Frequently Asked Questions

WHAT DOES THIS MEAN FOR YOU AS A CLIENT?

Our clinicians’ fees are determined based on a number of factors including type of services provided, delivery format and experience and certifications of the clinician(s). Though insurance plans vary, most insured clients are able to receive some reimbursement for outpatient mental health services, ranging from 25% to 75%. We provide monthly itemized statements for submission to insurance companies or HSA plans.

CHALLENGES WITH WORKING WITH INSURANCE

Reimbursement Rates & Other Fees

Therapists encounter several challenges when dealing with insurance companies. One major issue pertains to the reimbursement rates offered by insurance providers, which often fall significantly below the actual cost of providing therapy. This makes it difficult for therapists to sustain their practices while accepting insurance.

In addition to low rates, therapists are also burdened with payment processing fees charged by insurance companies and credit card companies. Many therapists have found that they need to see a higher volume of clients to compensate for the shortfall due to low reimbursement rates, processing fees, and clinical and business expenses, often resulting in therapist stress and burnout.

Delayed Payments

Insurance companies often take months to pay therapists for the services they have already provided to their clients. This delay can seriously jeopardize the therapist's ability to stay afloat, both professionally and personally.

Insurance Clawbacks

After insurance pays therapists for therapy claims, it's shocking to learn that insurance companies can demand refunds months or even years later, claiming that the service was not covered. This practice, known as a clawback, is a serious issue that can cost therapists thousands to tens of thousands of dollars. 

Furthermore, insurance companies can also decline to pay therapists for current clients' claims that they owe the therapist for, adding further financial strain. These clawbacks jeopardize the therapist's ability to pay their own bills, and it's important to address this issue. 

Expenses

Insurance companies delaying payments and providing low reimbursements can affect therapists' ability to cover their personal and business expenses. In addition to standard business costs, therapists have clinical expenses such as licensing fees, continuing education, liability insurance, and health care benefits as self-employed individuals.

Limitations to Therapy

Insurance companies often impose limitations on the type and duration of therapy they cover, creating significant barriers for individuals seeking specialized or long-term treatment. For instance, insurance companies may pay the same amount for any session billed for 53 minutes or longer, regardless of the duration. This can restrict therapists who want to provide comprehensive care for their clients' needs. As a result, some therapists choose not to accept insurance in order to have more treatment flexibility.

Administrative Burden

Dealing with insurance companies can be a burden for therapists. The administrative tasks take time away from providing therapy and can lead to burnout. Many therapists choose not to accept insurance to avoid these tasks.

BENEFITS FOR CLIENTS NOT USING INSURANCE

No Required Mental Health Diagnosis

Therapists not accepting insurance for therapy can benefit both therapists and clients. Clients paying out of pocket don't need a mental health diagnosis to receive therapy, making it more accessible for those who don't qualify for insurance-covered therapy. It can also help individuals, such as first responders and military personnel, who may fear their employer knowing about their mental health condition to seek therapy. 

Once you become a client, you will receive a “Good Faith Estimate of Health Care Items and Services” that gives you an idea of the cost over a 12-month period. 

Privacy

Keeping insurance out of your therapy record ensures privacy between you and your therapist. You don’t have to worry about your insurance company having access to details of your therapy sessions. 

Quality of Therapy

If a therapist can make more money by not accepting insurance, they don’t need to see as many clients, leading to better quality therapy. Without insurance dictating the type of therapy or number of sessions, the client and therapist can decide on the best course of therapy, leading to a higher quality of care.

Possible Pro-bono Therapy

It is important to note that the decision to not accept insurance does not mean that self-pay therapists are only accessible to individuals who can afford premium fees. By charging premium fees to the majority of clients, some therapists may reserve some therapy slots to offer pro-bono services to clients who otherwise couldn’t afford therapy.