Why therapists and their clients are better off without Medicare and insurance rebates?


You want confidentiality and privacy.

Whenever Medicare or Private Health Insurance is used, your private information, psychiatric diagnosis, presenting issues, treatment plan and progress reports, are available to the insurance company and, at times, to employers. Medicare, Private Health Insurance and Employee Assistance Programs often ask for detailed personal information about clients in order to make payment decisions. This review can undermine the privacy and confidentiality necessary for effective therapy. Once you have a ‘Mental Health Plan’ diagnosis, it becomes part of your health records forever. When you pay for therapy out of pocket, there is no loss of privacy to third party companies.

You want to choose your own therapist.

Many insurance companies limit your choice of therapists. Some “preferred providers” offer good treatment, keep their clients’ interests foremost, and try to keep treatment brief without sacrificing quality. At times however, the insurance company asks preferred providers to divide their loyalty between the client and the insurance company. Many clients prefer to choose their therapist personally and choose to avoid seeing a therapist with a potential conflict of interest. Other clients may want to work with a therapist who was highly recommended but may not be on the provider list.

You want to choose the length of your treatment.

Medicare, Private Health Companies and Employer Assistance Programs limit the choice in therapist and the modality that you are able to use – usually medically orientated models such as CBT. They also limit the length of treatment. Most companies provide ultra-brief therapy (3, 6 or 12 sessions). One of the major issues with time limited therapy is ‘revolving door syndrome’ – this is widely recognised within the Medicare Better Access Mental Health Plan system.  It is not that certain techniques such as CBT aren’t useful or necessary – they are at times – but they don’t address the whole story. The majority of people require more sessions than this to provide long lasting change. Self-paying for therapy is preferable in order to receive the type and length of treatment required to suit your needs.

You don’t want Medicare, Private Health Insurance Companies or Employee Assistance Programs making choices for you.

When a third party is responsible for payment, they have the power to influence your treatment. A company employee evaluates your motivation, the severity of your problem, your progress, and makes treatment recommendations. The therapist must take the company’s recommendations into consideration or risk losing a contract to work with the company altogether. Many clients prefer paying for their own treatment to eliminate this outside influence.

You don’t want to be labelled sick.

Whenever insurance is used for therapy, the treatment must be “medically necessary”, which means that your therapist must label you with a mental illness or psychiatric diagnosis. When you pay directly, you may seek consultation from a therapist for any reason you choose. People use therapy for emotional, psychological and spiritual growth, for help coping with stressful life situations, and for marriage and family difficulties, as well as for chronic and serious psychological problems. Having a psychiatric diagnosis on your health records can restrict your ability to qualify for future health and life insurance coverage as well as when applying for future employment or to become an adoptive parent for example.