Why don’t I take insurance?
Contrary to popular belief, many therapists want to take insurance. We get into the profession of therapy with the main goal to help improve people’s lives. But the reduced rates, extensive paperwork, and rigid restrictions that are imposed on therapists by the insurance companies has pushed many of the most talented therapists away from working on insurance panels. Below are the main reasons why I no longer take insurance:
Required Mental Illness Diagnosis
One of the main reasons that therapists decline the use of insurance is that insurance companies typically only cover services that are declared as a “medical necessity”. In other words, your therapist is required to diagnose you with a mental illness in order for the services to qualify for coverage under insurance.
With the ups and downs in life that many people go through every day, many people seek mental health treatment for reasons that are not defined by a specific mental health disorder. If the reason that you are seeking a therapist is not a diagnosable disorder, then it can be quite difficult to get your insurance to cover the sessions.
Being that many people go to therapy to repair relationships, recover from a traumatic experience, or just generally to improve their lives, finding a medical diagnosis is often not applicable. As frustrating as this can be for clients, it would be unethical for a therapist to diagnose someone with a mental illness that they don’t really have, just for the sake of using insurance and doing so can result in the therapist losing their license.
Even providing “superbills” for out-of-network reimbursement requires that your therapist diagnose you with a mental illness. It also requires training in insurance coding and billing, which most therapists don’t have (I certainly do not).
Documented Sessions & Lack of Confidentiality
Another reason that therapists are hesitant to accept insurance from their clients is due to the fact that any documented health treatment filed through your insurance is required to be recorded on your permanent medical record.
In addition to your treatment being permanently filed, health insurance companies have access to the type of treatment that you receive and what your progress has been. They can also mandate what type of treatment your therapist provides you. Any details and private information that your therapist has, your insurance company would have. If an insurance company decides to do an audit on your records in an attempt to deny a claim, they would have access to details about what happened during each of your therapy sessions and other private details that patients would normally prefer to be left confidential. Using health insurance to receive mental health care opens a floodgate of your personal information to anyone who has access to your account at your insurance company.
Also, when such a mental health diagnosis is filed on your record, it is considered a pre-existing condition. In the future, this could potentially increase the costs of your insurance or prevent you from getting coverage altogether. When thinking about your mental health care in the long-term, this is a major factor that should be taken into consideration.
Lack of Specialty Care
Even if you find a therapist through your insurance, it often won’t be someone who specializes in your area of need.
When a therapist signs a contract with an insurance company, they are required to provide services for any and all patients that request to book a session. This means that if you would like to see a therapist for anxiety, you may instead be stuck with a therapist who specializes in couples and families, simply because that’s what your insurance company has to offer.
I am not a “one size fits all” therapist and you are not a “one size fits all” client. It would be unethical for me to see clients dealing with issues outside the scope of my specialties and trainings just because their insurance company says I have to.
Client Benefits of Private Pay for Mental Health Services
You choose the therapist best suited to your needs rather than the insurance company telling you who to see.
Expansion of mental health providers in your area that specialize in the services you need.
Flexible scheduling and availability
No insurance equals less documentation. This results in more quality time to focus on therapy.
If your therapist is in network for your insurance and you choose to pay private pay, rates are reduced to match that insurance rate.
Mental health diagnosis is not mandatory and not submitted to your private health records.
More services are allowed without restrictions such as online counseling and tele-counseling.
No limit on amount of sessions or time of your session.
You are guaranteed privacy and confidentiality.
Stigma of some diagnoses can often be avoided.
Private pay clients are able to choose the focus, duration, and frequency of therapy. You are even allowed to choose the length of sessions.
Research shows that clients who have to pay something for their treatment have more positive outcomes that those who receive free treatment.
Sliding scale rates can be offered to clients paying private pay. This means that privately paying clients can actually pay less than those who pay with insurance.
You won’t be labeled with a mental health diagnosis unless you request this type of assessment.
Insurance premiums and life insurance policies will not increase based on mental health diagnosis and treatments.
You won’t have to worry that your health records may create problems for you in the future.
You will be able to stay with your therapist even if your insurance plan coverage changes.