How much do you have to suffer before your insurance cares?

Or How sick do you have to be to get any help around here?

For anyone who has worked in the mental health industry, the usage of the term consumer as opposed to patient or client is nothing new. Paul Krugman recently brought it up here.

The real surprise is how badly these consumers are handled by the managed care system of today’s health care behemoths. If you are fortunate enough to be insured AND have a mental health component to your benefit, you may be very surprised that according to the penny pinchers, you are not eligible for mental health counseling. At least the kind that your health insurance will pay for.

If you didn’t know, the DSM IV is the diagnostic guide book that all mental health professionals use to categorize the various forms of mental illness out there. To be eligible for covered mental health services, you have to have a listed diagnosis—and it usually has to be serious. Like Major Depression Disorder, Severe with Psychotic Features (296.23), Or Generalized Anxiety Disorder (300.02), or Bipolar 1 Disorder, Single Manic Episode, in Full Remission (296.06). Confusing and spooky, yeah?

But what about an individual who is just feeling down, or experiencing grief and loss, or is one of the many victims of the terrible job market and economy? There is a diagnostic code for grief, called Bereavement (V62.82), but it is full of warnings about what is and what is not normal signs of grieving. Because surely, if the experts on the committee of the DSM can tell us all what real grief does and doesn’t look like, we should just bow down to their inestimable wisdom, yes? I don’t think so.

So, back to a regular Joe or Jane who just wants to work on communication issues, or maybe they are struggling with more, shall we say, existential concerns. The first meeting, or evaluation, you will have with your managed health care system (sometimes this will be over the phone) is going to be filled with a lot of questions meant to narrow down what specific DSM code diagnosis you are eligible for. And if you don’t fit into those prescribed diagnoses, you will most likely be determined to be, “not suffering enough to benefit from counseling.” There is a diagnosis, a catch-all, that is meant to help with this terrible situation: Adjust Disorder, unspecified (309.9). But Adjustment disorder is just not as sexy of a diagnosis as Schizoaffective Disorder (295.70) or Oppositional Defiant Disorder (313-13) these days, and it rarely will get much love from the health care industry.

As an experienced mental health counselor offering services specifically to the uninsured, or those fed up with their health care insurance, I can talk with you for hours about the DSM—pro and con. But I will treat you like a human being, not a diagnostic code number in a big, thick book full of a lot of politics and bureaucracy. And probably for less money out of pocket.

About Therapyisdandy

A dandy therapist
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