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:
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!).
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.
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.
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.
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 .
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
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.
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.
Click for Newsletter