Do I take insurance?

by Jan 30, 2016Finding a Therapist, Uncategorized

The insurance question is my most asked question.

The short answer is “no, I don’t take insurance.” But bear with me because I’m going to explain the whole shebang to you right here, right now.

I am an out-of-network provider. That means I am not in-network on any plan and you are on the hook for my fee. I am happy to provide you with a coded bill to send to your insurance company if you have out-of-network benefits. The out-of-network benefit is almost always less, and you need to meet a sometimes very high deductible–in the thousands, people. It sucks.

Business Models and Why You Should Care About That

Here’s why I am not in-network. In New York City, clinicians must choose between marketing their own practices and setting their own fees or allowing insurance companies to funnel patients to them and accepting whatever the insurance company deems “reasonable and customary.” My choice is to market myself and set my fees. The business models are very different. An insurance-based practice might hire a specialist to do the paperwork and ensure payment. My spend is on marketing and advertising. This means that when you are in distress and searching for help on the web, you find me, or somebody like me. And then we have an uncomfortable conversation. Because you thought you were paying for coverage for mental health care and you are realizing that it is more difficult to access therapy than you knew. The clinicians who accept insurance don’t have to market themselves so they are a little harder to find. I most often direct people to the Psychology Today website where you can filter by zip code and insurance plan to spin out a list of people who accept your insurance. Obamacare has created a new group of people who have insurance for the first time. Finding a clinician who takes your plan AND has an opening requires some legwork because this large group is seeking care in great numbers.

I am truly sorry that when you are at your lowest ebb, you need to be intrepid to find help.

Medical Necessity and Why You Should Care About That

Here’s another reason why I don’t take insurance. Oftentimes, folks have been feeling lousy for years and gritting their teeth and getting on with it. Then it gets harder than they can bear and they seek help. In this crisis stage, your treatment would be covered because it’s “medically necessary.” Your condition interferes with your ability to work and live. What about the person who has always had a low-grade, nagging depression which mucks up his life and prevents him from finding love and opening his own business. He works, he has friends, he pays taxes, he has a dog. It’s okay. He’s not “sick.” Insurance might pay for the first twelve sessions, and if your clinician knows how to argue with insurance company functionaries, she might get twelve more. And then what? This stubborn, sticky depression probably won’t yield to six months of once weekly treatment. And then you are paying out of pocket or as I call it, going off the insurance cliff. Were I to begin with a person using insurance who cannot afford anything close to my fee, I am almost guaranteeing that we go off the cliff. I don’t want to go off the cliff and neither do you. It sucks. I’m sorry.

Privacy and Why You Should Care About That

And another thing. When you use insurance, I have to give you a diagnosis code. If you work for a large corporation, your code may be seen by someone in your Human Resources department. Small businesses usually send it directly to the insurance company. A paper trail of your mental state is created. I believe that therapy works best in private. I speak to my analyst, my supervisor and my peer group. I speak to them in an effort to understand you as well as I can. There are two layers of protection here: my colleagues never know the particulars of your identity (your name, your job) and my colleagues are bound by the strictest confidentiality, as am I. Because I work with anger–an emotion that can induce shame–privacy is very important to me and the people who come to see me.

If money is tight, I have another blog piece that might help. See “Finding a Therapist: A Path to Treatment When Money is Tight.” There I go into some other options outside of paying out of pocket or using insurance. You might not be aware that there a training programs all over the city charging a very low fee for psychotherapy. Check it out.

Good luck.

Elizabeth Singer is a therapist and anger management specialist in New York City

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