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I wanted to get short term therapy for a mental health related thing this year, and made the mistake of switching from my PPO to Kaiser thinking that Kaiser wou

I wanted to get short term therapy for a mental health related thing this year, and made the mistake of switching from my PPO to Kaiser thinking that Kaiser would cover therapy sessions since they appeared to have thousands of therapists under their network. It turns out that Kaiser will only cover you if you have a diagnosed mental condition (eg bi-polar / ADHD). If you don't, then you're completely out of luck. Instead, they refer you to use an app where you can get counseling via text message, and it's only for 90 days. https://organizations.headspace.com/kp/faq https://organizations.headspace.com/kp/faq

lukevp 2y ago
Do you have access to an employee assistance program through work? We have made use of the therapy multiple times and it’s been great. Totally free, 8 sessions per person per incident. You can kick off another set of sessions if there’s another incident you need to discuss. It’s not a long term solution but it’s good to fill in the gaps and get you seen soon.
- theogravity 2y ago
  I haven't thought about it at all. I'll definitely check it out, thanks!
- theogravity 2y ago
  Update: Trinet does provide this service. Thanks so much for letting me know about it.
theoreticalmal 2y ago
It sounds like there’s a financial incentive for therapists to diagnose patients with conditions they may or may not have…big yikes
- KptMarchewa 2y ago
  Therapists don't diagnose, psychiatists do.
  - nothercastle 2y ago
    That is incorrect. Some do just depends on qualifications
- theogravity 2y ago
  Psychiatrists / neurologists do the diagnosis. I'm not sure about a financial incentive, or at least in Kaiser's case. It would mean they'd have to cover that person's therapy possibly indefinitely which isn't much of an incentive. They're more incentivized to not diagnose with a condition. I was considered not bi-polar and do not have ADHD by a psychiatrist and thus I couldn't get therapy covered.
  - MichaelZuo 2y ago
    There’s an even deeper problem, which is that insurance as a system simply doesn’t make sense for things that are not rare or that affect a sizable fraction of population If it’s that common, then there’s no need for a large bureaucracy of actuaries, accountants, agents, etc…, in the middle or to serve as your intermediaries. And a single paperwork error every five years, causing you to spend a few hours sorting it out, would more than outweigh all the tiny advantages that might theoretically benefit the customer.
    - jeremywho 2y ago
      This has been my view for a while. Basically health-care != health-insurance. People I've talked to can't quite to wrap their heads around that idea. Not sure why.
    - margalabargala 2y ago
      > might theoretically benefit the customer. As with any for-profit business, benefit to the customer is not a goal in and of itself, but rather an incidental side-effect of obtaining money from the customer, in that it is how the customer is convinced to give up their money. I would caution against assuming systems such as what you described are intended to help the customer. It sounds like instead, it is intended to help the company, by causing you to have to spend your (not their) time and potentially miss an appointment, saving the insurance company money. After all, what are you going to do, leave your employer for another one with a different insurance company over an insurance paperwork headache?
- someuser2345 2y ago
  Isn't that true of all doctors?
- resoluteteeth 2y ago
  > It sounds like there’s a financial incentive for therapists to diagnose patients with conditions they may or may not have…big yikes I think you might be thinking about this the wrong way. It's not like therapists want to diagnose people with conditions to scam them out of money (which I suspect might be what you're thinking), it's that insurance companies require there to be some specific mental health issue to be willing to cover therapy, so therapists have to come up with some acceptable reason to give to the insurance company. Insurance companies may accept "adjustment disorder" (which is just basically having trouble adjusting to a life change) for a certain amount of time, but will often want something else eventually, which can just be something like depression or anxiety. In some sense this means that therapists technically have to "diagnose" something (as in write it down as a possible diagnosis) to bill insurance but usually people are having some sort of issue if they are seeking therapy so it's probably often just a matter of determining what fits. Arguably maybe it would be better for insurance to cover therapy even without a specific diagnosis, but in any case, having to write down "depression" or something on a form for the insurance company doesn't mean that they're necessarily telling everyone that they have some sort of serious mental condition or need to get on psychotropic drugs (not that therapists who aren't psychiatrists can prescribe those anyway). Therapists aren't running around diagnosing people who aren't interested in therapy with bipolar or something to get them to hand over their money or to scam insurance companies.
francisofascii 2y ago
Also be careful about working to get a diagnosis, because then you risk paying higher life insurance premiums or being denied coverage.
e40 2y ago
I know three people who got therapy from Kaiser without a DSM diagnosis. It's not easy, but the key is to tell them you require therapy for something. The tricky part is to walk the line somewhere between "I'm really OK" and "I'm approaching suicidal" ... there is a lot in that range and if you're near the former they won't approve it. What you have to do is ask your PCP for a referral. You'll get a call from a therapist to screen you. You need to convince this person you need therapy. If you need further help, my email is in my profile.
- theogravity 2y ago
  I've unfortunately been through that dance three times already with my Kaiser PCP, Kaiser therapists (via intake survey) and a Kaiser neurologist. There's enough history with my interactions for them to say don't cover.
  - e40 2y ago
    Sorry to hear that. You can change your PCP anytime, but you can't change the history on their side. I'm not sure how long they keep it, there's probably some law which governs it. I will say that a family member decided to go outside of Kaiser for therapy because the work to get the official referral was just too onerous. I will mention the website they used: helloalma.com -- I have no affiliation with them. The nice thing about it: you can get a few free consultations with therapists after looking at their profiles, just to vet them. The family member was happy with that process and got someone that helps. Also, they list their "out of network" price and at my urging the family member negotiated the rate to be at the low end of the scale ($110/hr). There are many that list their hour rate in the range of $80-240. Good luck.

lukevp 2y ago

Do you have access to an employee assistance program through work? We have made use of the therapy multiple times and it’s been great. Totally free, 8 sessions per person per incident. You can kick off another set of sessions if there’s another incident you need to discuss. It’s not a long term solution but it’s good to fill in the gaps and get you seen soon.

theogravity 2y ago
I haven't thought about it at all. I'll definitely check it out, thanks!
theogravity 2y ago
Update: Trinet does provide this service. Thanks so much for letting me know about it.

theoreticalmal 2y ago

It sounds like there’s a financial incentive for therapists to diagnose patients with conditions they may or may not have…big yikes

KptMarchewa 2y ago
Therapists don't diagnose, psychiatists do.
- nothercastle 2y ago
  That is incorrect. Some do just depends on qualifications
theogravity 2y ago
Psychiatrists / neurologists do the diagnosis. I'm not sure about a financial incentive, or at least in Kaiser's case. It would mean they'd have to cover that person's therapy possibly indefinitely which isn't much of an incentive. They're more incentivized to not diagnose with a condition. I was considered not bi-polar and do not have ADHD by a psychiatrist and thus I couldn't get therapy covered.
- MichaelZuo 2y ago
  There’s an even deeper problem, which is that insurance as a system simply doesn’t make sense for things that are not rare or that affect a sizable fraction of population If it’s that common, then there’s no need for a large bureaucracy of actuaries, accountants, agents, etc…, in the middle or to serve as your intermediaries. And a single paperwork error every five years, causing you to spend a few hours sorting it out, would more than outweigh all the tiny advantages that might theoretically benefit the customer.
  - jeremywho 2y ago
    This has been my view for a while. Basically health-care != health-insurance. People I've talked to can't quite to wrap their heads around that idea. Not sure why.
  - margalabargala 2y ago
    > might theoretically benefit the customer. As with any for-profit business, benefit to the customer is not a goal in and of itself, but rather an incidental side-effect of obtaining money from the customer, in that it is how the customer is convinced to give up their money. I would caution against assuming systems such as what you described are intended to help the customer. It sounds like instead, it is intended to help the company, by causing you to have to spend your (not their) time and potentially miss an appointment, saving the insurance company money. After all, what are you going to do, leave your employer for another one with a different insurance company over an insurance paperwork headache?
someuser2345 2y ago
Isn't that true of all doctors?
resoluteteeth 2y ago
> It sounds like there’s a financial incentive for therapists to diagnose patients with conditions they may or may not have…big yikes I think you might be thinking about this the wrong way. It's not like therapists want to diagnose people with conditions to scam them out of money (which I suspect might be what you're thinking), it's that insurance companies require there to be some specific mental health issue to be willing to cover therapy, so therapists have to come up with some acceptable reason to give to the insurance company. Insurance companies may accept "adjustment disorder" (which is just basically having trouble adjusting to a life change) for a certain amount of time, but will often want something else eventually, which can just be something like depression or anxiety. In some sense this means that therapists technically have to "diagnose" something (as in write it down as a possible diagnosis) to bill insurance but usually people are having some sort of issue if they are seeking therapy so it's probably often just a matter of determining what fits. Arguably maybe it would be better for insurance to cover therapy even without a specific diagnosis, but in any case, having to write down "depression" or something on a form for the insurance company doesn't mean that they're necessarily telling everyone that they have some sort of serious mental condition or need to get on psychotropic drugs (not that therapists who aren't psychiatrists can prescribe those anyway). Therapists aren't running around diagnosing people who aren't interested in therapy with bipolar or something to get them to hand over their money or to scam insurance companies.

francisofascii 2y ago

Also be careful about working to get a diagnosis, because then you risk paying higher life insurance premiums or being denied coverage.

e40 2y ago

I know three people who got therapy from Kaiser without a DSM diagnosis. It's not easy, but the key is to tell them you require therapy for something. The tricky part is to walk the line somewhere between "I'm really OK" and "I'm approaching suicidal" ... there is a lot in that range and if you're near the former they won't approve it. What you have to do is ask your PCP for a referral. You'll get a call from a therapist to screen you. You need to convince this person you need therapy. If you need further help, my email is in my profile.

theogravity 2y ago
I've unfortunately been through that dance three times already with my Kaiser PCP, Kaiser therapists (via intake survey) and a Kaiser neurologist. There's enough history with my interactions for them to say don't cover.
- e40 2y ago
  Sorry to hear that. You can change your PCP anytime, but you can't change the history on their side. I'm not sure how long they keep it, there's probably some law which governs it. I will say that a family member decided to go outside of Kaiser for therapy because the work to get the official referral was just too onerous. I will mention the website they used: helloalma.com -- I have no affiliation with them. The nice thing about it: you can get a few free consultations with therapists after looking at their profiles, just to vet them. The family member was happy with that process and got someone that helps. Also, they list their "out of network" price and at my urging the family member negotiated the rate to be at the low end of the scale ($110/hr). There are many that list their hour rate in the range of $80-240. Good luck.