Why Therapists Are Moving Away From Insurance Companies

Published on 
October 23, 2023

Most people who have insurance prefer to utilize it for seeking therapy with the reasoning, “I pay for it, I might as well use it.”  Makes perfect sense.  And there are other things to consider.  I believe in being able to make an informed decision so let me tell you some other things you may want to consider.

It will be more difficult to find a therapist who accepts your insurance.  Not only do insurance companies limit the number of therapists on their panels, but fewer therapists are accepting insurance.  There are many different reasons why some therapists don’t accept insurance (or only accept certain ones).  Here is the long and the short of it:  Dealing with insurance is a pain.   I mean, have you tried to call your insurance company lately?  It is much easier and less time-consuming, to accept payment directly from my client (takes all of 2 minutes), than it is to work with insurance companies (which can take hours).    Not only is there the time and energy investment to call and verify your benefits (which can be rather lengthy) but there is no guarantee that the information they provide is accurate- crazy but true.  Sometimes claims are denied which leads to frustration and more time investment.  

Additionally, most insurance companies only cover medical necessity.  This will require a diagnosable condition.  Many people don’t want a diagnosis on their record.  More importantly, many people don’t qualify for a diagnosis.  When you think of mental health care coverage, it will help to think of it as you do physical health care coverage.  Your physical coverage most likely provides some coverage for illness, injuries, etc.  Your health insurance coverage probably does not cover wellness services like vitamins, healthy food, gym memberships, and other preventative measures.  Mental health coverage is similar.  Insurance typically only reimburses for diagnosable conditions such as depression and anxiety.  Often, they do not cover for the more common everyday things like improving communication or “adjustment disorders” which is an emotional reaction to a stressful event.  They also don’t usually cover couples counseling.  While some therapists prefer to play in the gray, or “work the system”, others (including myself) don’t find that approach ethical.  

Perhaps the biggest reason many therapists prefer to avoid working with insurance companies is their low reimbursement rate.  I mean, if it is such a hassle to deal with them and they can deny claims, the least they could do would be to pay a decent rate and/or issue regular “raises”.  Unless I take the time to renegotiate my fee with them, insurance companies are happy to reimburse me at the same rate for years.  I didn’t get into this field to get rich, but I certainly did not expect to be poor either.  I mean, when I am paying my dog groomer twice as much as an insurance company is willing to pay me…nothing against dog groomers.  It can be a 'ruff' job… but I digress.

The downside of paying for your therapy out of your own pocket is that it will likely (but not always) be more expensive.  However, it is an investment in your health and may be tax deductible (ask your tax professional).  The upside is you will oversee your healthcare decisions.  Moreover, you will not be required to have a diagnosis.  By paying for your own treatment, you and your therapist will determine the type of treatment that is best for you, what goals you want to achieve, how to reach those goals, how frequently to meet, etc.  You will have the power to make your own decisions without the input or restrictions of your insurance company. To sum it up, working with insurance companies is usually a hassle and takes time away from hands-on client care.  I would rather put my energy and effort into your direct care than wait on hold, deal with poor customer service, or go through an audit with your insurance company.  I have started to cut back on the insurance companies I accept.  This decision will enable me to provide my clients with higher quality care because I won’t be spending my limited amount of time and energy with the insurance companies.

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Mary R. Stanley, LMFT | 5053 La Mart Dr. #207 Riverside, CA 92507 | Google Map