Do you take insurance? This is a question I hear often. No. That is my answer. This surprises some people, potential clients and peers alike. There is no doubt taking insurance would broaden my referral base. More people would be likely to give me a shot if their insurance would pay for my services. It wouldn’t really have any financial downside for me because I could always adjust my rates to play the insurance game like so many providers do. But I don’t want to play games. And that brings me to why I don’t take insurance.
Insurance is a system designed by companies whose primary goal is to make money. Therefore, insurance companies make rules for their policies and policy holders that dictate what services policy holders can receive, how many services they can receive, and under which conditions they can receive services. These rules are meant to protect the insurance companies bottom line. These rules frustrate service providers so the providers try to find ways to manipulate the system so they can provide as close to ideal services as possible and still receive compensation from the insurance company. The insurance companies catch on to what providers are doing and change their rules, and the cycle goes on and on. I know this is how the insurance system works because I have billed insurance and worked for agencies that took insurance in the past.
I do not take insurance because doing so forces me to compromise my values as a therapist. First, billing insurance requires me to give a diagnosis. Insurance will not pay for services without a mental health diagnosis, and they will only pay for certain diagnoses. What if you do not have a significant mental health disorder and are seeking therapy for other reasons, say to improve a relationship or just be happier with who you are as a person? Well, that leaves us with two options. One, I can decide to not give you a diagnosis, which means your insurance won’t pay. Two, I can pick a diagnosis that sort of resembles some problem you’ve told me about and justify giving it to you by telling you and myself that it’s kind of close and it’s the only way insurance will pay. If you’re thinking option two sounds unethical, I agree with you. But it happens all the time. I don’t want to be forced into that ethical dilemma.
Second, billing insurance limits the types of services I can provide and how long or how frequently I can provide them. Different plans cover different services, but they all have limitations. You have a drug problem, need lots of accountability, and I think group therapy would be great for you? Too bad, your plan will only pay for individual services. You’re super motivated and want to come in twice per week? Too bad, your plan will only cover one hour per week. You’ve made great progress over the past three months and want to continue for another few months to see just how good things can get? Too bad, your plan will only pay for 12 sessions. You get the idea. Billing insurance limits what I can do and what you can get.
I believe you should be free to receive the services you need and desire, and I should be free to provide the services I think are most appropriate. In many cases, billing insurance threatens that freedom. Obviously, there are people with specific disorders who require specific treatment regimens that insurance will cover. For those people, having their insurance cover their treatment is a great idea. I’m just saying, for me, I prefer to operate without the limitations. I want us to be free.