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Insurance through the Lens of a Recovered Insurance Provider

by Amber Tolbert

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:

  1. Insurance pays less for more effective therapy services
  2. There is no accountability on when we are paid as providers
  3. Insurance can decide a client no longer needs therapy 
  4. 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.

Heal YOU 2024

Are you still breathing as we welcome in the New Year? 2024 came in with a bang!  Did you feel the energetic intensities in relationships, with work, or politically? Do you find yourself at the beginning of the year being swept into all of the “More”? 

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A fellow traveler in our weekly support group shared, “I don’t want all the “mores”, not unless it’s more recovery”!  I’ve been known over the years to speak out against the New Year’s traditions around resolutions and change. Why do I need to change? What’s wrong with who I am? 

The further into my recovery journey I travel the more of a rebel I become. In most ways that’s a good thing.  I spent more than half of my life being a “yes person” and working overtime to not ruffle feathers and follow all the rules. Changing, being, doing whatever I thought would make everyone else comfortable living under the delusion that I had that kind of power. What I know now is – my assumption that I knew what others’ needed was not my superpower but my pathology stepping into one’s role of Higher Power. Now that’s a lot to handle. How the hell did I get myself into that?! 

So where does the premise or theme come from to be “more” in the New Year? The diet industry is known to be worth billions of dollars, do they make up these rules? Culturally we are an obese society according to NIH (National Health Institute) 2 out of 5 people in America (43%) are suffering from severe obesity. Isn’t it also rather paradoxical the amount of numbing and medicating Americans participate in to cope with the unrealistic expectations of body image, productivity, and roles.

In my rebellious state I’ve started asking myself a lot of questions. Who makes up this rule? Do I subscribe to this rule? As a 43 year old woman, can I embrace my body and accept it rather than shame it based on the societal expectations of America. I can!  As a healer, fellow traveler, clinical provider researcher shows feelings follow thoughts. If I change my thoughts from that of judgment, shame, and criticism then I can also change my feelings to radical acceptance, self love, and compassion. 

In 2024 I want to challenge you to Heal YOU. Yes, there’s a lot of pieces of that journey that are meant to be done in connection, and I encourage you to take those steps. I also invite you to consider if the judgments you are subscribing to yours? Or are they beliefs that’s been put on you? What do you want more of?  What is within your power?  I’ve done billion dollar diets and I’ve eaten 500 calories a day. It’s not a part of my healing journey. It never gave me more health, only more scarcity. 

As you might be able to tell, I am no longer a “yes person”, at least not always. I don’t assume to know what people want or need, at least not other people. I have a hard enough time figuring out what it is I want and need. Recovery gives me solutions and permission.

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