Why NOT Take Insurance? (According to Therapists in Private Practice)

To take insurance or to not take insurance. That is the question…

…that has been asked to death.

Many blogs and therapist help sites have covered this question, and for a good reason: The decision will have a major impact on your practice.

It’s not just about the money. Considerations related to ethics, privacy, the current insurance environment, personal choice and more all play a factor. It’s a complex question, and every provider will have a different answer.

This question comes up a lot at conferences BreezyNotes attends and discussions in which we participate. We realized we had a valuable, knowledgeable resource in our customers and other connections, so we decided to ask them.

In this second of two articles we cover why providers decided against taking insurance. We hope their insights will help you.

Why Not Take Insurance

1. Insurance may not make sense for your client demographics.

It’s possible that most of your potential clients don’t have health insurance. Maybe they make too much to receive subsidized insurance through the government, but not enough to afford coverage. Or maybe they just decided to pay the penalty rather than purchase insurance.

For many years, Carla Maldonado, MA, LMFT of Un Pueblito Counseling didn’t take insurance: “I work with an immigrant population (Latinos) and unfortunately many of them are not able to receive health insurance due to their immigration status… For the first 4 years of my practice I did not accept insurance for the reason that 90% of the clients that contacted me for services did not have insurance.”

When so many of your clients don’t have insurance, it makes no sense to go through the long and expensive process of getting paneled. So when you’re starting your practice, try to get a sense for how many potential clients have insurance, and if that number makes taking insurance worth it.

2. Insurance may not cover the services you provide.

While the Affordable Care Act made the coverage of mental health care mandatory for insurance companies, not all mental health services are covered.

Lauren Robbins of WildTree Psychotherapy does take insurance. But, she also provides many services that aren’t covered.

“Sometimes people seek services for relationship challenges,” says Lauren. “And apart from [the relationship challenges], there really is not a diagnosable mental health disorder. A diagnosis is required for insurance reimbursement.”

If you have a specialized niche, make sure to look into multiple insurance companies and determine if your services will be covered. If most will not cover your services, why expend the effort?

3. Insurance compromises client privacy.

Clients expect their protected health information to stay between you and them. But with insurance, there’s a third set of eyes.

“Sometimes there is concern about privacy,” says Robbins. “And despite HIPAA laws, insurance companies still not only maintain information on diagnoses, but also may, at times, request full service records.”

This is one of the reasons Heather Verjovsky, MA, LAMFT, and her business partner decided to open two relationship and sexuality-based mental health clinics: one that takes insurance, Cedar Hill Therapy, and one that doesn’t, SkyHill Therapy.

4. Insurance reduces your flexibility when treating clients.

In order to be reimbursed by an insurance company, you need to follow their standards for care. That applies even if the standard doesn’t work for your client.

“Not using insurance also allows for more flexibility in treatment approaches and session lengths, which can be helpful in resolving issues, especially when traditional approaches have not been effective,” comments Robbins.

If the insurance company’s approach doesn’t work, you may have to refer that client out of your practice. Or, you may have to switch to private pay.

5. Taking insurance makes billing more complex.

Electronic Health Records applications like BreezyNotes EHR have made billing insurance significantly easier, but bringing insurance into the mix still adds a level of complexity to getting paid for your time.

For instance, another reason Verjovsky opened SkyHill Therapy as a private pay clinic was that collecting payments is simple: They charge their clients a single rate and the clients pay it.

 

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Want to take insurance without all the hassle? Sign up for BreezyBilling, our professional mental health billing service.

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With insurance, you have to collect money from two sources: your clients and their insurance company. And then you have to figure out how much to collect. There are delays in payment. Takebacks. What is the client’s deductible? How about their copays? Does their employer assistance program limit how long they can stay in therapy?

You may find yourself spending a lot of time navigating the pitfalls of insurance, time you could spend marketing your practice, hosting trainings, or seeing more clients.

Those are all the reasons our customers decided against insurance. Want to hear about why other customers decided to take insurance? Check out part one of this series.

Our Sources

We appreciate the time our customers took to offer their informed opinions on this debate. We hope you’ll take a moment to find out a little bit about them:

• Carla Maldonado, MA, LMFT
  Owner, Un Pueblito Counseling
  Solo practice
  Learn more about Un Pueblito on their website and their Facebook page
• Lauren Robbins, MS, LPCC, LADC
  Clinical Director, WildTree Psychotherapy
  Nine-provider psychotherapy practice
  Learn more about them on their website, their Facebook page, and their Twitter page
• Heather Verjovsky, MA, LAMFT
  Co-Owner, Cedar Hill Therapy
  Six-provider psychotherapy practice
  Learn about them on their website, their Facebook page