Why Do So Many Therapists Not Take Insurance
This has been an ongoing trend the last decade, and if you’re here reading this article, this is something that you’ve wondered about as well. This varies from region-to-region, but so many therapists in the Austin-area do not take insurance. When friends or family ask for a referral in the area, none of the people I generally recommend take insurance. So why is this?
Let me start by first explaining the reasons why I personally don’t take insurance.
In another life I worked in a practice that solely did insurance billing. With insurance billing, you have to keep copious notes documenting “medical necessity” of why someone would need counseling and why insurance should pay for it. Without the notes, insurance won’t pay for the services. They would often request to see the notes, allowing insurance staff to have intimate knowledge of a client’s personal life, family history, reported symptoms, and any past traumas. So therin lies my first issue with insurance-based billing. Having a third party, whom I don’t know, have access to my client’s personal information felt really icky to me. What are they doing with the notes they receive? Are they storing them? How are they storing them? Who has access to these records later? All important questions to ask yourself if you are using insurance to pay for treatment.
My next issue with insurance came a little while later, when certain insurance companies became notorious for doing “reviews” of certain cases to make sure the insurance company thought the treatment was medically necessary (Looking at you UHC!). This would typically be a 45-60 minute call, where a “clinician” from the insurance company reviews your clients records, asks invasive questions about a client, makes treatment recommendations, and finally decides whether or not your client should have ongoing treatment covered. These calls were particularly icky, as the “clinician” on the other end of the line doesn’t know the client at all, has no working relationship with them, and yet they are making treatment recommendations and authorizing sessions in 45 minutes.
This is the point where I decided moving forward, I could not ethically bill insurance for services. It became clear that my ultimate goal, for my clients to feel better using psychotherapy, went in direct opposition to the insurance company’s goal, which is to make as much money as possible. An insurance company is not in the business of helping you feel better, live your best life, or be the happiest/healthiest version of yourself. The insurance company is in the business of having happy share-holders, which means maximizing profits and minimizing expenses. In therapy terms, that translates to less authorized sessions, making you jump through hoops to get coverage, not covering certain conditions, and so on. This feels to be in direct oposition to my main goal- which is helping people feel better with weekly, high-quality psychotherapy where they explore the areas where they may feel “stuck” and work towards living a more fulfilling life.
Here are some things to think about in regards to whether a therapist who doesn’t bill insurance may be right for you:
Protects your privacy and confidentiality- details of your therapy will not have to be shared with insurance.
Ethical considerations- Insurance companies have nuanced policies on sharing data and secondary use with no consent
No surprise bills- sometimes insurance will guarantee complete coverage and then withdraw approval or only offer partial coverage
No limitations- Insurance can place limits on therapy available to you and even the frequency of therapy- so if you have a lot happening and need an extra session here or there, insurance would not cover this as it is not in the agreed plan of treatment.
No diagnoses required- Insurance companies require you to have a mental health diagnosis. Self-paying clients do not and will not have to be labeled.
No Preexisting condition on record- Diagnoses and mental health treatment stays permanently on your insurance record, so if you switch insurance companies, or even employers, they will see this as a preexisting condition
Availability and higher quality of treatment- Therapists that do not accept insurance tend to take fewer patients. This allows them to give more time and focus to each client. It also decreases wait times.
So for me and my practice, the ethical decision was to not bill insurance directly. Many of my clients still use their out-of-network benefits to receive reimbursement from their insurance companies. This is a workable solution for many of my patients. If you would like to be a patient and are worried about paying out of pocket, please don’t hesitate to reach out. Often I can work with clients who want to receive care to come up with a plan that works for them. Never let the cost of therapy prevent you from seeking out the care you deserve.
