While every therapist is different, there are often a number of client-focused reasons for choosing to be unaffiliated with any health insurance company:
Price - insurances are complex and they are businesses that work to make money, in addition to helping people find health care. The rates for clients are sometimes difficult to understand and not always what they thought it would be. By choosing to refrain from partnering with any health insurance company, therapists are attempting to be transparent so that the fee quoted is the price you pay.
Privacy/Confidentiality - each client can choose to seek reimbursement from their health insurance company, but is not required to. This gives the client complete control over their mental health medical records and does not introduce a third party without their initiation.
Less focus on diagnoses - Some diagnoses are not covered by insurance (for example, couples counseling, grief or loss, etc.). Therapy work can focus on caring best for the client rather than on a diagnosis.
Duration - some health insurance companies set limits to sessions. Therapists who don’t take insurance can make decisions about treatment based on the unique situation of the client, not an outside company’s blanket policies.
Consistency/Longevity - the therapeutic relationship is not influenced by the client’s insurance company or if their plan changes.
A personal note
As a client myself (who sees my own therapist), I have found navigating insurance to be confusing, frustrating, and disappointing. Since I am self-employed (what most therapists are), I get to choose my insurance plans each calendar year (and have a wide range of options, thanks to DC's Health Link and state laws). With that, I have tried to predict how much therapy coverage I anticipate having, consider co-pays and deductibles, and monthly premium amounts.
One year I thought I'd want to have weekly therapy sessions so I chose a higher monthly premium with a lower out-of-network deductible (since my therapist is an out-of-network provider (and worth every penny!)). What I had not anticipated was the "allowable amount," which meant that no matter how much I paid, the insurance company was only going to refund me based on their internal number.
In the end, I'm not sure if I spent more or less with the higher premium plan or not. But I do know I felt taken advantage of because the allowable amount was not in part of my policy coverage notes. While I appreciate my insurance company overall, I have realized that I trust them a little less after having this experience.
Allowable Amounts
Clients using out-of-network therapists are faced with allowable amounts. This is also true for therapists who are in-network with an insurance company. The company will offer the therapist a flat rate for each service and dictate the co-pay amount the clients will pay. In this system the insurance company is setting the rates for the therapists, which is often 20-50% less than the average market rate of therapy (between $150-$200/hourly session in DC).
Since therapists are small business owners, our client fees are how we make a living. With lower session rates than the market rate of therapy, therapists may need to see a higher load of clients in order to sustain a livable wage. This may mean that they are unable to provide the highest quality of therapy due to the volume of clients they are seeing.
Due to the nature of therapy work, being present, focused, and alert with clients is extremely important. We place a high premium on quality. Carrying a high client load runs the risk of sacrificing these qualities.
I think most therapists would like to work with insurance companies and have therapy be financially viable for their clients, and we are also weighing the cost of doing so.
Other Financial Options
If a client is faced with struggling to find a therapist who is the right fit and pay for therapy sessions (for either out-of-network or in-network), some creative suggestions for managing this are:
Check with your church to see if they have a benevolence fund that can financially support your mental health investment
Check with friends and family to see if they would like to contribute to you
Look into any HSA/FSA options. Many out-of-network therapists are able to take payment with these accounts
Consider how regularly you want to see your therapist. Some reasons for therapy lend themselves to regular weekly sessions, while others may be able to have bi-weekly or monthly sessions.
Look at your finances - see if there are ways to manage your budget that allocate more funds to mental health. This may not be possible. If it is, it may be an investment worth shifting money around for.
Overall, whatever options you choose I encourage you to find long-term, financially viable and responsible solutions. I know this is complex and complicated, and you may have limited choices. Do the best you can. You're worth investing in!
Read more about insurance and reimbursement in Let's talk money…
