Insurance & Diagnoses

I, like you, don’t like unpleasant surprises. The HAVEN Place is a fee for service agency and does not work with insurance companies for the broad reasons listed below. While The HAVEN Place does not accept insurance, we will provide information and assistance so you can file a claim for reimbursement with your insurance company.

Diagnosis and Stigma
I can provide psychiatric diagnoses based on psychiatry’s Diagnostic and Statistical Manual of Mental Disorders (DSM) if requested by you, but prefer to not provide psychiatric diagnoses for the reasons listed below:

  • The DSM focuses on “sickness” and problems. Our focus is on our clients’ personal growth, a renewed sense of enjoyment and purpose in life, autonomy, self-acceptance, and positive relations with others.
  • All the DSM-diagnoses are based on a medical model – what’s wrong with you – vs. a trauma-informed model – what’s happened to you.
  • The DSM explicitly states it ignores context, social environments, and human interactions in its diagnoses, which are often the root cause of emotional or behavioral problems.
  • All DSM-diagnoses are categorical concepts; they are not physical illnesses or diseases but merely subjective opinions of what is normal or abnormal.
  • There are numerous physiological, nutritional, social, spiritual, relational, and environmental causes of psychiatric “symptoms.” These symptoms do not identify any specific “disorder” or “illness” but often point toward underlying causes that the DSM ignores.
  • There is extreme overlap between DSM-diagnoses which often results in multiple diagnoses. These multiple, overlapping diagnoses increase stigma and renders DSM-diagnoses largely meaningless and unhelpful to both clients and professionals.
  • The American Psychiatric Association itself, in their latest version – the DSM-5 – states their categorical diagnostic approach doesn’t work (Introduction, page 13), e.g., people and their problems are unique and don’t fit neatly into categorical niches.
  • The National Institute of Mental Health has publicly stated they are moving away from the DSM-categorical approach towards a brain-mapping/systemic approach as they say the DSM approach has failed.
  • Over the past 40 years the field of psychiatry has failed to identify a single marker or gene that is useful in making a diagnosis of a major psychiatric disorder or for predicting response to psychiatric medications.
  • Psychiatry and pharmacy companies commonly promote the idea of “chemical imbalances,” focusing on only a handful of neurotransmitters (serotonin, dopamine, GABA, epinephrine, norepinephrine, etc.). No one knows the “ideal” or “normal” level of over 100 identified neurotransmitters within the human body, let alone at discrete points within the brain. The technology to measure such “imbalances” in the human body or at discrete points within the brain has never existed.
  • Managed Care Companies (MCCs)/insurance companies typically cover only those services they deem “medically necessary.” This means that they require a DSM-diagnosis of mental illness for our clients in order to approve care. In many cases MCCs will not pay for trauma-informed or trauma-specific care but do demand a diagnosis of a purported mental illness when perhaps that’s not the issue at all.
  • DSM-diagnoses will remain in your medical record your entire life and may result in a variety of life-long legal, work, and social problems, regardless of your recovery.
  • DSM diagnoses cannot be refuted or challenged by clients as they are all based on subjective opinions of clinicians in an “expert” position. Clients’ attempts to refute or challenge a diagnosis is often assumed to be proof of that diagnosis and may result in yet another diagnosis.

Costs
I want to keep clients’ costs as low as I possibly can and do so by charging a flat fee for my various services. If I billed insurance companies (MCCs), which includes extensive time to secure authorization to provide treatment, I would have to recoup those associated labor costs from my clients. Further, agencies typically receive only a percentage of what they actually bill to MCCs which forces agencies to further raise their fees.

 Recovery
My focus is on my clients’ recovery. Ideally this means a return to their original or an improved level of functioning without medication or other artificial assistance. While this goal is not always achievable, time limits imposed by outside sources may and often do result in maintenance / stability (lifetime medication) versus actual recovery.

Conflicts of Interest
Ethically, I am bound to avoid potential conflicts of interest. My primary concern is for my clients’ well-being. Therapists, working under the constraints of a MCC, are sometimes put in the position of having to choose between what is in their own best interest with a MCC and what is in their clients’ best interest. I do not want to be put in that position. MCCs were created to “manage” and contain health care costs. Their bottom line is to reduce costs and not necessarily increase the quality of care or quality of life for clients.

Unexpected Bills
I’ve worked with MCCs in the past who approved clients for multiple sessions with minimal co-pays, only to surprise clients with very large and unexpected bills months later. Clients in those instances had to abruptly terminate treatment and pay the bill they received or lose all of their health insurance. We do not want to place our clients in this position.

Restricted Choice
MCCs often restrict what therapies are offered and how many sessions a client can receive, even if research shows MCC-approved therapies are ineffectual. Some problems in life, especially past trauma, may require more than a handful of visits to successfully resolve. Brief therapy meets the financial criteria of MCCs but may not afford clients the opportunity to get the information and therapy that they want and need. This may result in clients’ quality of care being compromised and their needs going unmet.

Professional Expertise
I believe that my clients should be able to access the full range of mental health professionals and available therapy according to their needs. MCCs often restrict the professionals that clients are allowed to work with, ­preferring to refer clients to therapists who have a record of providing short-term therapy rather than to other therapists who may provide better results or offer a different packaging of services.

 Contractual Limitations
I believe that my clients have the right to full disclosure of any arrangements, agreements, contracts, or restrictions between any third party and myself that could interfere with or impact their treatment. By disclosing this information to my clients MCCs may label my efforts as “Managed Care Unfriendly Behaviors” and take such actions as they deem fit. Typically, “violations” such as these can result in therapists being removed from MCCs’ provider panels or censured in other ways. The result can be serious disruption in clients’ therapy and recovery.

Medication
Research has consistently shown that medication for mood problems is most effective when combined with psychotherapy. Nevertheless, MCCs frequently approve only medication for their members rather than permitting them to also work with a therapist. Again, the appearance is that of being more concerned about money rather than clients’ needs and actual recovery.

Privacy / Confidentiality
By contracting with MCCs, it is likely that I would be required to share my clients’ deeply personal information with gatekeepers and utilization review professionals; potentially allowing dozens of others to have access to clients’ personal information.

Time
MCCs require therapists to justify and convince utilization review professionals before treatment is approved or continued. This is expensive and time consuming for the therapist. Its also time consuming for the client who is required to continue his or her therapy in “fits and starts.”