I did not accept insurance for therapeutic services for a variety of reasons, but primarily because it's bad for the consumer and it's bad for me as a small business owner. Using insurance for mental health services is bad for the consumer for the following reasons:

1. You lose your confidentiality. When you use insurance to pay for mental health services, the therapist is required to disclose information to your health insurance provider in order to receive payment. Not only that, a therapist frequently must receive prior authorization to provide services meaning that therapy cannot begin until the insurance company gives its approval. This can cause delays in the client receiving needed and, perhaps, urgent service.

2. The use of insurance to pay for mental health services requires a diagnosis. Many individuals come to therapy and do not necessarily meet the requirements for receiving a diagnosis. Does this mean that they don't need some counseling or guidance? What about the millions of people who struggle with stress management, who have experienced the death of a loved one, or lose a job? Many insurance providers do not cover couples counseling and if they do one of the partners must be diagnosed in order for the couple to receive treatment. All these things are problematic in the use of insurance to pay for mental health services.

3. Mental health treatment becomes a part of your permanent record. Let's say that you receive treatment after the death of a spouse or parent and you meet the requirements to be diagnosed with Major Depressive Disorder. And let's say that you apply for a job that has a certain level of security clearance requirement (like the FBI or CIA or other law enforcement) or you attempt to switch insurance carriers at another date, you could be denied employment or insurance in the future.

4. Many insurance companies determine the type and length of treatment. For instance, if someone is diagnosed with Major Depressive Disorder, an insurance company may limit treatment to Cognitive Behavioral Therapy for only 8 sessions. If you have not sufficiently recovered from your depressed mood after eight sessions, you will have to pay out-of-pocket or discontinue therapy.

5. There are frequently long wait times for therapists who accept insurance. Many therapists on insurance panels have full caseloads, so finding a therapist with an opening anytime in the near future can be challenging.

6. Insurance changes can affect therapy treatment. If you change jobs and that employer does not offer the same insurance plan, you may be required to start all over with a new therapist. Since the relationship between client and therapist is the number one predictor of therapeutic outcomes, starting over with a new therapist can be problematic.

7. Deductibles have a big influence on cost. Let's say that you're insurance has a $5,000 deductible before it begins paying out. If your therapist charges $150 per session, you will have to pay for 33 sessions before your insurance pays anything.

8. Occasional therapy sessions may not be covered. After the main work of therapy is done and the person has met their therapeutic goals, they frequently want to have check-in sessions with their therapist to solidify their gains or for specific questions. These types of sessions are not covered by most insurance panels.

Personal Reasons I do not accept insurance:

1. The insurance companies are looking out for themselves, not my clients. The insurance companies have the ability to look at my notes treatment plans and outcomes and determine whether or not my client’s therapy is a medical necessity. Insurance companies are in the business of making money. Therefore, it is in their best interest to limit the number of sessions that I can have with the client regardless of whether or not my clients have met their therapeutic goals.

2. Insurance companies assume that the best therapy is brief therapy. To a certain extent, I agree. I don't believe that clients need to get in therapy and stay in therapy forever. This approach to therapy fosters an unhealthy dependence on the therapist. While I believe in establishing a strong therapeutic alliance, establishing goals, creating a workable plan to achieve these goals, and staying focused on implementing that plan, sometimes a course of therapy lasts more than six to twelve sessions.

3. I disagree with the assumption of illness that insurance companies require for providing therapeutic services. The diagnosis of Major Depressive Disorder, Social Anxiety Disorder, or Generalized Anxiety Disorder (and others in the DSM) are considered a medical diagnosis. Treatment then must be a medical necessity. There are some diagnoses that are not deemed serious enough the warrant therapy by the insurance company so they deny these claims. If a person wants therapy, a more serious diagnosis that is reimbursable is required. Unfortunately, some therapists engage in this behavior, but it is unethical and can have potentially negative consequences for both clients and therapists.

4. From a pure self-interest standpoint, accepting insurance cuts into my bottom line. For example, let's say that my fee is $200 per session (it's not, but to make the math easy I chose that number). Let’s say that I agree to see ACME Insurance company’s clients for $60 per session and the client is responsible for a $40 copay. That means my hourly rate is reduced from $200 to $100. That's a 50% reduction in income. Would you, or anyone, be happy with a 50% income reduction?

5. In order to make up for that loss of income, I would have to increase the number of people that I see each week. In other words, I would have to double the number of people that I see each week to make the same amount of money. This would very likely lead me to deliver poor-quality services and increase my likelihood of burnout.  Like you, I want to love the life I live.

6. When you take insurance money, you have to work twice for your money. So, the real cost to me is that I lose $100 per hour plus I have to work another hour in order to get reimbursed by the insurance company, thus reducing my actual hourly rate to $50. Now, $50 per hour may seem like a lot of money, and it is, but it is 25% of what my original hourly rate would be. Of course, I could pay a medical billing company to handle my insurance claims for me, but that would reduce my income by another 10% or so. Additionally, insurance companies frequently do not pay therapists for three to six months after a claim is made.

7. Sometimes, insurance companies will deny claims after the service has been rendered. This is called a claw back. In essence insurance companies will stiff therapists for work already performed.  If you or I pump gas and drive off without paying for it, the police will track us down and take us to jail. But insurance companies do the same thing with impunity. Clients are still responsible for the full amount of therapy, so this puts the therapist and client in a very awkward position that can have very negative effect on the therapeutic relationship.

In short, using insurance is bad for the client and it is bad for the therapist. Insurance companies are not looking out for the best interests of their policyholders. They are in the business of making money. Is insurance a sometimes helpful necessary evil? Absolutely, but their goal, like all businesses, is to maximize profits by increasing income and reducing expenses. Unfortunately, in the insurance business, people’s lives and well-being are at stake.