Information on using in-network insurance vs out of network and private pay:
It’s been decades since the major insurance companies have increased our reimbursement rates in the field of mental health. Most recently, our reimbursement rates have dropped fairly consistently during the 10 years I’ve been in practice. During this same time period, insurance premiums have continued to rise to unprecedented levels while the amount of coverage continues to decline. When using in-network insurance, therapists run into a number of problems that significantly impact you, the client.
The first of which is the mandatory diagnosis. In order for the insurance company to cover the cost of your therapy, we have to provide a diagnosis (or diagnoses) that is actually covered. These diagnoses then go on permanent record with your insurance company which often impacts your future ability to obtain insurance and the premiums of that insurance. This diagnosis will literally follow you for the rest of your life and will almost definitely negatively affect you.
Second, the moral dilemma of the therapist with regard to your diagnosis. Often clients come in with sub-clinical issues or diagnoses, life coaching, adjustment disorders, etc. None of which are covered by most insurance companies. This leaves the therapist with a very serious ethical and moral dilemma. Do we report a “no-diagnosis” code or a code that is accurate, but we know won’t be covered, or do we provide a “close enough” diagnosis that can be argued, but will follow the client for the rest of his/her life?
Third, the insurance companies determine your treatment length. The insurance company will know nothing about you at first other than a diagnosis. Your plan will have a pre-determined number of yearly visits. Say, for instance, you have an anxiety disorder of some kind that is complicated by present situations or other diagnoses, the insurance company can say, “This person has an anxiety disorder and it should be fixed in 15 sessions. Therefore, we are not covering anything beyond that.” We, as therapists, can do basically nothing to dissuade the insurance company from this very unfair and uninformed decision. The only thing we can do is appeal. In the appeals process, we then have to divulge a significant amount of your personal information in therapy to some other “authority” that is usually paid by the insurance company to argue our case for more sessions. I’ve never had one approved or overturned in 10 years. Of course, why would someone being paid by the insurance company to hear appeals make a decision that is going to cost the insurance company more money?
Fourth, what if what you need is not what the insurance will cover? Say for instance, you are in crisis and need a two hour session or sessions on back to back days? The insurance company will pay for neither. Period.
Next, HUGE deductibles. Many insurance plans now have deductibles that are absolutely outrageous (mine for instance is $2500). These are figures that many people don’t often come anywhere near, so it doesn’t make sense to put your diagnosis in the system forever, simply to try to reach that deductible and then never get there. If you do get there, its often at the end of the year and you only have a few sessions left until you have to start all over with meeting the yearly deductible again. If you do happen to meet it, you still could have a substantial co-pay or co-insurance. Just food for thought.
Finally, your PHI (Protected Health Information) is always at risk. We (the therapists and insurance companies) go to great pains to secure your information; however, mistakes happen. There is a risk.
By choosing not to use your insurance, we (you and the therapist) can take control over your therapy. We can give you what you need with no arguments and no questions asked. You can improve your life and get better without the influence and involvement of the insurance company. Don’t get me wrong, about 50% of our clients still use the in-network insurance (who can pass up a $20 co-pay?), but the other 50% of our clients do choose the private pay route to avoid the issues mentioned above. If you choose to use in-network services, we’ll be more than happy to get your services authorized and file for you with no problem at all. If you’d like to do private pay, we can definitely work out a fee that works for you!
Note on Travel Expenses: We do frequently go out into the community to drive with clients who have driving phobias, elevators/heights/enclosed spaces, and fear of flying. However, any time beyond the normal 45-50 minute session will be charged a fee per hour that will not be covered by insurance. These extended sessions are almost always extremely beneficial and very necessary for treatment. If, for example, we need to take a short flight together we will discuss and agree on a reduced rate fee.