Why Doesn’t My Therapist Take Insurance?

When I was a brand new baby therapist, there was a lot to think about as far as what it meant to not only be a therapist, but to run a business. It was a bit daunting. I wasn’t well prepared to think about how to be a business owner as none of my studies included this along the way.

To get myself going, I joined a group practice. I figured I could let someone else manage all of the business-type things while I focused on developing my craft as a new therapist.

 In the process of that here’s what I learned about insurance billing:

 · I learned that claims could get denied and you wouldn’t get paid. You’d have to resubmit and hope it would go through.

· You’d sometimes have to call insurance and spend hours getting through to someone who could help you resolve why the claim denied.

· Getting paid could take up to two to three weeks.

· In your contract with whichever insurance company you credentialed with, they would set the rate for what you could get paid. This means that regardless of what you bill, you agree to accept what they want to pay you. Getting them to renegotiate with you is near to impossible.

Having learned this, I moved into private practice knowing that these challenges would exist as I moved forward with insurance. I felt prepared to have to experience some of the annoyances of what it would mean to deal with insurance. BUT, I wanted to have a solid referral network which insurance did offer. I rationalized that having a safety net of solid referrals would balance out the lack of making my full fee.

Which it did… for a while.

As I have gotten further along in my career, the world has changed. We went through a global pandemic (which I never in my life imagined I’d have to experience). During that time, inflation went up, but my income didn’t adjust with it. Insurance continued to pay what they pay despite the radical changes to our food costs, gas expenses, and rental increases. I continue to have to pay for continuing education each year, renewing my licensure, malpractice insurance, and my business license. Things were going up in cost, but my income wasn’t going with it.

As I looked at the circumstances of where my practice finds itself, it became increasingly clear that if I want to continue to do this work (that I LOVE to do) I would need to make a change.

Part of that change looked like letting go of insurance. Moving to a private pay model, quite frankly, scared the shit out of me. Why would I let go of a steady stream of referrals just to get paid more? Couldn’t I just take on more clients and make what I needed to make? Sure. I could do that. However, the emotional toll of having to do that was just not something I could ask myself to do. I know too many therapists who increase their caseloads only to burn out. I am not willing to burn out.

As I talked with other therapists who let go of insurance I realized that part of what needed to change was my perspective.

I consider myself a really great therapist and work hard to do my own work to continue to be a really good therapist. Why couldn’t I ask my clients to value me and pay my full fee? Part of me wondered if they’d even consider continuing to work with me if I no longer took their insurance. Would I lose everything I had built for making this choice?

The other thing I had to shift in was realizing that what I offer people is deeply skilled work and that those who saw the investment of that would work with me. I am important to the journey that my clients are on and asking them to pay more for that would be reflected in if they chose to keep going.

I lost some folks. That’s okay. I don’t think it means they didn’t value me. But I kept a lot of other people and made new clients along the way.

The work keeps going and I can continue to invest in myself so they can invest in themselves. It’s a team sport.

Each therapist may have differing reasons for why they do or don’t take insurance, but this was my journey. I encourage you, whether client or clinician, to think of therapy as an investment because the effects of it are life changing.

Feel free to share this post with others. If you’re a clinician who wants to talk through whether you want to go into private pay, please reach out to me at jacqui@liminal-psychotherapy.com.