After careful consideration, I have decided to resign from insurance contracts effective September 1, 2017.
Regardless of how this may affect my practice financially, my intention is that my behaviors in conducting business are congruent with my values and ethics, as well as those of my licensing board and the National Association of Social Workers.
Unfortunately, like many other medical and mental health providers, I have been forced to choose between committing insurance fraud in order to get paid, or turning away clients whose presenting issues fall outside the scope of medical necessity. Quite simply, I’m tired of “pathologizing for profit”.
Here are some facts about medical insurance, that many “members” aren’t aware of when seeking therapy:
Insurance coverage is not guaranteed, you will usually have to pay some portion of the fee, in the form of a deductible and/or co-payment, and personal information about you and your diagnosis will be sent to the insurance company. This information establishes "pre-existing condition" for future insurance providers, and may stay on your record for years.
Most insurance companies do not cover marital therapy or any kind of relationship issues. Your treatment has to be considered "medically necessary".
Your insurance company has the right to determine the "type, frequency, extent, site, and duration" of treatment. They require the treatment to be "medically necessary", and some of them require a treatment plan so that they can "approve" additional treatment.
Your insurance company has the right to audit your medical records, including therapy notes, for up to 7 years to determine if the treatment you received was medically necessary. If they determine that it was not, your provider has to reimburse the insurance company for those payments. This could amount to thousands of dollars.
If you pay out-of-pocket for your therapy sessions:
You and your therapist decide the length, frequency and duration of your sessions and are able to negotiate a fee.
You and your therapist decide who, besides you, will be part of the therapy process.
Your diagnosis, if you have one, remains between you and your therapist.
You and your therapist do not have to spend precious time discussing treatment plans, insurance denials, and other administrative issues.
I realize that people who have been used to paying $25 or $30 dollars for a co-pay may have a difficult time justifying $100 per session. Many clients have found it to be more manageable if they simply decrease the frequency of their visits from weekly to once or twice per month, or as needed. Others have Health Savings Accounts that can be used to pay for therapy. Additionally, I offer a discount for pre-paid sessions which reduces the cost per session.
Please feel free to contact me if you have questions, or would like further clarity about how this change may affect you.