The decision on whether to participate in insurance panels or not has been something we feel very strongly about for various reasons. As a practice as a whole being on insurance panels is not a viable, healthy business structure (see below for outlined reasons). We understand that private-pay psychotherapy is a commitment, an investment, and is out of reach for some people.
Below are a few important pieces to be aware of and consider before you use in-network benefits.
Confidentiality
Client’s health information (diagnosis, treatment plan, history, and progress reports), which must be submitted to insurance for payment, is not fully confidential as most clients think. Using insurance requires the client to carry a mental health disorder/diagnosis, which can have a lasting impact on a client’s health records, insurance premiums, and work promotions in some cases. We believe you should be aware of any potential impact.
Clients may be unaware that there are many situations where confidentiality must be waived. We have seen many situations where a client has had to waive his/ her rights to confidentiality for promotions at work, application into law enforcement, personal lawsuits for emotional distress, custody/ divorce proceedings, and life insurance. This means that these organizations/bosses will have access to your mental health diagnosis.
Quality of Work
Insurance companies have placed great restraints on the quality of work a therapist can provide. Due to the extremely low reimbursement rate for services, we as an entire practice can not survive on what insurance companies reimburse. Typically, a therapist in a private fee-for-service practice, providing the type of depth work we do, has a full-time caseload of about 20–25 clients per week. An insurance-based practice needs 40–45 clients per week to earn a similar rate. We would not be able to provide the level of clinical competency we currently do if we had to maintain a caseload of 45 clients per week. Our therapists would get burned out and be unable to hold the quality of presence and energy needed for depth work.
We were able to create this as an externship position with therapists in training, seeking our clinical direction as a part of their development.
When Using Insurance for Couples Therapy
In cases of couple therapy, very few plans actually offer couples therapy, which means the treatment needs to be billed under one partner’s plan, and he/she must be able to be diagnosed with a Mental Health Disorder.
Additionally, when couples come to therapy for systemic relational issues, having one partner carry a diagnosis can make the treatment feel unbalanced. This is something to keep in mind if you feel it may be difficult for you both. Especially if any issues arise around custody or divorce.
Be aware if you call another practice and they very easily say they will take your insurance. Oftentimes, they will diagnose the partner on the benefit plan, without your knowledge of the diagnosis.
If you wish to use in-network coverage – check with your provider to see if they cover couples therapy. If they do, then the above issues don’t apply
Direction of the Clinical Work
Insurance companies are trying harder than ever to limit the frequency and amount of sessions allowed. For lasting, permanent healing, long-term work is often needed. Insurance companies come from a place of medical diagnosis and focus on acute symptoms. Relational dynamics and hurtful attachment patterns, often caused by years of suffering, are not healed in 12–26 sessions. Therefore, the clinical work has more substance and lasts longer than the band-aid approach that companies want to reimburse for.
When you speak with your insurance company, find out if they have limitations on the number of sessions you can have each year. In certain cases, you may have to advocate for the treatment you may need.
Out-of-Network Reimbursement
We do understand, however, that paying out of pocket for mental health services is not always a possibility and that the choice is ultimately up to the client. For this reason, we will write receipts for reimbursement for clients with out-of-network benefits. Please contact your insurance company to determine what reimbursement they will provide.