Health insurance & Mental health therapy
The topic of mental health coverage by insurance companies is a big one, which is being talked about more and more lately. As therapists, we have a certain unique perspective of the challenges and benefits that health insurance can offer for our services. I’m no expert on health insurance- but I have learned a lot over my time working as a mental health professional that you may not be aware of. Here’s what I’ve learned as an in-network provider:
First, insurance companies actually dictate the amount of time you meet with a client. Therapists are reimbursed at different amounts depending on the time a client is seen. For example, there is a certain billing code for seeing someone for 45 minutes versus 60 minutes. A session that’s 53 minutes and a session that’s 60 minutes are the same code and reimbursed at the same amount. Similarly, a “45-minute session” can be anywhere from 38 minutes to 52 minutes and anywhere in that range would be the same reimbursement rate. Meaning, if you see a client for 50 minutes, that extra 12 minutes is essentially unpaid. Additionally, this does not allow therapists to be reimbursed for more than 60 minutes of therapy. Intensive sessions (usually 80-90 minutes) can be extremely beneficial to clients, however, insurance companies do not recognize these as a billable service.
Second, insurance companies get to decide and dictate to therapists what their services are worth. As private practice owners, we are thoughtful and considerate to set a rate that will sustain our business and our livelihood. However, to insurance companies, it doesn’t matter if you have spent time determining a rate for your services. Two different therapists could be charging $100 and $200 for their services, but paid the exact same amount by an insurance company.
Third, when receiving in-network services from a therapist, clients are required to be assigned a mental health diagnosis upon first meeting in order to file a claim and receive reimbursement for that session. Many mental health diagnoses require months to years of the presence of symptoms in order to meet the criteria, so the expectation that therapists can immediately have a full understanding of a client after one session is unrealistic. I also find that many clients come in to do deep work, process different experiences, or work on relationships and don’t always need or benefit from having a true mental health diagnosis.
Lastly, being in-network with insurance companies comes at a cost to many therapists in private practice. This includes time spent on billing, denied claims, follow-up calls, and interference with client care. A recent article from ProPublica titled “Why I left the network” highlights some therapists’ incredibly challenging experiences working with insurance companies as in-network providers. The clinicians in this article have faced immense obstacles in caring for their clients, sometimes with detrimental effects. While not all therapists have experienced this level of interference, it seems to be more common than not that accepting insurance creates more headaches than benefits for a therapist.
For all of theses reasons and my own personal experiences being in-network with insurance, I have decided to create my practice solely as an out-of-network provider. The main difference here is that I bill clients at my rate, and they can then submit on their own to be reimbursed by their insurance company. This allows me to ensure that I am able to work the hours and schedule I need to sustain myself and my business.
Outside of accepting insurance, there are many ways therapists can provide accessible resources, such as sliding scale rates, group therapy, workshops, free online resources, and other free community engagement events. These are all options I provide through my practice and plan to provide within my community.
If you’re looking to learn more about using out-of-network benefits or receiving any other accessible resources, I’m happy to share my experiences and knowledge.
You can also reach out today using my contact form here to set up a free 15-minute consultation call today to see if we would be a good fit for therapy or ask any questions you might have.
Elizabeth Allen, LCPAT, LGPC, ATR-BC
Creative Pathways Counseling LLC
