I love what I do. I love working with my clients, working on their goals, helping them heal themselves. 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 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 the info below explains a little more about the process & risks of using your insurance for therapy. Some of my clients choose to use their out of network benefits, and I support their choice, now that they have all the facts.
We pay for insurance, 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”. So I created this FAQ just for you!
Jess, why don't you accept my plan?
The current insurance model requires therapists to provide a mental health diagnosis to you, even if you are just going through a break up and need some support. Insurances pay because you are “sick”. In order for therapists to treat you, we have to tell them why they should pay for treatment. We 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 (for instance, 12 sessions per calendar year).
Therapists let your insurance company know how sick you are by providing them with a mental health diagnosis. This diagnosis is based on the “International Classification of Diseases”. 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 diagnosis you have. I would love to tell you that HIPAA compliance ensures that no one will ever know about your diagnosis 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 therapists to contact your PCP and let them know you are in therapy, and also want therapists 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. It is always my goal to ensure private, confidential, high quality therapy.
But Jess, how does my insurance limit therapy?
Most insurances have limitations on how many visits you get, and often this is based on what kind of diagnosis you have. For instance, you may only get you eight sessions covered. Your insurance company also can audit your chart from me at any time, which means I need to give them every page. Not everyone is comfortable with this. Your insurance company may also require me to contact your primary care provider to let them know you are in treatment, for continuity of care.
Basically, therapists have to continue to say you're sick, even though you might be getting better, in order to continue seeing you and getting paid for their 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.
What's up with your fee?
You can find my fee schedule here. What is well being worth? It's hard to put a price on it. Therapy can seem expensive, 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.
I give solid, ethical, healing care, in the way that I was trained years to do. 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:
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 (HSA) for your payment, if you have one.
If you are struggling with the out of network process, you may want to simplify things with the Better App. Better helps clients manage out of network benefits in exchange for a percentage of the claim payment.
I can't wait to get started with you, and appreciate you taking the time to read all this stuff. I hope this demystifies the process!