well as what information is shared about your healthcare Insurance companies must justify payments for counseling and/or psychiatric services; a mental illness, then, necessitates treatment.  Clinical Hypnosis is generally considered an “intensive specialty service”, thus the fee for hypnosis is generally not covered by insurance. Non-traditional online digital mental health services, regardless of diagnosis are seldom covered, and generally initial claims are either denied, delayed or become ‘ghost claims’ (unlocatable for some reason).  As such, the practice of LaRose is moving to a system of care that allows patients to utilize and seek online services (24 hour access to many online services), to engage in self directed care (ie: you control the scheduling since you self schedule) and the practice is now offering various services in two jurisdictions: both Florida and Washington DC!  As a self pay client, you no longer need to be concerned about what is covered, what is not covered and what may later become uncovered due to policy and company variability.  Here you control your care (outside of risk of safety and abuse scenarios), your scheduling, and your costs (scheduling when you need to be seen, not just because of an opening or just because it is possibly covered)!


 How long will counseling services last?


   Diagnosis can be helpful, particularly in the case of a more severe disorder; and there may be times when something is going on, but a diagnosis is not really what is needed for effective treatment.  Many diagnoses are mild, requiring little to no treatment, while others are more severe requiring frequent or intense treatment.  Insurance companies are most likely going to pay for a mental illness that is in the latter category, rather than the former (but this is not always the case).  In either regard, you should ask your provider, if you’re billing your health insurance, what diagnosis is being made, how the diagnosis is made, and what the long term and short term implications of a mental illness diagnosis might be (for example, will a diagnosis affect a career decision or a school decision, etc. etc.).  You may also want to ask your insurance company if they are reporting your diagnosis to the MIB.


Diagnosis Pros & Cons...


   Sometimes an insurance company will request records about your diagnosis and treatment in order to approve payment or to approve continued treatment.  Mental health professionals obtain written permission to send information to your insurance company. You will give the written permission when you sign in, and when you complete the intake forms; an example of an insurance consent form is located here.  Appointments can be scheduled 24 hours a day (availability can be verified now).  


One way to keep a mental illness diagnosis from being sent to your insurance company, should that be one of your concerns, is to ask the mental health provider NOT to bill your insurance company.  Providers generally would rather avoid the insurance paperwork, and you can easily pay the provider directly. Plus, if you are going to use online services, where you can communicate online anytime you login to a client portal, nearly none of these services are covered.

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What if NOTHING is wrong?


   Whether you will be using insurance, whether there is a diagnosis, or if you have general questions about the mental health process, some providers offer initial consultations, some may do so free of charge.  Initial consultations can help to alleviate a part of the stress that often accompanies the selection of a mental health provider.  American’s shop for automobiles, houses, and clothing—why not consider interviewing the therapist—before you enter into a therapeutic relationship?   LaRose is now licensed in both Florida and the District of Columbia offering office, online, onsite and concierge services by your request!

This video series, accessed via the United States Department of Health and Human Services website, explains in detail how your healthcare information is used and shared, what your rights are and what to do if you find an error in your records.   DHHS Consumer Information