counselling psychotherapy

Why counsellors, psychotherapists and their clients are better off without Medicare and other insurance rebates

medicareWhy counsellors, psychotherapists and their clients are better off without Medicare and other insurance rebates

Counselling and psychotherapy associations have recently been asked to make a submission regarding the Medicare rebate for their clients. Insurance is great for people who really cannot afford counselling services but there are a multitude of reasons that Medicare is a bad idea for clients and therapists alike. Adapted from my FAQ page, here are a few reasons why it is better to self-pay for therapy:

As the L’Oréal ad says: Because you’re worth it!

Good therapy is life changing, worth its weight in gold and has life-long benefits. Check out my two articles on Why Invest in Therapy? Part One and Part Two.

You want confidentiality and privacy

Whenever Medicare or private health insurance is used, your private information, psychiatric diagnosis (yes, you need a diagnosis to receive the rebate!), 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 your sense of privacy and confidentiality necessary for effective counselling and psychotherapy. Once you have a ‘Mental Health Plan’ diagnosis, it becomes part of your health records forever. (See how one woman lost her dream job due to her depression diagnosis!).

You want to choose your own therapist and style of therapy

Medicare and insurance companies limit your choice of therapists. Most “preferred providers” offer good treatment, keep your interests foremost and try to keep treatment brief without sacrificing quality. At times however, the insurance company may ask preferred providers to divide their loyalty between you and the insurance company. It is better to self-pay if a therapist comes highly recommended but is not on the provider list, if you would like to have unlimited choice regarding which therapist you would like to see and if you wish to avoid seeing a therapist with a potential conflict of interest.

You want to choose the length of your treatment

As previously mentioned, Medicare, private health companies and employer assistance programs often limit the choice in therapist and the modality that you are able to use – usually Cognitive Behavioural Therapy (CBT). Due to cost effectiveness, they also limit the length of treatment. Medicare and other insurance companies provide ultra-brief therapy (3, 6 or 12 sessions). The majority of people require more sessions than this to address the underlying issues and to provide you with long lasting change. 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 our innate wholeness and the whole story. 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 may be required to evaluate your motivation, the severity of your problems, your progress, and make treatment recommendations. The therapist must take the company’s recommendations into consideration or risk losing a contract to work with the company altogether. It is preferable to pay for your own treatment to eliminate this outside influence.

You don’t want to be labelled sick

Whenever Medicare or insurance is used for counselling or psychotherapy, the treatment must be “medically necessary,” which means that your therapist must label you with a mental illness or mental disorder through diagnostic methods. There has been widespread criticism of the DSMIV (Diagnostic and Statistical Manual of Mental Disorders) in that many psychiatrists are concerned that over diagnosis is leading to the pathologisation of everyday concerns. When you pay directly, you may seek consultation from a therapist for any reason you choose. People use counselling and psychotherapy for emotional, psychological and spiritual growth, for help coping with stressful life situations, 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 employment or to become an adoptive parent for example. For more information about the problems with labelling, check out my article on Stigma, Soul Sickness and Psychotherapy .

Therapists – don’t panic !

When I first returned to Australia from the UK, I panicked because I was starting up a new practice and I wasn’t able to get the Medicare rebate for my clients. I went back to university and trained in social work purely for this reason. Subsequently, I haven’t sought to be a part of the scheme and I don’t intend to for two main reasons:

a) In dialogue with many of my psychologist colleagues in Australia and therapist colleagues in the States, many of them are trying to get away from Medicare/insurance, not working towards it. Complaints range from clients not turning up for sessions (a lack of motivation perhaps if they aren’t full fee paying), clients often don’t commit to therapy beyond the sessions covered by insurance, the paperwork is out of control, therapists aren’t comfortable being tied down to using a certain style of therapy and most tend to work from a more holistic framework than that of the medically orientated model that is expected.

b) We can’t wait around for our associations or the government to recognise our worth. We all have unique gifts to offer clients. Read how to create your ideal practice in this article from Australia Counselling founder Clinton Power: Medicare Rebates:  5 Lessons in How to Create a Profitable Psychotherapy Practice Without Them

I’d love to hear what others think about this topic. Feel free to comment below in the comments section 🙂

The above article has been adapted from ‘Why Self Pay?’ with permission from the American Mental Health Alliance.

This blog is part of my Therapy Rocks! series.

About Jodie

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Sydney counsellor, soul-centred life-coach and psychotherapist Jodie Gale, is a leading specialist in women’s emotional, psychological and spiritual health and well-being. She has a private counselling, life-coaching and psychotherapy practice in Manly and Allambie Heights on the Northern Beaches of Sydney.

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15 Responses to Why counsellors, psychotherapists and their clients are better off without Medicare and other insurance rebates

  • See this paper by Dr Keith Tudor about why psychotherapists should not want regulation in order to get Medicare rebates. http://www.nzac.org.nz/journal/4_22be_careful_what_you_wish_for_22.pdf

  • Couldn’t agree more Jodie. I have always pointed out to potential clients the drawbacks of having Medicare rebates. ie the need to be diagnosed with a mental illness. The public is generally unaware of this. I do not support in any way counsellors or psychotherapists being regulated in order to get government rebates. I have many colleagues in the USA who are experts in their field and who also refuse to see clients under any kind of insurance as they feel, as I do, that they are required to treat people with a one size fits all model. this is why there is a revolving door to treatment and people don’t get better.

    • I don’t mention it above but I think by the time the rebate comes back, clients are only out of pocket a small amount more to pay privately anyway.

  • Well written Jodie. I agree whole heartedly. I have always let potential clients know of the disadvantages of Medcare and other insurances.

  • I agree, most of my long term clients don’t really care about the rebate. Paying for the service can be also part of gaining a sense of control and agency for people.

  • Great article Jodie. I agree that paying for therapy is really important. I now bring the whole issue of “payment” into my work with clients when it arises and it can be rich and challenging stuff – for us both! I find myself saying to clients now, “I’m curious, I have this hunch it is not really about the money as such, would you be willing to explore what’s going on around this a bit more?” So often when I use this tack, clients agree that more sits behind it, and we get to things like ~ fear of not having enough, fear of being taken advantage of, and often the real sense of despair that nothing can really help them change anyway etc. Once this stuff gets tackled, the resistance fades.

  • Thank you so much for writing this article. I’ve been holding myself back and reconsidering my Diploma in Hypnotherapy as I’ve felt I’m not competitive against other Professionals who use hypnotherapy with their Medicare rebate clients – even though hypnotherapy is not a claimable item. I’ve been searching for other qualifications to add to my name just to address this issue. Thank you for sharing your story and placing a different perspective on things and how to address client’s concerns when this arises.

    .

  • I am a patient who was unaware my personal data was being shared with Medicare. Could someone please explain how much information is shared? I did not know this was possible and no therapist in 20 years ever told me this was happening.

    When I found out this was possible I confronted my last therapist who told me every topic we discussed was reported to Medicare, even if it was just how I felt about my parents.I kept naming incredibly personal information I shared with her and she kept nodding, yes, to indicate that she put that in her reports.

    This cant be possible. What therapist would do that and do it without telling the patient? Is that ethical? Can I sue? Is there an agency I can report her to if she did share this information with Medicare?

    Do I have a right to see the reports she sent?

    Thank you.

    • Hi Rebecca, The best place to start would be with the professional association that your therapist is a member of. You will need to find out if the therapist is a psychologist or a social worker. Warm regards, Jodie

      • Is what she did illegal or unethical or just a standard practice ? If it’s standard practice I am involved in different support groups and would like the people in them to know they are being exploited if they made the mistake of trusting a therapist.

        • Hi Rebecca, I’m really not sure. Please contact the relevant association as they will have ethical guidelines. Warm regards, Jodie

  • Thanks so much for writing this article Jodie. I am constantly confronted with this dilemma as a counsellor and had not known how to handle it without essentially ‘bagging’ medicare supported services. You’ve made some excellent points!

  • Yes, great work, Jodi. I really like your article. It articulates some really important points that are essential as part of the therapeutic change process.

  • Thanks Jodie just came across your article today and you have put this beautifully! I studied psychology at Uni but didn’t continue down that road because of the restrictions. A psychologist friend with whom I completed a course in past life regression was told in no uncertain terms that she would lose her registration if she continued to do past life regression in the same office in which she was practicing psychology. I have chosen to practice outside as many restrictions as I can and offer my clients with private health insurance my own rebate to the value of their insurance companies contribution to counselling or hypnotherapy. My clients frequently say that they went to a psychologist and got more out of one session with me than all their medicare rebated sessions. This is a great shame!

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