Why don’t we accept insurance if we provide covered services for mental health?
Good question. Allow me to explain...

1) Insurance Companies are Sketchy

Towards the beginning of my career, I met a client who had insurance with a very popular Texas insurance company - but they couldn’t afford their co-pay due to other extenuating circumstances. This person needed help. Was I allowed to give them help without charging them their co-pay? Insurance rules say NO! I also discovered that when a therapist or other healthcare provider for that matter, signs an agreement with insurance companies you are also agreeing NOT to accept a lower rate or sliding scale for clients that have insurance.

People’s health insurance is so expensive now that it’s part of the reason they can’t afford treatment. Mind blowing. This is a systemic problem, that I am not qualified to give any answers to, but what I am qualified to do is keep that bad juju out of my space. Insurance Companies have a place. Their rules are meant to protect from insurance fraud which raises premiums, but I will not allow an insurance company to dictate to me how much I or my therapists are worth, or whether or not my client should be allowed to continue treatment - which brings me to my next point.

2) Insurance Based Treatment Plans

When therapists take insurance, they are required to use treatment methods and amounts that are covered by your plan. This means they have less say in how to treat you based on your specific and individual needs.

A great example might be the loss of a pet. Research shows that neurologically for some people, losing an animal looks the same in their brain as someone who has lost a child. Our brains do not care what other people’s opinions are about whether or not it should grieve as deeply as it does.

An insurance company may say that this person, regardless of event - does not qualify for therapy services or is only allowed to see a therapist once every couple of weeks or perhaps, only 12 times a year. It’s the same - even if you lost a child.

They are also dictating whether or not you can receive things like small animal therapy, equine assisted therapy, group therapy, and even how many MINUTES a therapist is allowed to spend in session with you at any one time.

Your plan is your plan and no matter what life throws at you, your therapist is required to work within the limits of the insurance plan if they’d like to be paid for the service.

Also required is that the therapist must send your diagnosis to the insurance company in order to receive payment. What if you don’t have a diagnosis? What if you’re seeing a therapist for skills building, relationship issues, or personal growth? Unless you meet the criteria for certain diagnoses, your insurance plan could dictate that you do not need treatment and therefore will not pay for your services.

3) Less Confidentiality

Everyone knows that what happens in therapy stays in therapy. Your therapist is required to keep everything you say confidential no matter what, right? Wrong! When you use insurance to pay for therapy, your therapist is required to provide your diagnosis and possibly treatment notes to your insurance company in order to get paid. This undermines the basic premise of therapy and also gives a lot more people access to private health information about you. If this is news to you, you’re not alone. It’s all written into the HIPAA document you get when you start therapy (or go to any doctor’s office) but most people don’t read all the fine print.

This is also true of using Out of Network Benefits. When we provide you with a superbill there are specific codes on this superbill that identify the diagnosis and the type of treatment received down to the minute. For example, for someone with DX: F41.1 billing for 90837 this means we are sending your insurance company the following:

Billing for Psychotherapy, 60 minutes with patient treating for Generalized Anxiety Disorder.

Typically we use code 90834 on our superbills which means: Psychotherapy 45 minutes. Time range: 38 to 52 minutes.

So a therapist who spends 38 minutes in session with you gets paid the SAME AMOUNT as someone who spends 52 minutes in session with you (refer to number 1 - Insurance is Sketchy).

If the insurance company asks for your progress notes - we have to hand them over if we would like to be paid for our services to you. Although HIPPA is in place to protect you, insurance companies are able to request these documents to insure that the therapist is not committing insurance fraud by filing for unnecessary services. Who dictates what a necessary service is? At The Hope Place, we work with the client to form an individual treatment plan. We are able to do this because insurance companies are not able to tell us if your service is necessary or not. (See Number 2)

4) Therapist Burnout

There are fantastic therapists and facilities out there that accept insurance. This is part of how they sustain the community and continue to provide care while supporting their families. Insurance companies are also the main referral source for many therapists, thereby eliminating the need for a marketing budget. When we opened in 2019 we did a good bit of marketing to get the word out that we existed. The team that I’ve been blessed with has done an amazing job with treating their clients to the point that we get a good amount of word of mouth referrals. Especially for people who have tried therapy before and felt it was unsuccessful.

At The Hope Place, therapists contract with us to see clients. We offer them only the amount of clients they request and that they know they can handle at the rate that they choose based on their family’s budget and their experience/licensure.

We want our therapists to be rested and focused on your case and your treatment plan instead of focusing on filing for insurance payments. We want our therapists to feel excited about learning new treatments and developing new programs for you. We do not want burned out, over worked therapists - and let’s face it. Mental Health for everyone has been a sinking ship the past couple of years. We do what we can to ensure that we’re not burning out the helpers here, and part of that plan is to not accept insurance.

5) Freedom to Serve

What happens if all the therapists that accept your insurance are full, but you know that your family’s budget is unable to sustain a cash pay therapy session? What happens if your deductible is so high that therapy sessions are out of the question?

Since we don’t take insurance and the therapist dictates their rate, we are able to contract with therapists who prefer to use a sliding scale! This would not be possible if we did accept insurance. It is also possible for us to provide the community with very low cost services to promote therapy student engagement. For more information about our student program - click here. It even allows us to maintain a non profit called Pine Trees Counseling Center that offers a low sliding scale to Veterans, First Responders, their families and others in the community.

I hope this clears up why we do not accept insurance, and frankly, do not plan to.

This blog post is adapted by Rachel Terry LPC-S from Dr. Sarah Schewitz’ article “The Real Reasons (That Nobody Tells You) About Why Therapists Don’t Accept Insurance.”