Look, I totally get it. I pay for insurance just like you do, and it’s great to use it for all kinds of things, including my PCP and emergency room visits. And it’s totally up to you to decide if using insurance for therapy is right for you-it’s personal choice. In my heart, I believe everyone should have access to quality therapy and that therapy should NOT be a luxury item.
But, there’s reasons why more and more therapists are moving away from taking insurance plans and I want you to understand all the “ins & outs”. Currently, I am only on three insurance panels (BCBS, Harvard Pilgrim, & Tricare) and I expect to be on fewer than that in the years to come.
Here’s the deal:
How I get paid because you’re sick:
Insurances pay me because you are “sick”. In order for me to treat you, I have to tell them why they should pay for treatment. I have to let them know why your therapy is “medically necessary”. Each insurance company gets to define what “medically necessary” means to them. Even then, as most of you have experienced, there are often restrictions on what kind and how much therapy you get.
I let your insurance company know how sick you are by providing them with a diagnosis. This diagnosis is based on the “International Classification of Diseases”. Are you getting the picture here? You are coming to therapy because you had a terrible break-up, and now I need to tell your insurance what mental health disease you have.
I attempt to be very transparent in this process with you because I want you to know what disease you have. I would love to tell you that HIPAA compliance ensures that no one will ever know about your disease or that you sought counseling, but that’s not guaranteed. This info is seen by multiple people at the insurance company, and can also come up (as some of you know) when you try to apply for life insurance, or health insurance in the future, with another company. Some employers also request this information from your insurance company.
Some insurance companies also require me to contact your PCP and let them know you are in therapy, and also want me to refer you for medication (even if that’s not what YOU want, because it’s LESS expensive than ongoing treatment), based on your diagnosis. It is also nearly impossible to erase any records held by your insurance company once they are on file. Several insurance companies have had recent privacy breaches as well. By not using your insurance, you ensure the most private way to protect your records & confidentiality.
How Insurances Sometimes Don’t Let me Do my job:
Most insurances have limitations on how many visits you get, and often this is based on what kind of disease you have. For instance, your terrible trauma experience may only get you eight sessions. Then I have to argue with your insurance company that your trauma may not be resolved in only eight sessions. Please oh please can they give us more? And so on, until they decide to stop paying.
Basically, I have to continue to make you sick, even though you might be getting better, in order to continue seeing you and getting paid for my work. Insurances can also not only limit how much therapy you get, but the type of therapy they will pay for. This sometimes limits my options on how you are treated, as you can imagine. Just to clarify, this is someone who has never met you deciding how you will best be healed, based on their financial bottom line.
A word about fees:
Therapy isn’t cheap. Especially good therapy. But then again…..its’ cheaper than weekly mani/pedis, a full body laser hair removal package, and a new car payment. It’s cheaper than a divorce. It’s cheaper than a month off work because you’re so stressed out you can’t face going back in the door. What’s it worth to you? I have always felt that therapy is in an investment in yourself and we invest in the things we care about. By not participating in insurances, I can then set a fair fee that works for us both.
Let’s do some math too! So my fee is $175 for the first initial session, and $160 for every session after that. Why is that first session so expensive? Because I have to write a lengthy report for your insurance company on my findings and justify what disease & diagnosis you have so we can continue treatment.
Also, I want you to understand what these numbers mean. $160 per session would be awesome. In fact, that’s lower than many of the fees in this area for therapy. BUT just because I charge your insurance company $160, this is not what I get paid from them. In most cases, I have a separate contract with each insurance company. They negotiate with me about what therapists should be paid to have the privilege of being on their panel and having access to their patients. On average, this is about $40-50, plus your $15-20 copay. Which leaves me with a $100 deficit. It is illegal for me (or any therapist) to “back bill” or charge you this $100 that is uncovered. So I eat that cost.
I want you to know that while most employers give you a raise every year, insurance companies often cut the fee they are giving me every year. So somehow, each year I make less and less, without factoring costs of living, etc.
Why does all this matter? Because I want to give solid, ethical, healing care, in the way that I was trained all those years to do. And I will no longer “play the game” of keeping you sick to get $60. I want you to heal, and I want you to be invested in doing it, and I want your privacy respected and confidentiality upheld. All the records that I keep belong to YOU, and if you do not use your insurance, I commit to the following:
I love what I do. I love working with you, working on your goals, helping you heal. I really believe I have the best job in the world. I’ve worked hard for the appropriate qualifications & trainings to provide you with the best, most competent care available. I don’t want to spend my time negotiating on the phone with insurance companies, fighting to get what you should have as a right, or doing hours of paperwork that I am not reimbursed for.
I want to answer questions for you about this process. Please let me know if you want to talk about this and how I can help. I hope this explains a little more about the process & risks of using your insurance for therapy. Some of my clients choose to use their insurance, and I support their choice, now that they have all the facts.
Even if I am not an in network provider with your insurance company, this DOES NOT mean they will not pay for care. "Out of Network" Benefits means you pay me up front, and then your insurance company reimburses YOU directly for the payment. Not every plan has them, but some insurance companies are more willing if you have a prior relationship with a therapist, or if there are very few "in network" providers that offer the same kind/type of therapy or specialization in your area.
Here’s more info on Out Of Network Benefits:
Services may be covered in full or in part by your health insurance even if I am not a contracted provider for your plan. You are responsible for any copay or deductible at the time of your session-check with your insurance to find out what your payment responsibilities will be.
You can check with your insurance carrier about "Out Of Network Benefits" by asking them:
• Do I have mental health benefits?
• What is my deductible? Has it been met?
• How many sessions per calendar year does my plan cover?
• How much will you cover for an out-of-network provider?
• What is the coverage amount per therapy session?
• Do I need approval from my PCP?
You can also utilize a medical savings plan for your copay, if you have one.
Check out more ways to work with me here, there's an option that's right for You!