As a client and patient myself, I know it can seem disappointing or frustrating when a provider doesn’t take my insurance plan.  I want to provide some insight into why I have chosen this path after 11 years in private practice (and after trying working with insurance!)

 

1. Diagnosis

        In almost every case, insurance companies require a diagnosis code to process your claim. As a clinician there are two things that give me great pause about this requirement.  I have seen firsthand that many clients are discouraged and sometimes even set back in their treatment by a diagnosis that they feel comes with stigma or a poor prognosis or triggers painful associations. The label of a psychiatric diagnosis is not always helpful and I believe strongly in doing no harm to clients.  

       Second, there are many people who come to therapy who simply do not qualify for any diagnosis but benefit greatly from counseling.  I would never want to discourage people who have no diagnosable pathology from seeking help in challenging seasons of life or crises or to address past trauma because they know they have to receive a diagnosis to have Insurance pay for treatment.  As well, ethically, I do not want to diagnose people who do not truly meet the criteria for any diagnosis.

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2. Limitations on treatment times and types

         Insurance can at times mandate or choose to cover only certain modalities of treatment.  I much prefer to be client-centered and try to stay well practiced and educated in numerous types of treatment interventions so that I can be nimble and attentive to the needs of various clients with various needs that can change session to session.  Being hemmed in by certain prescripted treatment methods does not serve the clients I work with well and them receiving the best treatment I can provide is my priority.

         Along the same lines, Insurance Companies can also set limits on how many sessions they will approve for a client often based on diagnosis and treatment method.  A client being refused services mid treatment is often not helpful at all to their recovery or wellbeing.  It is also not a good use of time or energy trying to justify why a client needs more sessions on a regular basis so I prefer to trust my relationship with the client and assessment of their needs as a guide rather than Insurance mandates.

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3. Clerical time vs Clinical Time

        In my experience while paneled with Insurance Companies, I found that I was spending a significant amount of time on forms, attestations, claims, specific note and treatment plan requirements and other clerical work that took away from time I could be spending with more clients or in professional development to deepen my skills and knowledge.  Even in using a company that handles some of that work, there was still much more clerical work involved that took time away from my passion for the clinical work and sitting with clients.  Without that oversight I am still a meticulous note maker, biller, and track client’s progress in their files every session, however, the time necessary is much less without the Insurance paperwork which benefits my clients and my work/life balance.

 

 

Sliding Scale Alternative

      My entire career, I have offered low fee sessions for clients with financial need.  I have had supervisors call me a “bleeding heart” for how often I was offering to see clients for a quarter of my regular fee!  Over the years I have found a set sliding scale based on income to be the best way to offer fees that fit client’s budgets.  I am happy to provide that for any client that asks and keep spots available for this purpose.

 

Finally, I am thankful that Insurance Companies exist and provide the coverage they do, however, the system often fails clients and clinicians when it comes to mental health.  For all of these reasons this is the path I have chosen.  I am thankful to serve clients of all socioeconomic backgrounds and that has always been true of my practice!