I get it, it’s not easy finding a therapist. You’ve got to search for someone who is licensed, has experience treating your particular concern, and someone with whom you feel comfortable opening up about your pain. Many know the frustration of finding someone who checks all of these boxes, only to realize that they don’t take insurance. The truth is, roughly one third of therapists in this country do not accept insurance.
So what gives?
Why Many Therapists Don’t Accept Insurance
I receive a lot of questions around this topic and thought I would use a blog post as an opportunity to shed some light on this question. There are actually quite a few reasons why some therapists choose not to panel/ contract with insurance companies, and this is not an exhaustive list.
Low Reimbursement Rates
The average cost of an individual therapy session around the country is typically between $110 to $200. With insurance, you may have a copay of $25 – $60. You may assume your therapist will bill the insurance company and be reimbursed for the rest of the money. But often insurance companies will reimburse for half the amount or less! It can be quite difficult for a therapist to make an actual living wage with average reimbursement rate of $40-$60. If you use EAP (employee assistance program) those plans are most of the time copay free for you, and they pay therapists $30-$60 per session.
Hassles
Another deterrent for therapists is the hassle of interacting with insurance companies. As you can imagine, there are far more pleasant things to do with one’s time. Insurance companies often require therapists to continually provide documentation to justify treatment of their patients. And, because mental health outcomes can be far more difficult to measure than physical ones, it can be harder to prove to insurance companies that care is essential or “Medically Necessary.” If an insurance plan disagrees with a treatment plan or approach used, they can require therapist to repay the funds.
Reduces Client Choice
The insurance company determines if you’re allowed to come to therapy weekly or biweekly; taking your right to choose the frequency- away. Let’s not forget time/ duration. A not- so- funny example, years ago when I participated with insurance, one claim was denied payment because I met with a client for an hour, the insurance said they would only cover 45 minutes sessions. That’s right, the insurance company said that I spent too much time with a client, and used it as a reason to not pay their part.
Supply and Demand
Far more people are seeking mental health therapy. We have actually seen a dramatic increase in new patients since the Covid pandemic. And what happens is, with so many patients willing to pay out of pocket, or seek out a specialist, there is simply less of a need for therapists to deal with the insurance hassles, charge backs and headaches of insurance taking weeks or months to provide payment.
Mandatory Diagnosis
There are MANY reasons to work with a therapist: grief, stress overload, family struggles, substance abuse or addiction concerns, the developmental traumas (small t trauma) we experienced in our youth that negatively impact our attachment style or couples struggling with their relationship. Many people just want to evaluate their lives and make different choices, identify what gets in the way or matters like creating healthy boundaries.
Insurance, being based on a medical model, REQUIRES clinicians and other mental health counselors to diagnose clients with a DSM-V Mental Health Disorder. So while the struggle, signs and symptoms MAY meet criteria for a disorder (let’s just say Adjustment Disorder), many times the symptoms do not meet the criteria for a disorder. A therapist is not going to to LIE on the record just to get paid, that is fraud!
And to be fair, some clients don’t want to be diagnosed with a mental health disorder for fear that information as part of their medical record could impact vocational options (pilots, boat captains) security clearances, life insurance, etc.
It is not wrong to want to use your health insurance, but please know there has to be a diagnosis (medically necessary). For many of us, it just feels wrong to force a fellow human into that label/ box, while not knowing if that diagnosis will show up later- limiting their options.
Finding A Mental Health Counselor for Your Mental Wellness Care
You do have options.
1 You can look at community mental health centers that are contracted with the state to provide low cost mental health care.
2 You can use your health insurance.
3 Some therapists that offer reduced fee or sliding scale payments. This simply means different people with different incomes are charged different amounts based on what they can realistically afford.
4 Another option is to look for a therapist who provides online sessions. Many therapists elected to let go of their leased offices after the 2020 and work from home. With no office rent or staff to hire, these therapists MAY be able to charge clients less because they have far lower overhead expenses to run their business.
5 The membership platforms that offer weekly sessions (video/ text/ live chat) could also be an option.
6 Private practice therapists that do not take your insurance- But can offer you a “superbill” incase you have a PPO or EPO health plan and may be eligible for Partial reimbursement. *Keep in mind this would require a Diagnosis to be on the paperwork.
7 Private practice therapists that do not take health insurance/ full fee. The fees paid can but paid with an FSA care or be considered part of the expenses toward the annual deductible.
The message is: You do have options. Take your time and make the best decision that is right for You and Your unique circumstances.
If you’d like to explore treatment options, please give me a call.
SOURCES:
https://www.heartmatterstherapy.com/post/5-reasons-why-some-therapists-do-not-accept-insurance
Leave a Reply