Why Not Accept Insurance?

Here’s what I’ve learned from my colleagues:

  • More work for less return: The insurance companies require reports and will then determine if the client is eligible for benefits. Often, the insurance company declines the initial request for coverage. The therapist will then need to call and discuss the case with the insurance company. However, this typically involves sitting on hold for a while, between 10 and 40 minutes. For many insurance companies, payments (copay plus what the insurance company pays) range between 40% and 60% of the going rates for therapists.

  • Some services not covered: Family counseling and marriage counseling are services that are rarely covered by insurance plans. Also, other services, such as helping a client grow beyond their current limitations are not usually covered. Thus, when a client initially seeks counseling, this aspect may not be well understood. Additionally, the nature of the sessions may change over time where a covered service morphs into a different service. This can add significant complexity to the therapeutic process.

  • Limitations: Even if the client and the therapist see a need to continue counseling, the insurance company can choose to limit/halt the therapeutic work. This can interfere with the progress that a client was making in their healing journey.

  • Decision Reversals: Therapists have been charged thousands of dollars after the insurance company decides that the client is actually not eligible for benefits. Thus, after many payments have been made, the insurance company may decide that none of those payments should have happened. In that case, they expect the therapist to return all of the funds. This seems to have no time limit. Thus, the counselor ends up taking on a significant business liability. Please note that the client is legally on the hook for the total bill, which could be crushing.

Example Colleague

Even though this video is intended for therapists who own their private practice, I think the lay person can easily understand how the issues affect them. It covers this one counselor’s experience with insurance companies. She lists the pros and cons of accepting insurance. Her story seems to be the norm in the counseling field, which is why so few counselors accept insurance.