Why I No Longer Accept Insurance
After much thought and research, I’ve opted to no longer participate in a system that is exploiting clients and therapists in the interest of corporate greed. Below are some factors that influenced my decision:
Insurance companies are phasing out individual contracts with therapists - those that you see listed as providers through the insurance website - and instead are opting for bulk contracts with venture capitalist companies like Headway and Alma. Working with these sites makes clinicians beholden to their questionable ethics and requirements.
One alternative to not working with these sites is to get an individual contract with insurance companies while that is still an option, and accept what they pay, regardless of cost of living in your area. This can take months or years, depending on the insurance company. To avoid dealing with rejected claims, clawbacks, documentation audits, billing deductibles, slow reimbursement, and hours on hold, some opt to pay a professional biller 6-8% of received claims, adding another column to the cost of running a business.
Another alternative is to work for a group practice, which is a practice with many therapists working under one employer. Generally you will earn 60% of what the practice owner makes from insurance and be required to carry a caseload determined by the practice owner.
An uptick in cyber attacks/hacks has made confirming benefits, billing, and receiving payment increasingly unstable.
Betterhelp, another option that anyone who listens to podcasts is well aware of, has proven that clients will opt for the convenience of cash pay therapy over insurance. Unfortunately, this platform attracts inconsistent clinicians who often leave due to exploitative pay and ethical concerns.
Companies like Forward and One Medical have begun to successfully disrupt the medical industry; further substantiating that folks are willing to pay a premium for a better level of care.
Insurance companies reimburse less for couples sessions than individual sessions, deny rate increases for therapists, and require a diagnosis for treatment.
If a client comes late to a session the therapist has to choose to either commit insurance fraud by billing for an inaccurate session time or earn less for a shorter session.
Intentional obfuscation within insurance policies make it challenging for clients and therapists to understand what is covered, how much they will be reimbursed, and what documentation is required.
I realize that for many people, paying out of pocket for therapy is simply not possible. I’m glad that pre-licensed clinicians, community mental health organizations, and Employee Assistance Programs are available to provide care to those folks.
We routinely make choices about how we spend our money: houses, cars, vacations, dining out, food delivery, subscriptions, clothes. While it may feel unfair to ask clients to pay extra for something that's part of their insurance benefits, I believe it’s important to look at the repercussions of not doing so.
Therapists don’t build wealth by taking on a high caseload, managing burnout to accept the nightmare of insurance red tape with low reimbursement rates. We don’t buy homes, pay off student loans, raise kids, and run a business, especially for marginalized populations, by continuing to participate in a rigged system.
