Counseling Using Your Military Benefits
How to Navigate Insurance, and Other Behavioral Health Options
The decision to get help is hard enough. Add to that the stress of figuring out where to get it and how to use your benefits and it's enough to shut down any level of motivation. With such a stigma in the military for receiving help, we wanted you to know what your benefits are and how you can get the help you need.
In the military, there are several options for finding help. Here we are going to discuss some of those options as well as some of the fears that are common in the military, confidentiality, and what you can expect in the process. Of course, options, insurance plans, and your family's specific needs can vary- so always check with your insurance carrier in your area for details.
A Valid Concern: Confidentiality and Active Duty
Soldiers are often dissuaded from going to counseling because of a valid fear that they will not have confidentiality. Often required to get help from on-post Behavioral Health, they are typically afraid that they will be labeled "unfit for duty" and Command will find out they are getting help. If an active duty soldier is suicidal and finding it difficult to function or perform their duties, chaplains and behavioral health will be set up on their behalf in order to provide the help they need during a time of crisis. But when a soldier is struggling with personal or familial issues, they often do not have the correct information to feel safe about getting help privately outside work's knowledge.
It is important to note that true confidentiality, in it's strictest sense, can be found from a soldier's chaplain. Not held to the standard of reporting abuse or harm to self like licensed professionals are, chaplains can provide a level of confidentiality even from command. Of course, chaplains (much like licensed professionals) know that being a secret keeper of dangerous information can be to the detriment of the soldier, and will often work with them to make a plan for safety and getting additional help that is needed.
Getting on-post help within behavioral health, or even in-theater, does indeed have limits to confidentiality. While therapy may be free and provided to a soldier through counselors, psychologists, and physicians within the military, they are obligated like any other professional to report threat of harm to self or others and abuse to minors and elderly. On-post or in-theater confidentilaity may be broken if that professional feels a soldier is "unfit for duty" and must provide the referral needed to help that soldier, including possibly explaining to command why they must be taken off the mission or off duty to receive those services. The desire, of course, is to help the soldier and get them back on duty when they are able to focus on the mission. This is where the stigma has developed that "a soldier cannot get help for fear of losing their job." It is an understandable fear and this works for when a soldier is struggling to the point that they would not be able to keep their mind on the mission, much less protect their buddy. In other situations, though, the system can make soldiers feel uncomfortable about getting help if they feel out of control of their confidentiality.
In order to get help off-post from a civilian provider, soldiers must get a referral from their primary doctor or be cleared for receiving off-post services. This can often involve some red tape if the issue is not urgent. Waiting lists for on-post help can complicate the situation and delay help to an urgent (real of perceived) need.
Tricare or Military One-Source?
Both options have it's advantages. In using Tricare, an active duty soldier must be referred by a primary physician to use Tricare and use an off-post Tricare provider. Although there is some minimal initial screening and questions about what the individual is dealing with, detailed information is not likely collected in the process. Active duty soldiers do not pay for counseling services when Tricare benefits are utilized. Tricare provides at least 8 sessions to the soldier and more can be requested if needed. Tricare will cover minor adjustment issues (work stress, marital disagreements, etc) as well as more major issues (Depression, PTSD, Bi-Polar, Psychological assessments, etc). Tricare is the way to go if you have ever been diagnosed with a mental disorder or think you may have PTSD, or other diagnosable issue.
When a provider bills Tricare for sessions, no details of the session are released. Information like the legnth of session is provided for billing, as well as a diagnosis and is all that the provider needs to report.
Military One Source is a great benefit for those who want quick off-post help without the red tape of getting cleared from on-post behavioral health. The provider must be contracted with Military One Source. Usually a thorough phone screening is done with the soldier or family member with a MOS representative to find what the presenting issues are in order to evaluate if MOS is the right for that individual. The important thing to note when considering MOS, is that MOS will not refer an individual to a provider if he or she has a diagnosable disorder. MOS provides 12 sessions, per issue, and issues must be minor adjustment types of issues. At the end of those 12 sessions, the provider must refer the client to another provider for further therapy. At the end of each session, the provider is required to send a document that outlines the presenting problem, whether or not the assessment of self-harm and substance abuse has been discussed, as well as how the therapist and client are making progress on the issue. Many feel this threatens confidentiality in that MOS is a DOD run program. This is a valid fear as the question rises "Who is privey to this information?". MOS also requires a provider to report domestic violence, whereas other insurance companies and the law in some states do not. It is also important to note that mental health providers are obligated to work in the best interest of their client while following laws and state rules and will usually work with and empower their client rather than surprising them or making a decision without discussing it with them first.
What about my spouse and family?
All dependents have access to MOS services as well as Tricare benefits. Of course you are encouraged to call your insurance carrier to go over specific details on your plan, but we have found that a referral is not needed to see a mental health provider. If your provider is contracted with Tricare, they will bill and send necesarry paperwork to get you started. You can go to the Tricare website and look up participating providers in your area as well as see more details on your plan. Retirees and veterans can expect a minimal co-pay for services. Private pay is also a way to have more control of who you choose to see, but is obviously more costly. Most clinicians have moved to private fee work and often use a sliding scale to make it more affordable. They often decide that contracting with the insurace company is difficult and time consuming.
When it comes to marriage help, I have found that getting counseling through your dependent spouse as the client can eliminate the red tape of getting off-post help and avoiding MOS. Having your spouse be the client on whom your provider keeps records enables you to quickly make an appointment without a referral, utilize your benefits and begin working on your marriage.
Of course these are just ideas, please contact your provider, physician, and insurance company for more information or how your circumstances may differ.