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Happy April! Today, I want to talk about a topic that often comes up in therapy circles: why some therapists choose not to take insurance. As of March 2023, I am officially not accepting insurance and am considered out-of-network. It can be frustrating to realize that your therapist doesn’t accept your insurance or is going out of network, but there are a few valid reasons behind this decision.
First and foremost, it’s important to understand that insurance companies have their own rules and regulations when it comes to mental health coverage. They may limit the number of sessions you can have, require specific diagnoses to be made, or dictate the type of therapy that can be used. This can be challenging for therapists who want to provide the best possible care for their clients without being restricted by these requirements. Insurance companies are less interested in what treatment modalities, meeting frequencies, or extra collaboration is helpful to the client and more interested in what is most helpful for their wallet. Sometimes, what the insurance company wants to pay for just isn’t what’s in the best interest of you as the client!
In addition, the process of working with insurance companies can be time-consuming and bureaucratic. Therapists have to fill out paperwork, make phone calls, and wait for reimbursement – all while balancing a busy caseload. This can take away from valuable time that could be spent with clients or on professional development. Therapists are also typically paid very little by insurance companies, usually between 50-60% of their standard fee. While your therapist may charge $120 as their standard rate, that means insurance companies would only pay the therapist $60-70. Less income from insurance companies means more clients are required to fill the therapist’s case load so the therapist can support their families, which can quickly lead to burnout and subpar care. We have bills to pay too!
A therapist’s standard rate usually reflects the amount of training and experience the therapist has in their field. Being a therapist can be just as expensive as any other business owner. In addition to getting a bachelor’s degree, master’s degree, completing 2 years of associate licensure in which you’re paid at a lower rate, therapists also have to think about continuing education requirements, license applications and exams, liability insurance, electronic health record programs, trainings, and therapy supplies (shout out to my play therapists!). In addition to these therapist-specific expenses, we also have typical business expenses like rent, utilities, office supplies, accounting fees, and technology supplies. While the $120 can seem like a big expense, the therapist is not taking all of that home.
Another factor to consider is the issue of confidentiality. When you use insurance to pay for therapy, your insurance company has access to your diagnosis and treatment plan. This means that your personal information could potentially be shared with others, such as your employer or other healthcare providers. For some clients, this is a dealbreaker.
So, what does this mean for clients who want to work with a therapist who doesn’t take insurance? Usually, it means paying out of pocket for sessions. While this can be a financial strain, it also means that you have more control over your treatment. They can work with a therapist who specializes in the issues they’re facing, choose the type of therapy they want, have a greater say in how many sessions they have, and can even decline to have an official diagnosis. Some clients don’t need a diagnosis and come to therapy, so they have someone to talk to!
If you have insurance and your therapist is going out of network or the one you want to work with isn’t in your network, be sure to check with your insurance about out-of-network benefits. These benefits are included in most insurance plans and can be a good option to use your coverage. When an in-network therapist bills your insurance, you pay your co-pay, your therapist sends a claim to your insurance, and your insurance reimburses your therapist the remainder of their contracted rate (remember that 50-60%?) by check or direct deposit. When you use out-of-network benefits, you pay your therapist’s full rate, your therapist provides you a fancy receipt called a superbill, then you submit a claim to your insurance, and your insurance reimburses you directly. Each insurance plan is different, so it is difficult to say exactly what you’ll receive back, but you can use the out-of-network reimbursement calculator here to get an estimate of what your costs will be. As a general rule, most plans reimburse between 60-80% of the cost. For more information about using out-of-network benefits, click here!
It’s also worth noting that many therapists who don’t take insurance offer sliding-scale fees or other payment options to make therapy more affordable. This can be especially helpful for clients who are facing financial hardship. If you want to attend therapy but are struggling with the price tag, don’t be afraid to ask your therapist about sliding scale, discounted, or pro-bono (free) options.
While it may be frustrating to learn that your therapist doesn’t accept your insurance, it’s important to understand the reasons behind this hefty decision. Ultimately, therapists who choose not to take insurance do so in order to provide the best possible care for their clients, without being limited by outside regulations or bureaucracy. If you’re considering working with a therapist who doesn’t take insurance, be sure to ask about payment options and any available resources to help make therapy more affordable. We want to help as much as we can!
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