You’ve decided to take the brave step of seeking therapy. It should be a simple process: you go to the website where your insurance company (to whom you send hundreds of dollars each month) lists dozens of providers within ten miles of your home or office, you pick one and schedule an appointment for the following week, secure in the knowledge that you will only owe your co-pay for treatment.
In the famous words of Cher Horowitz from that cinema classic “Clueless”: AS IF!
A more likely scenario: your insurance company’s list is outdated. You call therapists on their list, only to hear back that the therapist no longer accepts your insurance, if you even hear back at all. Maybe you get lucky and find a therapist who does take your insurance, but instead of the low co-pay you thought you’d be paying, you’re paying the full session fee until you meet your (ridiculously high) deductible. But then you find out that the company will only allow you to see your therapist a limited number of times…far too limited to work through the issues you were seeking help with in the first place.
This situation can be confusing and frustrating, especially considering the rising costs of mental health care. While it may seem counterintuitive for therapists to decline insurance, there are several important reasons why many professionals choose this path (and why even though you have insurance, you might choose not to use it!)
So, first things first: why might a potential client who has insurance choose to pay out of pocket instead? Many people are unfamiliar with how insurance for mental health works. In order for insurance to pay for sessions, insurance companies require that treatment be “medically necessary”. This means that you must receive a diagnosis of a mental disorder. Even if you meet that criteria, you might prefer not to have a diagnosis in your health record for any number of reasons.
In other cases, you don’t meet the criteria for a diagnosis but are still experiencing significant distress and want or need to see a therapist. It is unethical (and insurance fraud!) for a therapist to provide a diagnosis for you simply in order to claim reimbursement.
Even more distressing, for both you and the therapist, is that it’s not unheard of for an insurance company to initially approve reimbursement, review your claims, and decide that they have paid the claims in error, or that your claims weren’t, in fact, medically necessary. When that happens the insurance company demands repayment from you and/or the therapist. If the company requires repayment from the therapist for the services they’ve already provided, you are then responsible for paying their full fee out of pocket anyway! Unfortunately, insurance companies make their money by not paying claims. It’s not in their best financial interest to make it easy (or even feasible) for you to utilize the insurance you pay for.
So those are some solid reasons potential clients might decide not to use insurance. But therapists go into their profession to be helpers, not to get rich on sky-high fees, right? So why wouldn’t they accept insurance if that meant offering care to more people?
Insurance companies offer abysmal reimbursement rates. Average session rates in Austin are $150-250 per hour. Insurance reimbursement is substantially lower than that. Add in that companies can take months-yes, months-to pay claims makes it untenable for therapists to do business. Another consideration is the time it takes to interface with insurance companies in order to receive payment. It’s estimated that for every hour a therapist spends with a client who utilizes their insurance, an additional hour is required for administrative work on that client’s behalf-filling out extensive paperwork, managing prior authorizations, and negotiating with insurance companies, significantly detracting from the time therapists could spend directly with their clients (not to mention continued advanced training and self-care.) Therefore, therapists who accept insurance must see more clients in order to make a livable wage, while also increasing their workload on administrative tasks.
Seeing more clients for less money and substantially more work doesn’t serve our clients. One of the primary reasons therapists opt out of insurance networks is the desire for professional autonomy and flexibility. When therapists choose not to accept insurance, we can set our own rates, determine the length and frequency of sessions, and develop personalized treatment plans tailored to each client's unique needs. This freedom allows for more individualized care and to maintain control over our practice without being bound by the restrictions imposed by insurance companies. It also allows us to set aside sliding-scale openings in our practice for clients who couldn’t afford therapy elsewhere.
Therapists have a professional responsibility to prioritize the best interests of their clients. Unfortunately, insurance policies often limit the number of sessions covered or impose strict guidelines on treatment duration, which can hinder the therapeutic process. By not accepting insurance, therapists can provide uninterrupted care that is solely focused on the client's well-being, rather than being driven by the constraints imposed by insurance companies.
The most important consideration for both client and therapist in deciding whether on not to utilize or accept insurance? Quality, ethical, skillful care. Although therapists who are out-of-network can charge higher fees, it is important to note that these rates often reflect the true cost of quality care. By not being constrained by insurance reimbursement rates, therapists can set fees that reflect their expertise, experience, and the value they provide to clients. Additionally, without the need to navigate insurance company requirements, therapists can reduce their overhead costs and invest more in professional development, enhancing their skills to better serve their clients.
Finally, a strong therapeutic alliance is crucial for effective treatment outcomes. Some therapists argue that the involvement of insurance companies in therapy can disrupt the client-therapist relationship. By opting out of insurance networks, therapists can prioritize building a deeper connection with their clients, free from the potential intrusion of third-party payers. This allows therapists to create a safe and trusting environment conducive to meaningful and transformative work.
Working with a therapist is an investment in your health and wellness. While it may be expensive, it is an investment-in many cases, maybe the most important investment you will ever make. Therapy is expensive, but good mental health, quality relationships and positive self-regard is absolutely priceless.