To Par or Not to Par...The Insurance Question
At this time, I am not a provider for any insurance carrier. This decision was not made without careful consideration of the pros and cons, nor was it made without taking into consideration both myself and you, the consumer.
Philosophically, I cannot bring myself to “par” with a company that reserves the right to make ALL decisions regarding the provision of my services in the interest of their own bottom line. By this, I mean that in order for me to be included in a particular company’s “stable of preferred providers” I (and by extension, you) would have to agree to concede to their decisions regarding:
Can you imagine any real-life scenario wherein these terms would be acceptable?
I’m sure we have all had our share of battles with these carriers at one time or another, for example:
The list of nightmare-caliber scenarios created by insurance carriers could go on infinitely; we have all “been there and done that.” It’s not fair, and it does not make sense. What is important to remember is that insurance carriers are “big business” and they are in the business of making money by leveraging your healthcare needs against their profit margin. The notion of whether or not you receive needed or appropriate care is quickly fading into irrelevancy. Their formula is simple: Charge a hefty premium to the consumer; pay for some claims but deny or re-negotiate most; and pocket the difference – which happens to be nothing short of a fortune.
But for me the biggest “nightmare” of them all is the fact that the overwhelming majority of decisions that directly affect you and your health are made by people who have very little (if any) experience/training/expertise in the health professions! I’m not disparaging these people…as I am sure they are very nice and are skilled at what they do…but I cannot morally reconcile adhering to decisions regarding the mental health of my clients that are made by people who have no training or expertise in psychotherapy.
I would also be remiss if I did not make mention of how the insurance carriers affect me as well. The fees that I charge for my services are not arbitrary. I have carefully calculated the cost of my services based on my education, training, experience, and efforts to arrive at figures that I feel reflect my value as a psychotherapist. If I par with an insurance carrier, what I want to charge is irrelevant...I am forced to accept what they are willing to pay; even if that amount is 50 or 60 percent under my usual fee scale (which, in some cases, includes the deductible paid by the consumer).
I understand that by choosing to opt out of “network provision” I will undoubtedly lose clients right away; but I accept this as a natural consequence for the decision that I have made. However, it is my sincere hope that there are many of you still willing to participate in mental health services under your terms…not theirs. It is my hope that you view your mental health not as a simple commodity for purchase (much like a television or pair of shoes), but rather as an investment in your peace, contentment, and happiness; something that will continue to pay dividends for the rest of your life.
With that being said, I would like to add that many consumers are still able to engage in services with me AND be reimbursed by their insurance carriers (if your plan contains Out of Network benefits). I urge all prospective clients to contact their insurance carriers and tell them that you want to engage in psychotherapy services with me and find out how much they will reimburse you for the up-front expense. At the conclusion of each session, I will provide you with a detailed receipt that contains all of the information you will need to have the insurance carrier reimburse you directly. In fact, some prefer to not use their insurance for mental health services for various reasons, including:
I hope that this helps you understand my rationale for choosing to be an out of network provider…and who knows…if the existing model starts to undergo some much needed renovation, I may reconsider.
In the meantime, to hopefully meet your convenience, I currently accept the following payment methods:
Philosophically, I cannot bring myself to “par” with a company that reserves the right to make ALL decisions regarding the provision of my services in the interest of their own bottom line. By this, I mean that in order for me to be included in a particular company’s “stable of preferred providers” I (and by extension, you) would have to agree to concede to their decisions regarding:
- Whether or not treatment is warranted, appropriate, or justified;
- What my fee will be for providing services;
- What you will be required to pay if they permit you to commence services;
- Whether or not your confidential patient information is shared amongst the decision makers who demand periodic justification to continue with services;
- The length of time in which you will be allowed to participate in services;
- How long it will be before they process and remit reimbursement claims (which for some companies could be months).
Can you imagine any real-life scenario wherein these terms would be acceptable?
I’m sure we have all had our share of battles with these carriers at one time or another, for example:
- A doctor writes you a specific prescription for medication to address a specific health issue and your insurance carrier DENIES the claim indicating that they will not pay for it because they don’t feel it is necessary (read: they think it's too expensive). This leaves you with three options: go without; pay the full cost out of pocket; or accept an alternative medication that is more fiscally viable for them but may not be as effective for you…
- You engage in a particular health service but your insurance company decides that it isn’t “medically necessary,” denies the claim (or pre-authorization), and leaves you with two choices: terminate the service, or pay out of pocket…
The list of nightmare-caliber scenarios created by insurance carriers could go on infinitely; we have all “been there and done that.” It’s not fair, and it does not make sense. What is important to remember is that insurance carriers are “big business” and they are in the business of making money by leveraging your healthcare needs against their profit margin. The notion of whether or not you receive needed or appropriate care is quickly fading into irrelevancy. Their formula is simple: Charge a hefty premium to the consumer; pay for some claims but deny or re-negotiate most; and pocket the difference – which happens to be nothing short of a fortune.
But for me the biggest “nightmare” of them all is the fact that the overwhelming majority of decisions that directly affect you and your health are made by people who have very little (if any) experience/training/expertise in the health professions! I’m not disparaging these people…as I am sure they are very nice and are skilled at what they do…but I cannot morally reconcile adhering to decisions regarding the mental health of my clients that are made by people who have no training or expertise in psychotherapy.
I would also be remiss if I did not make mention of how the insurance carriers affect me as well. The fees that I charge for my services are not arbitrary. I have carefully calculated the cost of my services based on my education, training, experience, and efforts to arrive at figures that I feel reflect my value as a psychotherapist. If I par with an insurance carrier, what I want to charge is irrelevant...I am forced to accept what they are willing to pay; even if that amount is 50 or 60 percent under my usual fee scale (which, in some cases, includes the deductible paid by the consumer).
I understand that by choosing to opt out of “network provision” I will undoubtedly lose clients right away; but I accept this as a natural consequence for the decision that I have made. However, it is my sincere hope that there are many of you still willing to participate in mental health services under your terms…not theirs. It is my hope that you view your mental health not as a simple commodity for purchase (much like a television or pair of shoes), but rather as an investment in your peace, contentment, and happiness; something that will continue to pay dividends for the rest of your life.
With that being said, I would like to add that many consumers are still able to engage in services with me AND be reimbursed by their insurance carriers (if your plan contains Out of Network benefits). I urge all prospective clients to contact their insurance carriers and tell them that you want to engage in psychotherapy services with me and find out how much they will reimburse you for the up-front expense. At the conclusion of each session, I will provide you with a detailed receipt that contains all of the information you will need to have the insurance carrier reimburse you directly. In fact, some prefer to not use their insurance for mental health services for various reasons, including:
- Extremely high deductibles associated with mental health services;
- To maintain or ensure their privacy;
- To engage in treatment on their own terms/flexibility in treatment delivery.
I hope that this helps you understand my rationale for choosing to be an out of network provider…and who knows…if the existing model starts to undergo some much needed renovation, I may reconsider.
In the meantime, to hopefully meet your convenience, I currently accept the following payment methods:
- Cash
- Check
- Credit Card/Debit Card (MasterCard, Visa, Discover); INCLUDING Health Savings Accounts (HSA's)