Navigating the Intersection of Work and Mental Health

Working Better and Stressing Less

Ideas on work and mental health

Is career counseling billable to insurance?

The short answer is, "sometimes." Coverage for any condition through medical insurance hinges on the idea of "medical necessity." So generally, counseling is covered so long as it is providing an evidence-based service designed to treat a diagnosis. 

If you need help with your resume, that is not a medical diagnosis. If you want another job because you're kind of bored at your current one, that is not a medical diagnosis. However if you're super stressed out and sound like the definition below, you probably DO have a medical diagnosis. 

" Emotional or behavioral symptoms develop in response to an identifiable stressor or stressors within 3 months of the onset of the stressor(s) plus either or both of (1) marked distress that is out of proportion to the severity or intensity of the stressor, even when external context and cultural factors that might influence symptom severity and presentation are taken into account and/or (2) significant impairment in social, occupational, or other areas of functioning.

The stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder. The symptoms do not represent normal bereavement. After the termination of the stressor (or its consequences), the symptoms persist for no longer than an additional 6 months." - DSM V Definition of Adjustment Disorder

If you have a medical diagnosis, it is LIKELY (but not certain) that your medical insurance will consider counseling a covered expense. So if your job is creating significant stress in your life and you are having clinically relevant symptoms in response to that stress, your insurance may cover counseling that focuses on helping you cope with and improve functioning with that stress. Also, if you already have a mental health diagnosis and your work is exacerbating your symptoms, career counseling can likely be covered by insurance IF it helps improve your functioning with your mental health diagnosis. 

You're not entitled to insurance coverage if it's not medical necessity

Here's where things can get awkward: Sometimes I'm contacted by folks who want to use their medical insurance for career counseling but who don't actually have a medical diagnosis. I always feel a little bit bad explaining that I cannot in good faith, bill an insurance company for a service that is not medically necessary. However, I'm also not willing to go to jail... so I have to explain to folks, at least once a month, that I cannot commit insurance fraud because it would be less expensive for the client. 

This is the challenge, I suppose, of being a practitioner who provides both medical services (mental health counseling) and consulting services. 

The good news for you, if you're currently looking into career counseling but are not highly distressed by your job situation, is that career counseling NOT secondary to a mental health concern like anxiety or depression, is often VERY FAST. Clients who present with career issues alone typically see me for six to 10 sessions. At my rates today, that's $600-$1,000 in total. That's not cheap - but it's not like a hospital visit. 

So even though your medical insurance may not cover career counseling, it's not the worst type of "non-covered service" to have to pay out of pocket for. 


Katie PlayfairComment