Why Do So Many Therapists Not Accept Insurance?

In your search for mental health care, you may encounter a common theme among mental health counselors, websites reading "we do not take insurance" or "self-pay preferred." This can be very confusing and frustrating for clients in the already difficult process of finding the right care. This post aims to provide some information about the relationship between mental health counselors and insurance.

The search for a mental health counselor can sometimes feel like a scavenger hunt filled with confusing jargon and puzzle pieces that will not fit together, one of those pieces being insurance. So, take a moment to pat yourself on the back, take a deep breath, and thank yourself for putting yourself first and starting your process towards mental wellness. Of course, counseling is an investment, and insurance may not always be the best option. As counselors, we have to give you all of the information (informed consent), so let's look at this together.

Insurance Determines “Medical Necessity” 

Insurance companies are rooted in and operate on a medical model. To receive support from insurance companies, a counselor often has to "prove medical necessity." This means that the insurance companies determine which diagnoses and which life circumstances are “enough” to need mental health treatment. Through this model, the following common reasons for treatment are not included: relationship issues (couples or family therapy), developmental/attachment trauma, existential issues, life transitions, personal development, or self-improvement. Since these common reasons for treatment are excluded from the diagnostic manual (the DSM-V), a therapist may have to give you a less accurate diagnosis that then becomes part of your medical record. 

Wait a Second… Not all Mental Health Counseling is Covered?

No, not in the policies of many insurance companies. I would like to spend another moment to clarify that many insurance companies choose whether or not individuals’ therapy is covered based on the diagnosis (or lack thereof). At Obsidian Counseling and Wellness, we acknowledge that there are many reasons that one may benefit from mental health counseling, and each is important. It is unethical to deny an individual treatment based on their diagnosis. See below for a list of questions to ask your insurance provider when considering using insurance, and make sure that the care you are requesting is covered by your insurance plan.

Assumed Illness

As previously mentioned, insurance companies often require the clinician to provide a diagnosis, even if there is not a specific diagnosis that applies to you and your treatment. Through this, insurance companies assume that illness is the sole reason individuals receive counseling. You may be thinking, "that's not too bad." However, these diagnoses become a part of your medical record. Here's an example, you and your partner may seek counseling that focuses on communication or parenting. However, your therapist may still need to provide one of you with a diagnosis to receive reimbursement from the insurance company. 

Less Confidentiality

Your privacy is one of the most important parts of building a therapeutic relationship. In your first session with your mental health counselor, they will remind you of your rights to confidentiality and the limits to confidentiality. This is discussed right at the beginning of treatment because it’s important that you feel safe and able to be open within your counseling sessions.

Insurance-Driven Treatment Plan

Often, insurance companies try to dictate treatment. This includes setting the number of sessions, frequency of sessions, and the type of care provided for the client. At Obsidian, we believe that these choices should be made by you and your therapist. Self-pay provides the flexibility that you need for your care. We acknowledge that each person's schedule and lifestyle are unique and that life is unpredictable. We would like to be able to cater our treatment to you and your needs. For example, an individual may begin counseling to address recent feelings of anxiety but suddenly lose a family member; in this scenario, we would shift our treatment plan to include grief to suit your present needs. 

Burnout and Insufficient Pay

The unfortunate reality of insurance is that many providers who accept insurance are often overbooked and working overtime to keep up. Reimbursement rates are not always consistent with a therapist’s standard rate, which often makes therapists take on more clients than they may be able to handle in order to keep a sizable caseload. In addition, therapists need to apply individually to each provider panel, and each provider comes with its own complex billing process. This means that your therapist is often taking on a substantial amount of work (about 1.5 hours) and providing treatment that they are not being reimbursed for. This practice leads to therapists who are stressed, frustrated, tired and distracted from what matters most- the client and their treatment.

What Are Some Other Options?

 Self-Pay

This option is just what it sounds like. You are paying for the treatment yourself. With this option, a lot of the power is returned to you; you are playing a role in your treatment with the freedom to find the right therapist and choose an individual who specializes in your specific problems and goals. You are also in control of the length of treatment and how often you attend therapy sessions, and your treatment records remain private.

 Out-of-Network Insurance

Many therapists who do not accept insurance will work with you as an out-of-network therapist. For this option, you will pay the therapist directly, and then the therapist will provide you with a document called a "superbill." You then use this bill to seek reimbursement from your insurance company. If you choose this offer, it is important that you first check with insurance (see the list of questions for your insurance provider below). This option is the middle ground between using insurance and self-pay, with the added benefits of finding a provider that is the best fit for you, without the specific constraints of finding a provider paneled with your insurance. 

Sliding Scale

Therapists understand that individuals may experience financial hardship or want to use their insurance for other reasons. Many mental health therapists use what is called a sliding scale. Sliding scale therapy refers to treatment priced based on each person's income and dependents. When a therapist uses a sliding scale, they consider the individual's financial needs, the therapists' licensure, experience, the type of therapy requested, and more. If this option sounds like a necessity for you, ask about this option when inquiring about fees. 

Questions to Ask Your Insurance Company

For some, you may be thinking about your own insurance as you read this, wondering about some of your own policies. Here is a list of questions that you may consider asking your insurance company before starting your mental health counseling search:

For in-network:

·      Is the provider in-network with my health insurance? (Make sure to double-check for your specific plan)

·      Is there a limit on the number of sessions my plan will cover per year? How many?

·      What length of session does my policy cover? (60 minutes, 45 minutes, etc.) 

·      Which diagnoses do you cover?

·      What type of sessions do you cover? (Types of therapy)

·      What is my in-network deductible for outpatient mental health?

·      How much of my deductible has been met this year?

·      What is my copay for outpatient mental health visits?

·      Does my plan require a referral for psychotherapy?

For out-of-network:

·      What is my out-of-network deductible for outpatient mental health?

·      How much of my deductible has been met this year?

·      Which diagnoses do you cover?

·      What type of sessions do you cover? (Types of therapy)

·      Is there a limit on the number of sessions my plan will cover per year? How many?

·      Do I need a referral from an in-network provider to see someone out of network?

·      How do I submit a claim for reimbursement?

Begin Mental Health Counseling in Chicago, IL Today 

Learn more about our payment options here, and please contact us with any questions about details and fees. At our Chicago, IL, area therapy practice, we want to help you make the best decisions for yourself and your care. Our therapists are honored to help guide folks along their healing process. We offer services for anxiety, depression, parents, work stress,trauma and PTSD, and more. One of our more unique services is yoga therapy, which can also be done using online sessions. We also specialize in supporting LGBTQIA+ folks for a variety of issues. We hope that you take the leap to begin counseling with us. You deserve it.

Other Services At Obsidian Counseling

When you work with a therapist at our counseling practice in the Chicago, IL area, you will be met with compassion and authenticity. The team at our therapy practice feels honored to help guide folks along their healing process. Specifically, we help people in addressing anxiety, depression, trauma, and work stress. One of our more unique services is yoga therapy, which can also be done using online sessions. We also specialize in supporting LGBTQIA+ folks for a variety of issues. We hope that you take the leap to begin counseling with us. You deserve it.