Healing on your terms: The Implications of Insurance & Why therapists opt out
One of the most common questions that prospective clients have when exploring therapy options is: “Do you take insurance?” These days, more and more clinicians in private practice are opting out of insurance. The principles of insurance are well intended to ensure equal access to treatment, essential health benefits and refinancier relief to those seeking mental health support. However, as with all things, insurance process holds its complexities and limitations. This article is written to help provide understanding as to why therapists may not accept insurance.
reasons why a therapist may not take insurance
1. Insurance dictates the duration of healing journey and treatment.
Often when folks bill insurance for therapy, it is the insurance company that holds the power in determining how many sessions are covered in your treatment. In reality, each human being is different. Some folks are able dive in deep and metabolize the experiences at hand rather quickly, but more often than not (especially when trauma is involved), the therapeutic process benefits from slowing down, working in body-time and providing adequate space to process and integrate. The imposed limitations of therapy duration restricts the often needed flexibility that allows us to dive beneath the surface layers of any symptom or imbalance to the root. In addition, there are instances where certain modalities are covered while others are not.
2. Diagnosis can be a double-edged sword.
Perhaps a longer article I’ll share soon, is on the topic of receiving a diagnosis. In order to use insurance for therapy, companies require a diagnosis code. (Some insurance companies only cover certain codes, which is problematic in its own nature because it infers a sense of hierarchy around what diagnosis or conditions “deserve” treatment, when in reality I believe all humans have an inherent right to healing). A diagnosis has the ability to heal or harm. For many, a diagnosis can be affirming and validate our lived experience. Labels often calm the psyche, providing a sense of certainty and potential direction when it comes to healing. That said, a diagnosis can also be limited and at times even stigmatizing depending on one’s relationship to the word. We all hold implicit understanding informed by the unique mix of our socio-cultural upbringing and in reality the labels we identify with are nuanced with layers. At times labels can keep us stuck in an expectation as opposed to uncovering the multidimensional nature of one’s being.
3. Confidentiality & privacy concerns.
When working with third party payers such as insurance companies, what is shared in the therapeutic container is written in your life long medical records (specifically diagnosis and treatment notes). For some this may not be a concern, but others may feel inclined to limit access to their records from employers or other insurers.
4. Unsustainable energy exchange and the impact on the quality of care.
Money, time and effort are all forms of energy. Often when working with insurance companies, the financial reality leaves many therapists drained of these energetic resources to hold space effectively. Why? Many reasons. Most therapists in private practice are solopreneurs - meaning they manage all facets of the business beyond the heart-led work of therapy itself. In that, there are hours of unpaid labor in admin work which includes lengthy paperwork, in depth reports on treatment, back-and-forth communication and dealing with claims / appeals. Reimbursement for treatment is often significantly lower than marketplace value, thus requiring therapists to take on greater caseloads in order to make a living… the recipe of burnout.
There are a myriad of reasons why a therapist chooses not to work with insurance from the unsustainable energy exchange to the lack of flexibility in treatment approaches, duration and care. Ultimately it is a personal choice, but hopefully the above provides insight into the “why” behind the choice.
I want to acknowledge that for many, insurance makes receiving therapy and mental health services accessible. Undoubtedly the cost of therapy can be quite an investment (perhaps another article to come explaining why). That said, I am committed to finding more equitable models of providing services, which is why you’ll find a sliding scale structure on my rates & free resources on holistic wellbeing and referrals for affordable therapy.
The way I see therapy & coaching work is that it is an investment one makes in oneself that impacts our widening circles of relationship. The work we choose to lean into, undeniably changes us from the inside out. When we discover ways to access inner stability and live from a place of empowered awareness, we engage with work, love, life and others in more meaningful and kind ways. It’s a ripple effect.