I am accepting new patients for the following insurance plans (“In-Network” and Preferred Provider):
- First Choice Health Network PPO
- Kaiser Permanente (“Added Choice”)
- PacificSource Health Plans
- Providence Health Plan
- Samaritan Health Plans
If you are using an in-network insurance (above), I will submit a bill to your insurance company. If you are wanting to use your out-of-network insurance benefits or private pay, I can provide a statement for reimbursement. Payment for copayments, deductibles, and so forth can be done using Health Savings cards (HSA/FSA) as well as most major credit cards, in-state checks, or cash.
For current patients, I am also able to accept:
- Aetna (out of network after 12/31/2019)
- BlueCross BlueShield
- Cigna (out of network after 12/31/2019)
- Moda Health (out of network after 10/2/2019)
- United Healthcare
I am not a participating provider with medicare, the Oregon Health Plan, Worker’s Comp, or EAP (Employee Assistance Programs).
Should I Use Private Pay?
In a nutshell, these are the top four reasons my clients have told me why they prefer to use private pay and not use their insurance:
- “I don’t want to be diagnosed with a mental disorder” – For insurance to cover your sessions, you must be diagnosed as having a bona fide mental health issue.
- “I might be labeled with a pre-existing condition” – If the Affordable Care Act (ACA) is repealed, pre-existing conditions will no longer be covered, and this includes mental health.
- “This might affect me for the rest of my life” – Concerns that having controversial labels such as Panic, Bipolar or Generalized Anxiety Disorder may impact your future choices and options.
- “I’m in the middle of applying for a life insurance policy” – This one has surprised me; the concern expressed to me here is in being disqualified or limited due to a pre-existing mental health disorder.
Let’s dig into these a little bit more.
The Problem of Being Diagnosed
In short: If you are receiving therapy and your insurance is paying for it, you have been officially diagnosed as having a mental illness.
The reason you must be diagnosed as having a mental disorder all revolves around a mysterious term called, “Medical Necessity”. Insurance won’t pay for things that aren’t medically necessary (in fact, they’d prefer not to pay at all). In order to regulate this, they want to know that you are receiving treatment for an actual illness or injury, whether physical or emotional. More specifically, they don’t want to pay for anything that they call a “convenience,” which is a fancy way of saying that if it’s not a bona fide injury or illness, it doesn’t count.
So, having an official, permanent diagnosis of Major Depressive Disorder or Panic Disorder would be covered by your insurance. If you went to counseling just for issues of low self-esteem, marital therapy or personal growth, it wouldn’t count.
Privacy and Insurance
Talking with a therapist is a very personal and private event. Counselors strive very hard to keep what is said in session confidential. Unless required by law, your private information is not released without your permission. In reality, it’s a little more complicated than that.
What you talk about with your therapist ends up being coded and is ends up being available to marketers, advertisers and researchers, but not you. Some of this is done for honest and worthy reasons, such as helping researchers understand and improve mental health disorders. Some of the information is used to help pharmaceutical companies develop more effective marketing strategies. And the concern is that having the insurers developing specific profile about each individual, this information may be, someday, used against us.
Unfortunately, some of this data will be used for reasons we don’t know, a type of underground information black market. Why is this? The reality is that no one is talking about what is being done behind the scenes with this information and we have no legal rights to request these details. This mysterious battle for the possession of your intimate information is happening behind the scenes without our knowledge.
Having a Pre-existing Condition
Consider what happens if you’re seeing a therapist for problems with depression or anxiety. Since insurance companies won’t cover the costs involved with anything not deemed “medically necessary”, chances are you’ll be assigned a diagnosis indicating the presence of a bona fide mental health disorder.
The difference is profound: You may be feeling a little sad, but now your permanent medical record reflects a hard-core diagnosis of Persistent Depressive Disorder, for example. From your point of view, you’ve only seen your therapist. But in order to have your counseling session covered by insurance, the counselor enters your details into a third-party billing system, which delivers the data to a medical claims clearinghouse.
This organization acts as a claims processor, contacting your insurance company to confirm your coverage, co-pay amount and deductible and to arrange for payment to the therapist. But both the clearinghouse and your insurance company have now learned that you are severely depressed, sexually impotent, have trouble concentrating on things and suffer from uncontrollable panic attacks.
Why Does This Happen?
How these companies make use of their records on your mental health disorder is something they keep secret. Many routinely sell this data to commercial data collection companies (“aggregators”). If you ask, they will either decline to comment or give you a boilerplate generic answer such as, “We do not sell any information as we value our customers’ privacy” which is both vague and as suspicious-sounding as, “Your call is important to us, please continue to hold.”
The bottom line: Information is valuable, and most companies do indeed sell the information they gather to others to be collected and analyzed.
Not Really Anonymous Anymore
How anonymous is your information? Most people have heard about HIPAA (Health Insurance Portability and Accountability Act) in regards to patient privacy. And to be fair, it is protecting you to a certain degree: Your information cannot be shared without your consent if your name is included. The dilemma is that once your name is removed, your consent is no longer needed. And from this anonymous information, very specific patterns that identify you can be formed.
In today’s day and age, your name is no longer as uniquely identifying of who you are as is your details. Reverse-engineering and cross-referencing anonymous data in research studies have shown that privacy is, at best, an illusion. As anonymous patient data grows more extensive, it is indeed likely to figure out who is who.
Theft of Your Information
Theft of your personal information by hackers is another real concern. So far, we’ve been lucky (or simply misinformed). In the past five years, more than 41 million people have been affected by illegal U.S. health record theft and hacking attempts. In early 2015, Anthem Health revealed that much of its patient data on nearly 80 million people was compromised… back in 2014.
If your financial information is hacked, you can change your passwords and have the protection offered by FDIC insured banks; there is no equivalent protection offered for restoring your privacy. Perhaps the practice of anonymizing and sharing patient data is ultimately helpful. The big questions that we deserve answers to are how is our private information being anonymized, who is buying and selling our information, and what protections are being given to us to prevent the theft or sale of our data?
Until we are given a vote in the matter, we really are out of the loop.
If you need to see a therapist or counselor, you should still go. When your marriage is falling apart, depression is wrecking your life, or anxiety is ruining your career, concerns about privacy should not be placed above your health and well being.
If you are concerned about using insurance: Ask to be seen both as private pay and with a non-mental health diagnosis. These are more generic, not covered by insurance, and considered by many to be “safe”. They include codings such as:
- Relationship Distress with Spouse or Intimate Partner (Z63.0)
- Phase of Life Problem (Z60.0)
- Other Counseling or Consultation (Z71.9, my favorite)
Regardless of your choice, remember that in the end, the goal is to get help and to get it effectively.