Investing in your best self

Why don’t you accept more insurances?

As many of you are aware, our medical world has changed because of the Affordable Care Act as well as the COVID-19 pandemic. This includes changes to the way insurance is handled and the delivery of care. It is important to note that the ACA was more insurance reform and reigning in some of the worst abuses insurance companies were guilty of. However, the reforms did not go far enough and did not protect consumers and small private practices.

While we support many of the provisions and protections the ACA provides, it has changed the insurance world a great deal in ways that are harmful to patients and small private practices. Many of you have seen your premiums and co-pays and especially deductibles increase. One consequence of the ACA was the emergence and the widespread use of plans which utilize a coinsurance over a copay and forcing many to use HSAs or FSAs. What this means is that out of pocket costs are more and more frequent. Insurance costs are skyrocketing and benefits are plummeting. Healthcare costs have gone up an average of over 30% in just the past year. What good is a plan that you are paying $400 a month for with a deductible of $6000 and then a 40-50% coinsurance after. This is essentially no coverage.

In response to COVID-19, insurance companies quickly changed policies and payments without adequately notifying clinicians. This resulted in many hours of calling insurance companies to clarify what the new policies were. Additionally, given the chaos of these changes, insurance companies often paid out the wrong amounts and then issuing corrections months later and demanded we pay back any overpayments. In all, compared to the amount of time spent pre-pandemic insurance billing and during the pandemic, we are spending an additional 10 hours a week of unpaid time. Insurance companies are incentivized against providers due to the nature of reimbursement. Insurance companies want to maximize profits and therefore will intentionally set reimbursements low and make customer service non-existent for providers. They intentionally make the experience difficult to protect their profits.

Furthermore, insurance companies often take advantage of the fact that mental health professionals are overwhelmingly in private practice thus lacking the ability for collective bargaining for better reimbursement rates. In-network providers are often contracted to accept a 30-40% reduction in their fees in exchange for accepting insurance plans. Among healthcare professionals, mental health professionals are reimbursed almost three times lower than physicians. Average reimbursement for an hour session is around $105 in the Seattle area and $88 in California statewide. After factoring in expenses and overhead, the average take home per session is around $30. Given the nature of the work, most clinicians will only see at most 25 clients a week which then totals to around 80-100 appointments a month. A counselor will take home $2400-$3000 a month if they run a practice and accept insurance.

Most healthcare providers just do not tell you that this is going on because they have taken on the extra burden and cost of doing the billing for you as part of the services they provide, which is what I have done for years. The healthcare provider is not actually obligated to do this as it is actually the responsibility of the client. But insurance companies have made the process so complicated people need go to school and get a degree in medical billing and coding to be able to understand the process. I had to learn the process myself through countless google searches and many hours on hold with insurance companies. In fact, this is one reason why since the ACA was passed more and more providers are forming group practices and hiring billing specialists.

Also, most clients do not realize that when they use their insurance, the insurance has the rights to access the records whenever they request them from providers. This information is often used to determine coverage. This is disturbing to us. We firmly believe that medical decisions should be left to the provider and client, and not a for profit company.

Another factor in this decision is mobility. With COVID-19 many of providers have realized that we can telework. Our mission as clinicians is to make services available to as many people as possible. We have clinicians who operate in two States, but this runs against insurance company policies. We have been told by certain insurance companies that if the clinician is not living in the city then we need to exit their panel despite being fully licensed and qualified to provide services in that region or State. Insurance companies have not kept up with the realities of the new post-pandemic world.

Operating a practice without the abusive constraints of some insurances allows us to get out of the oppressive machine and allows us to provide the best possible care for our clients. It allows us to better control our business of practice and the administration of care and protecting client information. The research shows that, as a result of being cash only, practices actually provide better care because the healthcare providers can see fewer patients, which in turn allows for more time with their patients, and this allows them to provide better care.

Please use this tool to estimate your Out of Network reimbursement. Please note that this is just an estimate, final reimbursement is determined by your insurance plan when you file a claim.

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