Since starting my career as a clinical social worker, health insurance companies and big pharma have become bigger, stronger, and more intrusive in the therapeutic relationship. I have increasingly felt uncomfortable pathologizing normal life situations to suit the medical model diagnosis requirements of insurance companies.

Why Confidentiality Should Matter to You

First, if you are going through a contentious, protracted divorce of course, you are going to feel anxious (about money), depressed (at the ending of a relationship), angry (your spouse had an affair), have mood swings (you have good days and bad days) and may even temporarily turn to alcohol or drugs (to numb your feelings). You do not have a mental illness or a disease; you have a life crisis!

Second, a medical model diagnosis becomes part of your permanent medical record and will follow you for the rest of your life. Modifying or erasing this diagnosis is virtually impossible.

Third, certain diagnoses can be career ending, for example, depression for an air traffic controller; or could be used against you in child custody cases, for example, a substance use diagnosis may be used to imply you are an “unstable” or “unfit” parent; or used as a weapon against you in your intimate relationship, for example, an abusive partner may badger you with, “Are you off your meds?” or “What do you know, you have anxiety!”

Insurance Intrusion

If you are not directly involved in the mental health field, you may not be aware how much your insurance company is involved in your mental health therapy. These are some things you may not know:

• You are only able to have therapy paid for by your insurance company if you obtain a prior-authorization. You will need to explain to a random stranger what is going on in your life and why you want therapy. The insurance company can deny you.
• If your insurance company approves you to receive therapy, they will provide you with a list of therapists who are considered “in-network”. Do not be fooled into thinking these are the providers who have been vetted for excellence, though they may be very good!! No, they are providers who have agreed to accept whatever financial reimbursement the insurance company is paying in your particular geographic area.
• If you are approved to receive therapy, most insurance companies have an arbitrary annual or lifetime limit on the number of therapy sessions they will pay for. For example, if your spouse has passed away and you are depressed, insurance will pay for 12 sessions. If you want to continue therapy, you will have to go back through the prior authorization process to explain to a stranger why your depression is lingering beyond 12 weeks.
• For your therapist to be reimbursed by your insurance company, your therapist will be required to assign you a psychiatric diagnosis. If you do not have a diagnosis, one must be created for you to obtain payment. Are you feeling sad because your candidate lost, and you just want to talk with someone about it? For your therapist to be paid, you will be given a diagnosis, probably depression.
• Legally, your employee-offered insurance company can request and review all your therapy records any time they desire, without your knowledge or permission.