Why We Don’t Accept Insurance
Some of us have been around long enough to remember when insurance for psychological services was very different from what it is, today. Up until the mid-1990’s, if you had insurance and wanted to see a licensed psychologist, social worker, or mental health counselor, it was pretty simple: See the clinician, give them your insurance information, submit a claim, and they paid according to the terms of your policy, which was usually either 50% or 80% of the billed amount. They didn’t ask for records, trusted you and the clinician to know what you needed better than they, and didn’t put up barriers to you getting better. The client paid the difference, we did our work together, and that was it.
Times have changed, and not for the better.
In the late 1990’s, insurance companies began going to what they called “managed care.” What that meant was: Services had to be pre-authorized and that meant you (or the clinician, or both) had to talk with someone you did not know (and you would never get their last name) and convince them you needed care. They would dole it out, while requiring full disclosure of your records and everything you said in the sessions. They would then decide, often without telling either you or the clinician, when you were done. If you didn’t like the decision, you could appeal, which resulted in sometimes long delays in your care and an intentionally confusing process designed to get you to drop the appeal and accept their decision. It was no longer about getting you the care you needed. It was about keeping as many of your premium dollars as they could, by paying out as few of them as possible.
Since then, the situation has become even more complicated and even less consumer-friendly. There are now PPOs, HMOs, and a plethora of other acronyms. Deductibles have risen tremendously, along with copays. Preauthorization requirements have increased, while allowable amounts have gone down. Many insurance companies have restricted the allowable diagnoses, as well as the types of treatment services (known as CPT codes) that are allowed according to the diagnosis. Most insurance companies will not consider such matters as relationship problems, life transition problems, stress, and others as “a medical necessity.” This results in clinicians being asked to “fudge, just a bit” on the diagnosis, or to use a CPT code that will be reimbursed instead of a more correct CPT code that will not. People have asked, “What’s the harm in that? They’ll never know.”
Several things are wrong with that:
(1) It’s not honest, and that constitutes insurance fraud and a crime; (2) There is a fair likelihood that the company will demand your records (which, by filing a claim, you authorize them to obtain) and then they will know; and, (3) When they find out, they will demand their money back, with interest, and we all get referred for prosecution. We don’t play that game.
One of the expectations when seeing a mental health clinician is that (with only a few exceptions spelled out in the intake documents), everything we discuss remains private between us without your explicit permission. There is a freedom in that and it’s important for good therapy to happen. When insurance companies are involved, especially in the HMO/PPO world, that privacy ceases to exist. By signing up for, and using those systems, they automatically gain access to your records and everything we discuss. A nameless reviewer who doesn’t know you at all determines whether you are making enough progress, whether your services qualify as a “medical necessity” or whether what we are doing is consistent with “evidence-based treatment” according to their criteria for what constitutes sufficient evidence (which almost always translates to 6 to 10 sessions, regardless of the method). Some insurance companies will no longer reimburse for a 60-minute session, “because 40 minutes is long enough.”
Furthermore, the paperwork burden on the clinician has expanded and become overwhelming. Some clinicians hire full time staff to only deal with the paperwork. Your therapist ends up being tired, overworked, stressed out, and resentful. That’s not good for us and it’s not good for you. Given the situation as it is, now, it’s little surprise that half or more of behavioral health clinicians no longer accept insurance.
At Brain Health Northwest, we have this notion that we should work for you! We believe that you should be able to talk about anything with us without worrying about it ending up in a big company’s database, or that someone else, who has no responsibility to you at all, will make binding decisions about your care. We believe we have a responsibility to you to educate and inform you about everything that contemporary clinical psychology and clinical neuroscience can do to help you, even if it is cutting-edge and not yet approved by an insurance company. We believe that you deserve and should expect a clinician who is alert, engaged, informed, and doing their best, for you and only for you. We believe that it’s reasonable for you to be able to talk about the intimate details of your life and they will kept only between us. We believe that you can take charge of your life and determine for yourself about whether you receive value from our work and the goals you would like to achieve.