Insurance through the Lens of a Recovered Insurance Provider
Many people are confused by how and why so many therapists are no longer accepting insurance. I too would be one of these people if I weren’t a private pay provider. I know I would because I would feel as though I don’t have access to something I need. And how much of that is culture? I’d like to share a different perspective, a personal one of my story as an insurance provider who is now a private pay provider.
I feel as though this blog could go on and on based on my history and experience with insurance. This is not meant to bash insurance or deter anyone from using therapists that do accept insurance. This is ONLY my story and my experience to bring light as to why it doesn’t work for me and how I made the decision to become private pay.
When I started out as a therapist, fresh out of grad school with not one but two Masters degrees (Master of Social Work and Master of Public Health), I immediately began agency work where the agency I worked for required me to become paneled with all necessary insurance. My services were billed at a rate of 100-180/hr and I made $35-40/hr. My pay rate as a double Master’s degree clinician was insufficient to make my student loan payments, and contribute to my family.
Fast forward a few years and I started my own practice still on insurance. A provider in SC is paid by insurance anywhere from $40-$80/hr and therapists are silenced not to discuss reimbursement rates, EVER!
Why I came off insurance and transitioned my whole practice off of insurance:
Insurance pays less for more effective therapy services
There is no accountability on when we are paid as providers
Insurance can decide a client no longer needs therapy
A client must have a diagnosis to qualify for therapy
#1 A typical insurance panel pays less for family therapy and group therapy which is the model of my practice. In my experience the majority of my clients on the same insurance would reimburse me $80 for individual therapy and $67 for family therapy, $8-11 for group. A room with one person vs a room with 4+ people. The skill level needed to support that is worth so much more. Research shows the effectiveness of therapy inclusive of a system (family) is so much more effective and would decrease the number of sessions needed for stabilization.
Now some of you may be saying, $80/hr is really good, yes but I haven't even discussed overhead to pay for all the HIPAA compliant platforms, insurance liability, etc. Which means I have to see more people to make ends meet. The more people I see the less attuned, effective and available I am as a human. The difference in seeing 4 clients a day vs 8 clients a day is HUGE!
#2 Did you know the insurance company has no accountability as to when they have to pay us as providers? At one point in my practice, one insurance panel didn’t pay me for services for 10 months and owed me over $8,000.
#3 Insurance panels can deny clients and their need for therapy. Educators in crisis and burnout were denied by plans and then punished by systems for poor mental health, resulting in the need for FMLA just to seek a higher level of care because they were no longer appropriate for outpatient therapy. Those same systems did not hold confidentiality and received consequences because they needed mental health support and could not work. If clients don’t meet the requirements per the insurance subjective lens they can be denied.
#4 I work with clients that, if given a diagnosis, could lose their job or opportunities. This was verbatim from clients. These populations consist of: judges, attorneys, military personnel, police officers, paramedics, state legislature… Careers with some of the highest levels of vicarious trauma don’t have access to highly skilled professionals because of fear of losing their job. I’ve treated them all. Almost all insurance panels refuse to pay for therapy unless there is a medical need and a diagnosis. If there is a diagnosis, clients are in danger of losing their career.
My treatment model is highly effective, allows clients to feel again without the use of numbing and medicating agents, heals wounds through extended therapy sessions, and learns how to love self in order to love others. Insurance does not agree despite the 100’s of clients that would state otherwise.
Our culture sets us up to expect something for the least amount possible and we lose sight of the priorities. Doctors are paid much more for surgery. I do emotional surgery. If I can’t feel, I can’t heal. You get what you pay for. Come work with me for 5 sessions and I guarantee you will feel more than you felt prior and have clarity on what is holding you back.
I no longer take insurance because my clinical judgment as a practitioner for over a decade determines your need for care, not a subjective bulleted list.
