Because we accept health insurance plans, one thing we have to consider is whether or not we're presented with something insurance companies consider "medically necessary" or maybe something else. It's a complicated question.
When you visit the pediatrician following a skateboarding accident, it's more straightforward. Is the arm broken? Let's put it in a cast, and insurance is almost certainly going to cover it. If your arm is sore, and the doctor can't find anything specifically wrong with it, it's more likely that treatment won't be covered, and you'll go home with directions to rest, ice, compress, and elevate. You might hear, "if that doesn't work in a week, call me back and we'll see about physical therapy."
At the Bloomington Center for Connection, we offer both medically necessary mental health services, and relational and family services. This doesn't mean we value one more over the other. Relational services are preventative, growth-fostering, and healing. They just don't require a medical diagnosis.
This post is to help you figure out which pathway fits your needs best. And of course, we're happy to talk this through over the phone, just reach out.
When therapy is medically necessary
Medical mental health services are usually appropriate when there is risk, impairment, or significant symptoms that require clinical treatment and monitoring. Simply put, something is interfering with your daily functioning.
Examples (definitely not a complete list! For this you should see a mental health professional, or your doctor) include:
- A child or teen who is
- Self-harming or talking about wanting to die
- Not eating, not sleeping, or too much of either/both
- Experiencing panic attacks or other physical symptoms of anxiety (racing heart, nausea before school, a feeling of being unable to catch a full breath)
- Changes in emotions-- suddenly more irritable, acting out in anger, frequent tearfulness
- Unusual behavior (for that person) such as dramatic change in school performance, dropping out of extracurriculars they used to enjoy, isolating and cutting themselves off from friends
- A family situation involving
- Immediate safety concerns
- Abuse or neglect
- Severe trauma reaction (avoidance, flashbacks, night terrors and more)
- Symptoms that
- Interfere with school, work, sleep, or daily functioning
- Require diagnosis, documentation, possible coordination with other providers (psychiatrists, pediatrician)
In these cases, insurance-covered therapy, psychiatric care, or crisis oriented services are often the right starting point.
Sometimes there are in-between situations. For example, a child has improved enough that they no longer qualify for a diagnosis of anxiety, but are benefitting from checking in with their therapist from time to time. Some plans cover these visits, provided the clinician documents benefits. Other plans require that therapists demonstrate continuous improvement in symptoms, something difficult to prove when symptoms have abated!
When something may not be medical, but could still benefit from services
Many families and individuals are struggling—not because someone is “ill,” but because life is hard, relationships are changing, or connection has frayed. Sometimes a caregiver is going through a health crisis that is impacting other family members. Everyone goes through developmental challenges as they mature. In the same way children sometimes gain extra weight before a physical growth spurt, sometimes they struggle with relationships before an emotional growth spurt.
Examples include:
- A child whose parents are divorcing
- A family in which one family member has a serious illness requiring extra attention and resources.
- A young adult feeling stuck, or unsure how to "launch" in the changing landscape.
- Families who
- Want to communicate better
- Feel disconnected from each other
- Are navigating transitions, grief, or difficult decisions
- Couples who want support strengthening connection, not fixing pathology
- Caregivers who want help navigating limits, communication, and supporting their family.
- Parents caught in the "sandwich" generation-- pulled between caring for their parents and their children.
All of these experiences are impactful, painful, and deserving of support. They just might not qualify for a medical diagnosis.
What we offer beyond medical therapy
Our non-medical services focus on:
- Strengthening relationships (this helps everyone involved!)
- Supporting healthy development
- Building strong connections both inside and outside the family
- Helping families and individuals navigate life transitions
These services:
- Are not billed to insurance
- Do not require a diagnosis
- Will not appear on anyone's medical record
- Are often more flexible and creative (and fun)
- Can be short-term, preventative, or exploratory
Examples include:
- Family play and connection sessions
- Relational intensives
- Values clarification and future-planning for teens and emerging adults
- Sand tray and expressive experiences
- Using games to expand understanding and resilience
- Communication and play challenges for couples and families.
Helping you figure it out
Many people don't know if what they're seeing is a mental health crisis, a reaction to stress, a family rough patch, or a moment when relational support could make all the difference. You don't have to figure it out alone. We're happy to talk with you and help you decide what level of care fits, whether that means providing you with a referral for intensive care, providing clinical therapy, or supporting your journey through relational growth.
Sometimes the answer is "start relational and see." Sometimes it's "this needs clinical support right now." Other times it's both, at different moments. We believe that healing happens through connection, no matter what we call it. Let us help you build the growth-fostering relationships to sustain you through challenging times.
One final note-- as the insurance landscape shifts around us, many families will find other reasons to opt out of using insurance unless absolutely necessary. Some insurance plans have deductibles that are high enough to make therapy prohibitively expensive, with families meeting their deductible (the point where insurance kicks in) when the year. is almost over. Other families may be considering purchasing disability or life insurance where pre-existing conditions can impact both access and affordability. As self-funded and smaller insurance plans develop, it's important to watch for changes in these regulations to protect yourself and your family.