What do I need to know about insurance coverage?


Most clients are surprised when they learn the details of this tricky topic. It may not work the way you expect, so let me explain.

Insurers who provide coverage for psychological services typically have a limit or cap on the annual amount available, following which a co-pay percentage reduces the money-back by another 10-20%. They also typically insure just those practitioners who have at least a Masters degree in psychology … professionals who also typically charge 20-50% more for their services than counsellors (therapeutic or otherwise). Let me give you a typical example:

A psychologist charges $150/session and you require 12 sessions (a typical minimum for most clients). Your insurer, who has a 20% co-pay policy, covers these services at 80%, to a cap of $600. Your first 5 sessions will cost you $750, following which you will receive 80% from your insurer … or $600 … so your first 5 sessions have cost you only $150. Since you have reached your annual limit, the remaining 7 sessions will cost you $1050, with no reimbursement. The total cost to you for the 12 sessions will be $1200.

An Accredited Counsellor, like myself, charges $75/session. Your 12 sessions will cost you $900. This is $300 less than with a psychologist. If more than 12 sessions are required then your costs increase more rapidly.

You might think, “I’ll just switch to a cheaper counsellor after my first 5 sessions.” However, that would never be recommended for a couple of reasons:

1) a client-counsellor relationship takes time to establish to be effective and starting over with a new professional would likely mean that 12 sessions would not be adequate to complete the work;

2) psychologists are trained to provide help that is often beyond the scope of counsellors, so your initial choice of professional is very important, depending on the type of help you require.

Therefore, if costs are a factor for you, before choosing the professional you will see, make sure you know what type of service you need and make sure you know the details of your insurance coverage.

I am a member of the Association of Cooperative Counselling Therapists of Canada (http://acctcounsellor.com). We are currently in negotiations with the various insurers to provide coverage for the services of our professional counsellors who do not have at least a Masters degree in psychology.  In many cases, clients do not need the services of someone with an advanced degree, rather, they require the guidance of an accredited counsellor who will go on the journey with them to help them get back on track. Often times, beginning with a counsellor is a good start because if your needs are beyond their scope they will be able to determine this in the initial visit and they will recommend the level of service you actually require along with specific referrals.