Quick answer: You do not need an existing diagnosis to contact a therapist or ask for help. People seek therapy for stress, grief, relationship concerns and other difficulties. Whether a diagnosis is relevant depends on you and your situation, and your clinician will talk with you about it when it is. Insurance claims generally require a diagnosis code.
You don’t need to arrive with a diagnosis
People come to therapy for burnout, a breakup, a career decision, grief, or because they want to understand themselves better. You don’t have to know what to call your experience before reaching out. We begin by discussing what brings you in and what you hope will change, and you can go at your own pace.
How assessment and diagnosis fit in
Once we start working together, I take time to understand what you’re dealing with. I talk about diagnosis with a client only when it is clinically relevant, and that is decided case by case. If it comes up, I’ll explain what it means and how it is documented in your clinical record and on any billing paperwork.
Where insurance comes in
Insurance reimbursement for psychotherapy generally depends on your plan’s benefits, medical-necessity criteria and claim requirements, including a diagnosis code. A diagnosis code alone does not guarantee coverage or reimbursement.
- If you have insurance, you can still choose to pay privately. You would sign a form stating that you are opting out of using your insurance. Ask me how it works.
- If you receive a superbill for out-of-network care, you can decide whether to submit it to your insurer for possible reimbursement. A superbill lists the dates of service, service codes, a diagnosis code, my license information and the amount you paid. I provide superbills monthly.
Questions worth asking your insurer first
Before using out-of-network benefits, ask whether your plan covers outpatient telehealth psychotherapy, whether you have an out-of-network deductible, and what documentation is needed. You can also ask how claims information and explanations of benefits are shared with the policyholder.
Privacy and your records
Paying privately does not eliminate clinical records or the limits of confidentiality. Ask me what information I document and when it may be disclosed; I’m glad to walk you through it, and we go over the limits of confidentiality at the start of care. If you submit a superbill for reimbursement, your insurer receives the information on it, including a diagnosis code, and may request additional records to review the claim.
What I tell people who worry about this
You’re welcome to ask me anything about how I document my work, at any point.
Next step
If you’re weighing whether therapy is right for you, a free 15-minute consultation is a no-pressure place to ask these questions. You can also ask about current availability, session fees and payment options. Call (813) 906-9810 or send a message.
I work with adults and couples by secure telehealth who are physically located in Florida, Pennsylvania or California at the time of the session.
This article is general information, not medical or legal advice. If you are in crisis, call or text 988 or call 911.