One common question I hear from prospective clients is “Do you accept insurance?” Or I see posts in therapist-only groups asking for someone who takes X insurance on Y side of town and has appointments at a certain time. Sadly, I see too many people choose a therapist based on insurance coverage rather than experience and expertise. There are four main reasons I do not accept insurance:
Dangers of Diagnosis
Under the Affordable Care Act (ACA) or Obamacare, health insurance plans were required to cover mental health conditions. Many prospective clients wish to utilize those benefits without considering the hidden costs. A diagnosis is required by insurance companies to fund treatment. Even if you qualify for a diagnosis it is not always necessary, and it can be detrimental. A diagnosis helps healthcare providers quickly understand a cluster of symptoms and proper treatment, but those undergoing counseling don’t often bring other providers into the mix. When a client chooses to see a psychiatrist or medical doctor for medications, that professional will do his or her own assessment and rarely ask for my input even if I have been seeing someone for quite a while. A diagnosis of Major Depressive Disorder has been known to make it difficult to impossible to obtain life insurance, even when the diagnosis is more than a decade old. While Obamacare allows for coverage of pre-existing conditions, new legislation may not, so you may be denied coverage for further treatment. If the Affordable Care Act truly does go through Repeal and Replace, there may be even more costs beyond increased life insurance premiums. Now those same diagnoses that seemed to make counseling more affordable, could increase your medical insurance premiums, costing you more each month. The list of pre-existing conditions considered for American Health Care Act also known as Trumpcare include the most commonly used diagnoses in counseling, including anxiety, depression, ADHD, addictions, etc.
Insurance companies set limits on treatment, rather than considering an individual’s situation and needs. Years ago when I worked in a community mental health center that did accept insurance, I had to literally argue with an insurance company that was trying to require a specific type of counseling that could have been traumatic to the child with whom I was working. We are all complicated, messy, and fascinating which is one of the reasons I love what I do. It is also the reason I am aware that each client is their own case, and I will work to address their unique challenge or situation in the treatment and timetable that brings results for them.
More Time With Clients
A therapeutic hour typically is a 50-minute hour. The left over ten minutes is not enough time for the therapist to complete the notes required by the insurance company and submit the forms requesting reimbursement. By not filing insurance claims, I have more time available per week to see clients, answer their emails, meet with other professionals who may be helpful to my clients in times of crisis, and yes, I work on my books. It also affords me the flexibility in scheduling extra time, such as 90 minute appointments, or fit in an urgent counseling need. I utilize a full hour (or 90 minutes) for appointments.
Ethics & Honesty
Beyond the hidden costs of adding a diagnosis to your permanent medical record, I find it unethical to give a diagnosis to someone who does not qualify for a diagnosis simply so the insurance company will fund counseling. Most insurance companies will not fund marital counseling for couples. To receive reimbursement from the insurance company some therapists will identify one partner as the client and report a diagnosis for him or her and bill for family therapy with the patient present. I am not interested in working the system. I want to spend my energy working with my clients.
More than ever, I believe not accepting insurance reimbursements better serves my clients and allows me to provide services to a wider range of clients regardless of their coverage. Many are surprised to learn that seeking treatment without insurance reimbursement or paying “out of pocket” is affordable and allows for greater flexibility in terms of treatment schedules and length of care. My clients are always welcome to apply for direct reimbursement from their insurance company for out of network benefits. I accept payments via cash, checks, credit cards, and HSA (health savings account), and I offer a fee reduction based on household income, as well as the opportunity to work with interns under my supervision. The most current Fee Reduction Contract and sliding scale can be found here. It is also possible to deduct medical expenses, including counseling, from your taxes.
Regardless of the future of the health insurance structure, your best possible option may be direct pay. It allows you to be in control of frequency, length of treatment, and selecting the best provider for you.