Many people struggle to find talk-based therapy that’s covered by their insurance plans. Of all practicing medical professionals, therapists are the least likely to take insurance. Only 55 percent of therapists accept insurance plans, compared to 89 percent of other health care providers, like cardiologists, dermatologists and podiatrists, according to a 2014 study.
That’s a big problem, since approximately 1 in 5 Americans will experience some sort of mental health disorder in a given year, according to the National Alliance on Mental Health Illness. Many will also seek counseling for divorce or grief.
Treatment is highly individualized, but experts agree that talk therapy is the gold standard for treating psychiatric problems. A 2015 study revealed that cognitive behavioral therapies were just as effective as antidepressants for treating depression.
So why is therapy so unaffordable for so many people? And why don’t more mental health professionals work with third party payers? It turns out several factors contribute to making therapy unaffordable ― many outside individual clinicians’ control.
Insurance systems don’t support therapists’ diagnoses.
Poor insurance coverage for therapy is largely a reflection of how society views mental health.
Insurance companies tend to see things more from a medical perspective ― where if you get sick, for example, then you take a blood test, they figure out what is wrong with you, they give you a medication and then you are all better.
But with mental health a lot of times what we are trying to do is preventative maintenance-type work, and it makes it a lot more difficult to justify medical necessity with insurance companies.
Even when insurance companies consider a mental health diagnosis a valid billable condition, the coverage may only be temporary. Insurance companies do not cover marriage counseling, relationship counseling, family counseling and grief and loss.
More and more insurance plans we see either have a high co pay or a high deductible. So technically, people do have mental health coverage, but they are paying for most or all of the cost out of pocket anyway.
All of the major insurance companies are closed to enrollment for Licensed Therapists in the Tampa Bat area, including Brandon, St. Pete and Tampa. We receive calls all the time from potential new clients complaining they can not find a therapist in their insurance network.
Another thing insurance companies do that most people don’t know about is sub contract the mental health portion of a policy to another insurance company. I had an instance recently where a client had Blue Cross and Blue Shield insurance but Cigna actually covers the mental health portion of the policy. In most cases of sub contracting the mental health portion of a policy, they sub contract to a much smaller insurance company that pays extremely low and has very few Mental Health Providers in network. A good example is Hillsborough County School Teachers and Employees. They have Humana for the medical part, but they have MH NET for the mental health part of their policy. MH NET requires authorization, treatment plans to get authorization every 8 sessions, you have to fill out a paper form that they “conveniently never receive” and they pay $40 per session. Therapists literally spend more time collecting their $40 than they do therapy with the client.
Therapists honestly can’t afford to accept insurance.
The gap between a therapist’s hourly fee and the reimbursement rates they receive from insurance companies can be massive.
I’ve seen it lower than $50 a session. We charge $120 a session, so that would be a major blow in terms of income for us.
We can’t sustain our practices when that kind of value is put on mental health.
While $120 per session sounds steep, it helps cover rent, the cost of business and malpractice insurance, advertising, administrative staff, office equipment and credit card processing fees. Many therapists have also accrued massive student debt. Therapists have to get a Master’s Degree, at minimum, then do a 2 year Registered Internship and pass a State Board Exam to become a Licensed Therapist in Florida.
Therapists are health care professionals that all have master’s degrees or higher. Many have doctorates, medical degrees, and [have] graduated from specialized institutes for the teaching of psychotherapy.
Lawyers, accountants and architects generally make $120-$400 per hour or more. One should expect to pay the same for therapy from a competent, highly trained professional.
Therapists are in a no-win position. Therapists are almost forced to charge the patient directly because they are not able to be reimbursed at equitable rates as their counterparts that have M.D. or D.O. behind their name.
More equitable rates across all insurance companies would allow patients to have greater choice and access in terms of their health care decisions.
Filling out insurance paperwork is a full-time job.
It’s a Catch-22: To keep overhead low, many therapists don’t hire staff or assistants. But without them, the job of working with insurance companies is overwhelming.
Many people who work in mental health don’t have the volume of patients that primary care [physicians] might have. They might see seven or eight patients max in a day, where a primary care doctor might see as many as 40 patient’s a day and also have dedicated staff who handle billing and who are very familiar with what the requirements are with all the different payers out there.
Submitting a bill to an insurance company can involve jumping through an array of hoops including justifying your services to an insurance representative, providing status report updates and getting on the phone with providers to track down late payments.
This can be particularly complicated because not everyone who sees a therapist has a diagnosable mental illness.
Common reasons for coming to therapy, like couples counseling and grief counseling, are typically not covered by insurance.
We do try to provide lower cost therapy at Star Point Counseling Center by utilizing a sliding scale based on household income. This way people who are needing therapy can get the help they are looking for without going into debt.
Please visit us at starpointcounselingtampa.com or call us at 813-244-1251 if you have insurance questions.