On one of the therapist message boards I look at there is an ongoing debate regarding therapists accepting health insurance. I do accept insurance and for the foreseeable future plan on continuing.
Many on the boards are against accepting insurance. Most are or want to be private pay only therapists. Some will have nothing to do with insurance and will give super bills to the client so the client can request some reimbursement. Some will submit out of network bills for the client.
I get it. There are a lot of negatives to taking insurance.
- Insurance companies generally do not seem fair to therapists. The reimbursement levels for therapists vary hugely. Often reimbursements are way below the therapist’s fees and there are lots of hoops to jump through to get paid. For a therapist trying to run a practice this can be devastating. A therapist generally has education, has obtained a license, engages in specialized training and should be compensated for these skills. Therapists are running a business. They have overhead of rent, taxes, supplies, utilities, ongoing licensure and training etc. Being paid a low rate can mean they are unable to provide service at all. Many therapists are unable to run a practice on insurance rates alone. Also, why would a therapist who is going to want to have a healthy lifestyle of their own want to work a lot more for a lot less pay. Doesn’t make sense.
- Insurance companies require a mental health diagnosis. Insurance will be provided some information about you. Most therapists I know try to be discrete and share as little as possible with insurance companies but insurance companies will not pay without a diagnosis. Some insurance companies have gone as far as to wanting your session notes. No one wants all this personal information shared with random people. These diagnoses can follow you throughout life just like a physical diagnosis.
- Insurance companies sometimes try to decide treatment for you. This hopefully happens less with the mental health parity law but it happens. They may say your diagnosis is not severe enough. They may question your therapist on why you are not making more progress and why you keep on needing therapy. Insurance may try to limit your sessions and so many other things.
My experience is that insurance companies are not necessarily going to approve of the best services for the client because they are, after all, business too trying to make money. There are other reasons not to use insurance but the above is a good start of why some therapists refuse to take insurance.
Why I will keep taking insurance (at least for now).
- Therapy is definitely worth its cost but the reality is that it is expensive. Lots of therapists will work with you but even a reduced rate of 75 dollars a session can be expensive. I totally agree with people who say, clients should make it a priority if they are seeking help. I agree with the sentiment that a client should look at what they can get for the costs. For example, how much is it worth to have your marriage saved or how much is it worth to have a healthy child or family. I think people should prioritize these things and should try to find the money to pay for it. However, I also know the reality is that money is tight. If a person has the option of paying $100 a session vs. a $20.00. It is hard for many people to justify not paying only the 20 dollars. If money were not a consideration that maybe no insurance for therapy for everyone would be the best option but finances are often a huge consideration.
- Keeping on from the above reason – I don’t want therapy to be only for the wealthy. Why shouldn’t we all have better mental health? If someone has suffered trauma should they only be able access services if they have money. If someone is grappling with anxiety should they just live with it until they get a higher paying job or something? Therapists will argue that there is lots of low cost therapy out there. Its true there is high quality, low cost therapy out there. I worked in an agency and I know lots of good therapists that work in agencies. However, there are pitfalls. Often these services are high demand and as a client (and as a therapist) you often get whoever is available. You might meet your new therapist for the first time and you and the therapist aren’t a good fit. Well, too bad this is who is available. There are waiting lists and not always ideal locations and appointment times. You may get with a phenomenal program but often you lose your choice along the way.
- I am someone who thinks almost everyone could benefit from therapy so I should do my part to make it affordable. I can’t offer $20.00 sessions and stay in business but I certainly can take insurance and accept a $20.00 co pay.
- One of the biggest reasons for me to take insurance is that, for me, it is almost hypocritical not to. What I mean by that is that I believe that as a society we stigmatize mental health issues and there is often shame related to it. How can I as a therapist say there is nothing wrong with a mental health diagnosis but then say – don’t tell anyone though. Maybe if everyone kept giving the message that our mental health is important and any issues we may have are not something to be embarrassed about, stigma might lesson. I wouldn’t be at the doctor’s office saying “could you not put I have migraines – I don’t want that following me.” Mental Health shouldn’t be any different. I understand we live in the world that is not the ideal but I want to work toward the ideal.
As the client you will need to make the decision if using insurance is for you or not.
Thankfully for you there are a lot of options out there and you can choose the path you want to take. There are great therapists out there with all sorts of financial options. And don’t believe that the best therapists don’t take insurance. It may vary by area of the US but there are plenty of good therapists that take insurance around where I practice. In fact I know very few therapists that aren’t on at least some insurance panels. Lots of therapists pick and choose which companies to work for even. I am even getting off one panel that has ridiculously low rates and are slow payers.
In the end it is about you and you get to make the choice that works best for you. I definitely know clients who will pay what they have to in order to keep their confidential information between themselves and their therapist and I know individuals who could not participate in therapy without insurance.
Good-Luck with your therapeutic journey!!!!
