Why Therapists May Not Accept Insurance
Most therapists acknowledge that the use of insurance can make psychotherapy more accessible for most individuals. While this may be true, it can also create more barriers than access.
You may be wondering why we we limit our interactions with insurance companies:
Insurance companies require a diagnosis and medical necessity, meaning that in their eyes there must be something wrong with you that needs to be fixed in order for you to access therapy. We do not view you in this way. You are a person with varied life experiences seeking support and engaging in self care. Therapy is for everyone, regardless of what they are hoping to achieve in session.
Insurance companies dictate how we can engage in the therapy process. There is no allowance for relationship counseling, sex therapy, art therapy, therapeutic and skills groups, or other specialty areas of counseling that are valuable, and sometimes necessary, tools in the toolbox. We can’t be the best clinicians we can be if we are being told by an insurance company how to do our job.
Reimbursement rates from insurance companies are less than 60% of what is necessary to earn a living wage. By accepting this rate of pay we would have to see double the number of clients per week. This places our own self care at risk, therefor placing you at risk.
Reconciling insurance claims and payments is a full time job. We would have to hire additional administrative staff with no additional funding from the insurance company to support this position.
Insurance companies can retroactively deny a claim and take money back that they have already paid. This decision rarely has to do with quality of care. More often it has to do with what content was omitted from a note (often to protect your privacy) or other items that are administrative in nature. This a) distracts from our job of being a clinician and b) places us at financial risk.
Group practices are small businesses and we have overhead expenses. The average reimbursement rate in the US is $91 dollars for a 50 minute individual session. If a therapist sees 20 clients per week for 49 weeks a year they would earn $89, 180. The average overhead costs, not including required continuing education, is 30%, bringing them to $65,426. From this they still have to pay their personal taxes, student loans, personal expenses, therapy, healthcare, and continuing education. Income needed for one person in Atlanta to live comfortably is $100,000. This is not sustainable Why only 20 sessions? Because the remaining 20 hours a week is used to prepare for sessions, document sessions, file and respond to insurance claims, marketing and networking, answer inquiries, and more.
Out of Network Providers
Therapists who are not in network with an insurance carriers is called an Out of Network Provider. Many will provide the necessary documentation for out of network claims. They are unable to guarantee that your carrier will accept their documentation. Many do not guarantee that they will meet the requirements your insurance carrier defines for out of network care. If you would like to use your out of network benefits it is recommend that you call your plan, provide them with the credentials of the therapist you are considering working with and verify coverage and out of network deductibles. Most therapists collect their full fee at the time of service and any tasks related to claims submission and reimbursement is the responsibility of the client.
So when a therapist chooses not to accept insurance it is an agreement with themself to uphold their boundaries related to financial security, self care, and stress management. Exactly the skills we encourage you to implement in your daily life. When we choose not to accept insurance we set our fees considering the local market, our value based on experience and specialized training, and for many of us what we need to be financially secure. No one gets rich being a therapist. People are not a commodity, most often our fees are fair and necessary for our health and wellbeing which supports ethically sound care.