How Insurance Inhibits Good Therapy

by | Mar 10, 2011 | Therapy

The reason I do no accept insurance reimbursements is because I think that is what is best for my clients. I do get out of some paperwork this way, but I also lose some potential clients. Funded by insurance is pretty marketable for a therapist. Americans love getting things for free (although everything has a cost), so I can understand the appeal. I would probably make more money, even if my caseload remained the same. Although insurance does not pay practitioners market value for services, currently my sliding-fee scale (meaning what you pay is based on your income) goes as low as $25 per hour. It is not uncommon for clients to tell me that what they pay based on my scale is less than their co-pay.


Insurance requires Diagnosis

Everyone can improve their life (yes,this includes me), but not everyone needs a diagnosis. Counseling can be helpful to necessary when a parent dies or after a divorce, for example; yet, unless you are crying all day, making major mistakes at work, losing weight, etc. you will not qualify for a DSM diagnosis, which is required for insurance to fund treatment. Even if you might qualify for a diagnosis, it is not always necessary or helpful. 
Diagnosis is used as a quick explanation to communicate between health care providers regarding a cluster of symptoms and proper treatment for the condition. However, in counseling, much of the time, proper treatment and therapy is determined and executed between client and therapist solely without the involvement of other health care providers. You and your life story are bigger than the shorthand that diagnoses can provide. I want to work with individual clients not vague diagnostic criteria.
There is danger in allowing yourself to be diagnosed as well, at least in the current insurance system. 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. What diagnosis do you really want to be a part of your permanent record, especially if it is not a permanent problem? A lesser danger in diagnosis is how it may alter your perception of your own abilities and self-worth.


Insurance Directs Treatment

Beyond the dangers of diagnoses, insurance companies often try to direct treatment, rather than allowing the goals and needs of the client to direct the process. My experience has been that insurance companies seem to have flow charts to direct the path of treatment of each diagnosis, rather than contemplating each individual situation or consulting the expertise of the mental health professional. If flow charts really worked, most of the answers needed should already be in the self-help section of a bookstore.
People are complicated and messy and fascinating and wonderful. What works for one client may not for another. To be a good therapist, I must meet each client where he or she is currently, know where he or she would like to be, and learn about all those things that make him or her unique. My education and experience aid me, but they will only aid my clients if I can explain it in light of the personal experience of that individual client.
Not accepting insurance reimbursements also allows me to spend more time focused on the needs of my clients and less time on paperwork. I can see more clients in a week because the payor is not requiring additional work outside of the therapeutic hour. I am also able to schedule 90 minute appointments which have been much more productive for me in working with couples. It is important to me to always allow some flex in my schedule to fit in urgent counseling needs.
I have been paneled with several insurance companies in the past, and clients are always welcome to apply for direct reimbursement from their insurance company. For now, I will discount treatment based on income, because that is what I believe will be best for my clients. To find out where you fall on my sliding-fee scale, please contact me with your adjusted gross income from the most recent tax year. 
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