While it is an unfortunate state of affairs, most insurance* is not very user friendly about counseling or other mental health services, for either the client or the clinician. I encourage all counseling clients to take some time to become fully informed about the pros and cons of using insurance for mental health services. Some factors to consider are offered in more detail on the Insurance FAQ page, along with links to independent articles on the topic. My reasons for not directly accepting insurance are interconnected, but the 5 main reasons are here.

• Pressure to over-diagnosis to get treatment authorized:
  Most insurance companies treat everything like you're going to a doctor and will not authorize payment for counseling or psychotherapy unless it is deemed "medically necessary".  This puts pressure on the clinician and client to exaggerate the legitimate use of counseling into being a pathological condition, in order to receive payment. This is especially disturbing when children are the clients and from then on their medical records will  identify them as having had a mental disorder.
   

• Loss of Confidentiality:
  Insurance companies require diagnoses, treatment plans, reports of progress, and often other personal information before approving treatment or payment. Once that information is given by the therapist, a client can no longer be sure it will remain private. In fact, under current federal law many people can get that information without needing the permission of the client. In order for counseling to be most effective it is important that clients know they are in a safe setting and can talk about very personal information to their counselor in confidence. If clients are worried that what the say may become known to others, they might decide to withhold information that could be valuable to the counselor for helping them.
   

• Difficulty with Getting Treatment Authorized:
  Recent media stories have supported the idea that many insurance companies regularly resist authorizing payment, even for legitimately covered treatment. So, there is often a lengthy process to get an initial authorization for treatment or approved for more counseling after a few sessions. This can cause delays with clients quickly getting the help they need and being able to keep seeing their counselor on a regular schedule.
   

• One Size Does Not Fit All:
  The counseling needs (frequency of sessions, length of treatment, methods of counseling, etc.) of clients varies widely; but many insurance companies have a standard flat number of sessions they will approve. To get approved for more counseling sessions beyond that number often requires a lot of effort from both the client and counselor, even if the client has not reached the maximum number of sessions allowed by their policy.
   

• Having Insurance Coverage Does Not Assure You'll be Reimbursed:
  I've worked with several clients having genuine mental health issues who were surprised to have their insurance claim denied. Unless you have contacted your insurance company and received "pre-approval for treatment" before your first session, they might deny your claim even if it appears to be a covered service. This is often done by a process called "utilization review". Mental Health America has a very informative article on utilization review and the process for appealing such denials. Going through these appeals can be very time consuming for both the client and the clinician.
  
  Insurance FAQ's
   

  Please go to the Insurance Frequently Asked Questions page for more detailed information on how your insurance may be used to pay for my services and the pros and cons of using insurance for outpatient counseling.

* For the purposes of this section, "insurance" is use to refer to all 3rd party payments, including HMO, PPO, self insured business, etc.