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​​Why I don't accept insurance for services

Life is often very stressful, especially so now during these extraordinary times of recent economic crises and now political change. Insurance of many kinds - health, homes, vehicles, and loved ones are often essential so that ruinous financial circumstances are prevented.

Financial considerations for counseling sessions can be very important and a way to lesson financial burdens. However, a financial reason is the only advantage for using health insurance for individual counseling. The disadvantages are many and significant.  

In order to use insurance, I will have to give you a mental disorder diagnosis. If you don't meet criteria for a specific mental disorder, counseling will be disallowed by your insurance. I don't believe labels of that magnitude serve your best interests. I counsel individuals with specific issues and goals they want to work on, not a diagnosis, and for this and many other reasons, I don't accept insurance. 

Along with this mental disorder diagnosis, I may have to write a report every few session to show that you’re getting better, but still “disordered” enough to warrant continued care. Someone at your insurance company who doesn’t know either of us is going to decide how well we’re working together and whether or not we can continue to work together. I think you and I should make that decision, not someone who doesn’t know either of us.

We would have no idea who is reading the reports I would have to send in.  Many people at the insurance company can and will look at it to decide if the carrier will cover payment for our work. Your privacy can be compromised. I want to keep our meetings completely confidential.   

Records from insurance companies and hospitals have been released to the public in the past. (In a well known case, U.S. Congresswoman, Nydia Velázquez, during her campaign for the House seat had her medical records, including documented clinical depression and an attempted suicide, leaked to the press. see http://en.wikipedia.org/wiki/Nydia_Velasquez.)  

Furthermore, when companies are sold or merge, your records are seen by still more people.  I don’t mean to say that insurance companies have bad motives, but profit is their first motive, not your care, and all employees who work there are fallible.  The more eyes that see your records and the more records are transmitted electronically, the higher the odds that your privacy can be compromised.  

(For those wanting more information, see the article by John Grohol, Psy.D. at  http://bit.ly/o8Rpkl or if you want to see more about the scope of the problem, click http://www.wired.com/threatlevel/2009/03/p2p-networks-le/. Update:  In November, 2011, records of more than 4 million patients within the Sutter Health Care network were stolen from a computer, putting over a million people's private and sensitive health information in the hands of others.  Additional update: As of this writing in 2016, I hardly need to warn you of the threats hackers pose to electronic information. Cyber security is a cat and mouse game between developing systems of protection and bad actors' ability to thwart those systems.  Many experts believe there is no such thing as foolproof anti-hacking software and likely never will be.

If you are self-employed now, or ever want to be, and you have a mental disorder diagnosis on your insurance records, getting health insurance may be prohibitively expensive or impossible in the future. As of late 2016, the Affordable Care Act (aka Obamacare) is still preventing this injustice, but our current congress and president is threatening to do away with the ACA. There is no telling what the future holds, and insurance companies may be able to deny you care once again for having a preexisting condition.  The same can be true if you apply for life insurance.

If you ever have a child custody evaluation or dispute, having a mental disorder diagnosis on your records will not benefit you.

If you work at a company that has medical savings accounts or is self-insured, a report with a mental disorder diagnosis may be sent to the HR department of your company, so your employer potentially has access to your records.

Your insurance company may promise privacy, but I can't guarantee your privacy once information is released.  My practice does not require me to label you with a mental disorder diagnosis, and I don’t want that on your records, and I don’t want that information to be out in the hands of someone who doesn’t know you. Because I don’t want you to be financially or personally impacted in the future, I don’t accept insurance funding.  I am committed to working with you on a fee-for-service basis to reach your goals, not on a disorder an insurance company thinks you should work on.

However, I completely understand that in some cases financial considerations cannot be ignored.  If you still feel that you would like to use your insurance, you have two options.  You can contact your insurance company for a list of referrals to providers in your area who accept your insurance.  

Or you can accept treatment with me and a request what is called a superbill.  On it, I list dates of treatment, a mental disorder diagnosis, and very brief information about our counseling sessions.  You can send this superbill to your insurance company and request reimbursement.  If you decide on this option, please check with your insurance company before beginning counseling with me so that you can be sure if they will reimburse you and for how much and how long.  Regardless of their decision, I will still work with you on a fee-for-service basis.


Steve Mackey is a cognitive-behavioral, exposure based, and motivational coherence-based mental health counselor and psychotherapist who offers individual  counseling and psychotherapy services for issues related to anxiety, depression, fear, mood problems, low self-esteem, anger, habits, and relationship struggles  for adults at 2020 Capitol Ave., Suite 5,  Sacramento, CA 95811, serving the Sacramento, Elk Grove, Folsom, Roseville, Citrus Heights, Orangevale, Carmichael, Davis, and Galt communities. For more information contact  916 549-5772.

The information provided on this website is not intended to diagnose or treat any condition. Visiting this website does not constitute a therapist-client relationship.  Information found on the internet is not a substitute for individualized evaluation and treatment by a mental health professional.  All written and visual materials are the exclusive copyright of Steve Mackey, © 2011-2016.

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Steve Mackey, LMFT  
Licensed Marriage and Family Therapist
Midtown Sacramento Office 2020 Capitol Ave, Suite 5, Sacramento, CA 95811

Free 2-hour street parking on Capitol Ave. from 20th St. and up.

Office Hours: Tuesday - Thursday.  Evening Appointments Available Click here for Directions

Call me at (916) 549-5772 for a free 15-minute consultation.