Why I Don’t Take Insurance
Why I Don’t Take Insurance
Many people often wonder why some therapists don’t accept health insurance plans. Having been asked this as a clinician on numerous occasions, I thought it might be informative to outline my reasoning on the matter.
My highest priority is the health and wellbeing of my patients. In order to follow through with this, I must be able to provide consistent care in a way that aligns with my core values and my therapeutic philosophy about mental health care management. Here are the top 3 reasons why I don’t accept any insurance plans.
Insurance companies require that you diagnose a patient immediately in order to qualify them for coverage.
I like to steer clear of labels in general and I don’t believe a diagnosis is necessary to begin treatment. I do not work with prospective patients who are at high risk for suicide or violence or have severe symptoms, so there is no reason for me to “diagnose” someone unless a particular patient would like me to share such clinical feedback. Often times, it is impossible to get the background and historical health information needed to diagnose within the first session. By demanding a diagnosis, the insurance system excludes clinicians who choose to take a depth psychology approach and work psycho-dynamically with patients. These more classical therapeutic approaches utilize interventions that don’t require a diagnosis for treatment and typically require many sessions. During these sessions, the therapist and patient take a dive deep into a patient’s life, including their childhood, their family of origin and its impact on attachment issues, and their history of trauma or setbacks. Together, the clinician and client can explore conscious and unconscious patterns that are affecting an individual and preventing them from achieving the life they desire.
I believe that treating the whole person is necessary to achieve optimum mental health. Simply looking at symptoms to diagnose a patient will not provide lasting results. A diagnosis also stays on a patient’s health record indefinitely. Many patients do not realize this and it should be kept in mind for patients that value privacy or have a high profile, high-security clearance jobs.
Insurance companies often limit the number of sessions allocated to each client.
This goes against my vow to offer my patients continuity of care. This also puts some therapists in the awkward position of having to transfer out or “abandon” their patients after only a few weeks or months of therapy.
Insurance rate reimbursement to therapists is sadly, very low. If I had a full caseload of insurance patients I wouldn’t be able to live, let alone maintain a private practice.
I’ve had clients tell me, “I pay so much for my health insurance—I REALLY need to use it for therapy.” Unfortunately, managed care in the United States does not compensate licensed therapists in a way that is sustainable for our field or our livelihoods. Insurance company’s pay out rates can be appallingly low and so a therapist is often ‘losing money’ by seeing insurance patients. Therapists are not like other healthcare workers such as MDs who can cycle through 10 patients in one hour. We can see only see one patient in one hour. We have limited hours and limited patient slots available each week. I own and operate a small practice and see less than 20 clients per week. I also do not hold another clinical position as some other therapists do, such as chairing a mental health non-profit or teaching at a local university
Clinicians who accept insurance must also devout additional unpaid hours to processing and submitting claims and these hours add up quickly. Many group practices are able to accept insurance because they have hired an administrator to deal with their billing and/or have hired intern therapists (now referred to as “Associates”), which keeps their employee costs lower. This isn’t meant to bash individuals who use insurance for therapy or to bash therapists who accept insurance plans. There are some PPO plans that compensate at a higher rate, but I have found those to be rare in my practice. Every clinician reserves the right to practice how they see fit.