Why I do not accept insurance
As a licensed therapist, I have made the choice to intentionally divest from accepting insurance for reasons rooted in personal, ethical, and financial considerations which I’ve elaborated upon for the sake of transparency. Health insurance companies in this country are for-profit entities which, unfortunately, prioritize capitalism and wealth over the wellbeing, preventative care, or holistic and cultural considerations of the individuals who they are supposed to service.
My intention with this choice is to remove myself as a form of protest against a multi-billion dollar, gatekeeping industry which oppresses and exploits individuals in favor of profit.
I also want to name the complexity of existing and working within an imperfect system (the mental health field in general) that can perpetuate harm, especially to those with historically under-resourced identities. There’s no perfect way to do this, and I’m committed to continued growth and understanding.
Diagnoses and the medical model
Insurance companies treat mental healthcare the same way as physical healthcare, which is to say that mental health concerns are labeled as problems to be fixed or cured, or something “wrong” that needs to be made “right”. This lacks the nuance and complexity of the impact that trauma, a sick society, and unique experiences or identities have on an individual. I believe that the therapeutic process should be relational, not based on a narrow concept of “disorder”. Furthermore, this perspective has significantly harmed BIPOC communities, as the mental health industrial complex services white supremacy.
Insurance companies require a mental health diagnosis in order to provide coverage for therapy services, which remains on your medical record. Ethically, I am not comfortable with diagnosing someone with a mental health disorder upon meeting them for the first time; in fact, I’d argue it’s not possible to accurately do this. Diagnoses come from the DSM-V, which has a long history of racist, sexist, and homophobic etiology.
Two things are true here (such a therapist-y thing to say): diagnoses can be extremely validating and important in providing a framework for care and self-awareness; AND, they also have the ability to be stigmatizing, pathologizing, ableist, and can impact coverage and quality of life (for example, certain diagnoses can factor into employability and life insurance coverage).
Limitations
If a person is approved to work with an in-network therapist, the insurance company limits the number and duration of sessions that are covered based upon the received diagnosis. This is incongruous with my style of therapy, which is highly collaborative and eclectic - what works for one person may not work for another, as we are not monoliths. It takes time to build the rapport and trust needed to determine the best course of action.
Trauma is sometimes described as experiencing “too much, too soon”; therefore, my perspective as a trauma therapist includes eliminating a rigid timeline, allowing therapy to be relational and at a regulating pace. Insurance companies require that therapy is proven to be a “medical necessity”, which thereby limits creativity and flexibility. It also means that it is possible that a client is cut off from services before they are ready and resourced to terminate therapy. This does not align with my professional style, and I believe it robs clients of their agency to determine the timeline of care.
Time is money
Insurance companies notoriously deny claims or create barriers for therapists to be paid. In addition to this devaluing pattern, working with insurance often requires lots of time and effort devoted to paperwork and justification for services. This is time that could be better invested in continuing education, research, and therapist self-care.
Boundaries
A huge support in burnout prevention is being fairly compensated, and maintaining a professional and personal boundary as someone who provides a service (in other words: a radical notion that therapists should be paid for their work!). Insurance companies often take months to pay therapists, and can also conduct a claw-back or retroactive payment denial (aka: taking back money earned). With this being at no fault of the insured person, it does run the risk of resentment and a felt sense of exploitation of the therapist: a recipe for burnout.
OPTIONS FOR ACCESSIBILITY
Superbills
If you want to try and use your health benefits with an out-of-network therapist, one option is to ask for a Superbill. This is essentially a detailed receipt that you can provide to your insurance for potential re-imbursement. When I provide these, I prioritize transparency about a diagnosis being on the bill, and discuss what this means with my client so that they can fully consent. The client is responsible for full out-of-pocket costs at the time of service, and then has the choice to submit to insurance.
Here’s a highly detailed guide outlining exactly what to ask your insurance company to determine your benefits.
Other ways that I attempt to increase access to my services is to provide thoughtful sliding scale options, and create offerings rooted in donation-based, affordable community care.
Outside of my own practice, I recommend seeking out counseling with an interns. Interns are unlicensed graduate students, working towards their required hours to be eligible for licensure. They typically offer free or reduced cost sessions, and meet regularly with a licensed supervisor. If interested, I recommend looking up Master’s in Social Work or Clinical Mental Health programs in your state and reaching out to inquire.
Mental health funds & scholarships:
Resources for Queer & Trans folks:
If you are curious to continue reading about this topic, I highly encourage investing in the work of Dr. Jennifer Mullan.
Related stuff:
https://www.decolonizingtherapy.com/
https://www.kindman.co/blog/why-not-to-use-insurance-to-pay-for-therapy
https://www.liberationhealingseattle.com/mental-health-therapy-out-of-network-benefits-guidee
