You pay for your health insurance benefits to help cover your expenses, and you wonder why a mental health provider doesn’t accept insurance for services. That’s a great question! I invite you to read on for more insight on my reasons, both personal and professional, for choosing to be a self-pay provider.
For anyone who wants/needs to utilize their insurance benefits, please know I fully appreciate that and the following is meant to shine light on how our current system works and not pass judgment on folks’ individual needs. For any providers who work with insurance, I appreciate you being available to provide services in that way and want to reiterate that this post is focusing on my own experience and reasons for running a self-pay practice.
What Happens When Insurance is Involved?
I have previously worked in settings where the majority of my clients used insurance to cover services. Let me walk you through how that process can go from the provider side.
A person looking for a mental health provider and looking to use their insurance benefits has to locate a provider who both accepts their insurance and has openings for new clients. Then, they have to request an appointment and provide insurance information to the provider’s office. The therapy provider can spend anywhere from 30 minutes to 2 hours attempting to verify the potential client’s benefits. The provider is given information regarding the benefits, and can then contact the potential client and schedule. Keep in mind, sometimes what the provider is told by the insurance company is not accurate.
Insurance in the United States requires that the client be given an official mental health diagnosis in order to cover services, and that diagnosis must be given after the first session (often within less than an hour of speaking with the client). Some insurance plans will only accept particular diagnoses, or will limit the frequency or amount of therapy sessions an individual may have with their therapists. These blanket regulations do not take into consideration the immediate needs of the individual seeking mental health support.
I have actually had experience with an insurance company contacting me and asking why I had 60-minute sessions with a client rather than the approved 45-minute session. Upon describing the situation and explaining that I was ensuring the client was safe, I was told to keep future sessions to 45 minutes. To me, this directive was about following regulations rather than caring for the actual person with whom I was interacting.
That brings up another concern for me – confidentiality. Many folks don’t realize that when you choose to use insurance benefits in the current US healthcare system, you forfeit your right to confidentiality with regards to the insurance company’s access to your records. Now, this may not be a big deal if you’re getting your annual wellness check or flu shot, but mental health treatment can be a different story.
Though your provider may do their best to keep details to a minimum in their notes, they do have to provide evidence that your sessions are “medically necessary” in order for insurance to cover them and they do have to provide a fitting diagnosis. Folks working at your insurance company have the right to ask for that documentation at any time, and by using your benefits you have already consented to that access.
For providers working with insurance, the process continues after the session. Either the provider has to take time away from being available to see clients in order to handle the billing (i.e. getting all the details about each session to the insurance company so the provider can be paid for their services), or they have to hire someone to do this process which is an additional cost to the provider. If things run smoothly, the insurance claim will be processed without issue and the provider will get paid…. 2-4 weeks after providing the service.
What about if things don’t run smoothly? Well, the provider and/or their billing department can spend months going back and forth with the insurance company in an attempt to ensure services are paid. Ultimately, the insurance company can deny the payment, which could mean a big, unexpected bill coming to the client to cover services both they and their provider were told would be covered by their insurance coverage.
Now, let’s say things have gone well with finding a counselor, getting scheduled, and your insurance is covering your services. If your insurance is through your employer and they decide to make a change for the new year, you may lose access to your counselor if they are not contracted with your new insurance. Once you’ve built a relationship with a therapist, it can be devastating to have to start over with someone new. To me, this is another example of the system not taking into account the human aspect of mental health.
Why Have I Chosen To Run a Self-Pay Practice?
I believe that, ultimately, the way a provider in private practice chooses to run their practice is based on personal values. Those values are going to vary from person to person and provider to provider. For me, some of the top values that influence my practice are: respect, collaboration, and transparency. These values drive the policies of my practice and my interaction with clients and potential clients.
Transparency
I believe it’s important for a potential client to know from the first interaction (even the first view of my website) how I approach therapy and what they can expect to pay for sessions. The documents that folks review and sign prior to our first session also clearly lay out things like my background and training, my cancellation policy, my approach to social media, and details related to telehealth. When clients bring up concerns about which I may not have previous training or knowledge, I am honest with them about that and we work together to determine how to move forward.
Collaboration
Working together with my clients is the foundation of how I approach counseling. Many of the folks I work with have had experiences where their voice, needs, and preferences were never acknowledged or considered.. I want my clients to know they are welcome to take up space in the counseling relationship, they are encouraged to have a voice in how our sessions go, and they are free to let me know when something I say is off-base or doesn’t fit for them. We work together from the first session to determine what they want to focus on, how frequently we need to meet, and whether or not an official diagnosis is helpful for their situation.
Respect
Finally, I believe respect is foundational in the counseling relationship. An individual who is working with me has to know that I respect their experience and their perspective in order for the counseling relationship to have its full, healing impact. I acknowledge that my clients are the expert on themselves. While I help them make connections and move toward their own goals, this is always in the context of their own inner strength and knowledge.
I also believe that confidentiality is a part of respecting my clients. Often, folks talk about things in therapy that they are not able to share anywhere else. So, outside of the limits of confidentiality around issues of safety (something we discuss from the beginning of our counseling relationship), our sessions are completely confidential. No one else has access to a client’s records or information without their consent.
Next Steps
I hope this post helps you understand the reasons I have chosen not to work with insurance based on the values behind my therapy practice. I encourage you to locate a provider whose values align with what’s important to you. If that sounds like it might be me, please contact me and we can chat more to determine if I’m a good fit to provide you support along your journey.
Michelle F. Moseley (she/her) is a Licensed Clinical Mental Health Counselor in NC. She believes ALL people deserve respect, compassion, and access to mental and physical healthcare. Michelle specializes in working with survivors of religious trauma, and with those who have body image concerns, finding there is frequent overlap in these areas. She also frequently supports late-identified neurodivergent individuals as they navigate the grief and relief of a new understanding of self. You can learn more about Michelle by visiting her website at MichelleFMoseley.com or following her on Instagram – @therapy_with_michelle
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