Are you struggling to find an in-network counselor?

You may have found it challenging to find an in-network therapist recently. Many therapists, myself included, have opted to not accept insurance. There are good reasons for this.

Diagnosis that remains on your health records

If billing to insurance, your therapist HAS to provide you a diagnosis and report that to your insurance provider. Insurance does NOT reimburse for relationship challenges, grief, stress or many other reasons many of my clients seek counseling. Insurance is dictated by a medical model, and so this means that payment can only be for a diagnosis…a diagnosis that your insurance company deems that treatment for is “medically necessary”. This means that (even in couples or family therapy) a person has to receive a diagnosis, a label. These labels will be part of your official health record permanently. Why does this matter? It can impact your future…If you ever find yourself unemployed, you apply for a job with security clearances, you need to purchase your own benefits — a mental health diagnosis can make the difference between preferred coverage or none at all.

Limitations to your privacy

Confidentiality is critical and something that every therapist is mandated to offer both by law and by code of ethics. Your insurance company is not so invested in your confidentiality. Your records are not as protected when using insurance. Your insurer can audit your records at any time they wish. This means any details that your therapist might not have included in the paperwork to them (perhaps for good reason) is technically open to the eyes of any “claims specialist” the company hires. Again, this might not matter to everybody, but if you hold high clearance for a job or have other reasons you want your information to be held confidential than it is important to be aware of this.

Your counseling experience is somewhat dictated by your insurance carrier

Most insurance requires some sort of treatment plan to be submitted by in-network providers. This means that, rather than giving you the care that best fits your needs, the therapist is responsible to the claims representative (by the way, they typically have no training in mental health) for how you spend your time. Also, insurance will often limit the amount of sessions you are able to receive each year. So your treatment has to fit the allotted sessions your insurance has determined ahead of time. Not everybody is the same, there is no cookie-cutter approach to therapy so this puts a lot of pressure on you and your therapist to reach your goals within the allotted sessions. This often results in terminating counseling prematurely.

To put it simply, an in-network therapist works for the insurance company, not you. It doesn’t matter what you and your therapist decide is in your best interest, it needs to fit their matrix of decisions.

Options for quality services is limited

Insurance pays therapists poorly, very poorly. This means your therapist is working for less than a fair market wage (less than ½). This can lead to several problems…A therapist relying on insurance for reimbursement must see many clients in order to keep their practice alive. This often results in seeing more clients in a day than what is within their mental and emotional capacity. I would not want to be a therapist’s 8th or 9th client of the day. You deserve a therapist that can be fully present with you and not distracted by fatigue or burn out. Secondly, due to this low pay you will find that a large percentage of the providers in-network with your insurance are either unlicensed or inexperienced or just have not been able to establish a positive reputation in the community. Choosing to utilize your insurance means your quality options are limited.

I fully understand the financial strain that on-going counseling can impose for many people, but if you have the means to invest in yourself without using your insurance, these are just a few reasons you may want to consider doing so.