Why I Don’t Accept Insurance
I love being a therapist. There is nothing like seeing your clients thrive. I feel so grateful to have the opportunity to witness healing and growth regularly. However, there is one thing I do not like about the mental health field- insurance. I don’t accept insurance. This is an important boundary for me as an ethical obligation to my clients and a self-care obligation to myself. Accepting insurance for psychotherapy can be problematic in multiple ways, some of which I explore below.
Insurance companies require therapists to provide a mental health diagnosis to justify medical necessity. There are a couple issues with this. First, you might not meet the criteria for a diagnosis that insurance would cover. Second, any diagnosis goes on your permanent health record.
Many therapists encounter clients facing challenging life situations that may not qualify as mental health disorders warranting insurance coverage; people often seek support for issues like relationship counseling, life transitions, or coping with change. Some people just need some extra support. While these experiences can be distressing and warrant therapeutic attention, they might not require a clinical diagnosis, and insurance companies will not pay for treatment without a diagnosis.
If you do meet the criteria for a mental health diagnosis, it can stick with you for life, and it can impact you negatively. Your diagnosis can be accessed by insurance companies and government agencies. This leads to my next issue with insurance- privacy and confidentiality.
In general, therapy is private and confidential. There are laws in place to protect privacy. The Health Insurance Portability and Accountability Act (HIPAA) includes provisions for privacy to protect individuals' medical records and personal health information, including mental health information. Clinicians and health insurance companies are legally bound by HIPAA rules. However, there have been many HIPAA violations involving insurance companies.
When insurance is used to pay for therapy, insurance companies have access to psychotherapy notes and treatment plans to determine what level of care is covered. Insurance companies do this because they’re the ones paying the bills. They routinely request access to private health information. Once insurance companies are involved, therapists have very little control over who sees your personal and private health information. I’m unwilling to reveal confidential, potentially damaging information to the insurance company to justify my clients’ needs for services. Avoiding interactions with insurance companies protects the confidentiality of my clients.
Disclosing your information to a third party makes it easier for your information to not be protected once it leaves a therapist's hands. If you need a background check for a government job or to join the military, if you are involved in court/legal troubles, or filling out applications for life or disability insurance, your diagnosis could be disclosed by your insurance company.
Insurance companies are also in control of what treatment is covered. Essentially, they’re the ones that call the shots. They get to decide how long they will cover your therapy. If they feel you no longer need it, they will not pay, often without any warning. I’m not willing to have my clients’ treatment cut off or limited by an insurance company.
The last reason I do not accept insurance is a personal boundary I hold for myself. Insurance is a headache. Insurance requires a lot more paperwork and time, for often less than half the reimbursement for session rates, if any reimbursement at all. There are often claim denials, delayed payments, and rate cuts. This additional time fulfilling the demands of insurance companies is time that I can be working with my clients or spending with my family. As much care and compassion as I have for my clients, I have to be able to provide for my family.
There’s not really a great solution when it comes to insurance and mental health, however, there are some options.
Some health insurance plans will allow for reimbursement for out-of-network benefits. Additionally, oftentimes employers provide health savings accounts (HSA) — which are pre-tax — and are usually accepted by most clinicians (including myself.)
The choice is yours if you choose to use your insurance. I am hoping this information will help you make more informed decisions for your mental health care. There is a lot to consider when it comes to paying for mental health services, and if you need to use your insurance, it is understandable! I make choices for myself and my business that are best for me and my family, and I want you to be able to do the same for yourself.