One of the most common questions asked by potential clients seeking counseling or therapy services is 'Do you take insurance?'. While every therapist and counseling practice is different, this seems to be a question that is unavoidable. There are some therapists who choose to take insurance. They have their reasons for why they find it beneficial for them or their practice. This post, however, is taking a look at why some therapists choose not to take insurance (Please note that this is not a comprehensive list).
"[Some] therapists choose not to accept insurance because they cannot wait months only to be paid breadcrumbs." – Bree Vanley, LPC
#1 - Insurance Companies Require A Diagnosis
Insurance companies require mental health professionals to diagnose clients using the DSM-V or DSM-V TR during the initial appointment. The diagnosis you receive becomes a part of your health record. For those of you who do not like labels and just want someone to help them sort out their life experiences, using your insurance would not be beneficial. Your therapist, if they accept insurance, will be required to diagnose you and provide that information back to your insurance company.
Therapists do not have to take insurance. Those that choose not to accept insurance may do so for two reasons: (1) to take their time understanding the problem within context so they can provide you with an accurate diagnosis, or (2) to avoid providing you with diagnosis at all.
#2 - Limited Confidentiality
The Vegas Rule of 'what happens here, stays here' does not apply when insurance companies get involved. When a therapist submits treatment plans or notes to your insurance company for reimbursement, your personal information (including your diagnosis) is reviewed by several individuals employed by your insurance company. This means that more people have potential access to your information than you think. Some therapists prefer to keep counseling and therapy services as confidential as possible by not accepting insurance at all. By doing so, this limits the insurance company's access to your mental health record.
If you are using EAP (Employee Assistance Program) services for therapy or counseling, your experience would be similar to seeing a therapist that does not accept insurance. These are employer-covered sessions where insurance companies are not involved, unless you choose to use insurance after you have reached your session limit. Oftentimes, diagnoses are not required and there is little documentation involved.
The limits of confidentiality should be explained in the HIPAA Privacy Notice you sign and receive during intake and before beginning services. If you have questions about HIPAA or confidentiality, please ask your provider.
#3 - Insurance Has Control
When a therapist accepts insurance, he or she has to follow the guidelines that the insurance company outlines. This includes what modalities of treatment are covered, which diagnoses are covered/paid for, how often you can receive services, and so on. Because the insurance company is the one "paying" for the sessions or services, they have a significant influence over how your therapist conducts sessions and how they write their notes/documentation.
Insurance companies also decide what services they will not cover (i.e. couples or marital counseling). This can feel limiting to the therapist and to the client. Some therapists feel the need to remove themselves from this type of control and provide care to their clients in an unrestricted but progressive manner.
#4 - The Pay
Just like you, therapists have to make a living and support themselves. Insurance companies are known for not paying therapists what they are truly worth. When you factor in the years of school, the clinical or internship hours, the trainings, and continuing education hours, therapists are truly underpaid and undervalued by insurance companies. Some therapists choose not to accept insurance because they understand what they are worth and choose not to accept the low pay from some insurance companies.
To add to that, some insurance companies do not pay on time. Imagine that you have been asked to do a job and you are told you will be paid a certain amount of money. Two weeks go by...one month...two months...and you have yet to be paid. Not all insurance companies take this long to pay out or provide reimbursement for services, but some do. Because therapists have to make a living and support themselves just like you, some choose not to accept insurance because they simply cannot afford to wait months only to be paid breadcrumbs.
Lastly, if your therapist submits a request to your insurance company to be paid for a service they completed, there is always a possibility that the insurance company will reject it. Insurance companies want to know what the 'medical necessity' is for that session or service provided. If they do not agree that it was necessary, they will reject the claim or recoup the money if they already paid the therapist. This means that the therapist is losing money rather than making money.
Bonus - They Just Don't Want To
Simply put, some therapists simply do not want to deal with insurance companies. They enjoy having the freedom to conduct therapy or their business the way that they see fit and that is most beneficial to their clients. Some therapists do not want the hassle of preparing for audits of their charts and documentation, despite how accurate it is. Some therapists prefer to keep services private and confidential without any outside interference from an insurance company that has never met their clients and more than likely never will.
It is absolutely every therapist's right to choose whether or not to accept insurance. Both options have their pros and cons. It is also your right to choose whether or not to use insurance when seeking therapy services. There are pros and cons to both as well. Therapy is an investment. How much you invest into yourself determines how much your return will be.