FINANCE

Why I Don't Accept All Insurance Policies

I understand that my decision not to accept all insurance companies may raise questions. I want to be transparent about my reasons and how this policy benefits my patients in the long run.

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Financial Sustainability

As a small private practice, I face significant challenges when working with insurance companies:

 

1. Low Reimbursement Rates: Insurance companies often set reimbursement rates that don't adequately cover the cost of providing high-quality care.  Sadly, many insurance companies are run by corporations that are looking to increase profits and reduce their costs. This means THEY set the prices they are willing to pay for your care.  This means that providers who take insurance have to agree to write off the difference in pay for the "privilege" of accepting insurance policies.  

 

2. Payment Delays: Insurance companies can be slow to process claims, leading to cash flow issues that can be detrimental to a small practice. Some insurance companies write into their contracts that they can take 90-180 days to pay claims. For a small business, these claim delays can be devastating.  

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3. Claim Denials: Insurers may deny claims they deem lacking in "medical necessity," even when we believe the care is essential. Many commercial insurance companies are starting to deny claims based on the length of sessions, diagnosis codes, and even for Telehealth sessions.  This can cause a breakdown in the relationship between the provider and patient because the patient thought the session was covered, only to learn later that they are now responsible for the full fee.

 

4. Clawbacks: Insurance companies can demand repayment for services rendered years ago, creating financial uncertainty and risk.  Insurance companies are increasing the number of "Risk Adjustment Audits" for mental health services. During these Audits, insurance companies review notes and determine if they are entitled to take the money back for a previously paid session.  Sometimes the reasons for the clawback can be as silly as the time on the appointment note did not match the actual time with the client.  There is no limit currently on how far back insurance companies can clawback. Therapists are experiencing clawback payments that can be for years of services to a patient. 

 

5. Administrative Burden: Dealing with insurance requires significant time and resources, taking my focus away from patient care.

 

Quality of Care

 

My policy allows me to prioritize your care in several ways:

 

1. Focused Attention: I can dedicate more time to your treatment rather than managing insurance paperwork.

 

2. Longer Sessions: Without insurance restrictions, I can offer session lengths that best suit your needs.

 

3. Innovative Treatments: I'm free to use the most effective treatment methods, not just those approved by insurance companies.

 

4. Privacy: Your treatment details remain between us, not shared with insurance companies.

 

My Philosophy on Mental Health

 

I believe that seeking help to navigate life's challenges is a normal, healthy behavior. By not relying on insurance:

 

1. No Diagnosis Requirement: I don't need to provide a clinical diagnosis for you to receive care, avoiding unnecessary labeling.

 

2. Holistic Approach: I can focus on your overall well-being, not just treating specific symptoms or disorders.

 

3. Preventative Care: I can work with you before issues become severe enough to meet insurance criteria for "medical necessity."

 

Working with You

 

I am committed to making my care accessible:

 

1. Transparent Pricing: My fees are clear and predictable, with no hidden costs.

 

2. Sliding Scale: I offer reduced rates for those facing financial hardship.

 

3. Superbills: I provide detailed receipts for you to submit to your insurance for potential out-of-network reimbursement.

 

I believe this approach allows me to provide the highest quality of care while maintaining a sustainable practice. If you have any questions about my policy or how we can work together, please don't hesitate to contact me.

 

Submitting Superbills for Reimbursement

To help you maximize your insurance benefits, I offer monthly superbills that you can submit to your insurance company for potential out-of-network reimbursement. On the 10th of each month, I'll provide you with a detailed superbill that includes all the necessary information your insurance company needs, such as dates of service, CPT codes, and diagnosis codes (if applicable). To submit your superbill, contact your insurance provider to learn about their specific submission process, which may involve mailing the superbill or submitting it through an online portal. While I can't guarantee reimbursement, many of our clients have successfully received partial reimbursement for their sessions. If you need any assistance understanding your superbill or have questions about the submission process, please don't hesitate to ask me for guidance.