Why don't you accept insurance?

This is probably the most frequent of my frequently asked questions! To be honest, I was shocked when I learned that many therapists are choosing not to work with insurance.  There are a variety of reasons for this, all of which add up to better care for clients. After doing a lot of research on the reasons for and against billing insurance, these were the main points that tipped the scale for me:

1) Client Privacy - Psychotherapy is intensely personal. When therapists bill insurance they must disclose a diagnosis, prognosis, treatment plan, and occasional updates on progress, as well as justification for ongoing treatment. By assigning your insurance company as the payer, you authorize the insurance company to access any of this personal information at any time. This information also often goes through the therapist's billing specialist (see point #3). By taking insurance billing and reporting out of the equation, clients have more control over their privacy. Any information you submit to the insurance company is at your own discretion.

2) Ethical Issues with Diagnoses - Insurance companies require therapists to submit a DSM 5 / ICD 10 diagnosis for reimbursement. The problem with this is that many people who are seeking help do not meet full criteria for any billable diagnosis, or it may not be apparent which diagnosis is appropriate until the therapist has developed the therapeutic relationship over the course of several sessions. This forces therapists to choose a diagnosis, even if it is not appropriate. Additionally, labelling a client with a diagnosis can cause later problems for the client (e.g. being denied for life insurance because of an earlier diagnosis of Major Depressive Disorder) or can cause the client to wrap their identity up in their diagnosis, thus inhibiting progress. 

3) Time (and Energy!) for Clients - Billing insurance can be time consuming; so much so that most practices hire a billing specialist, whose sole job is to make sure services get paid for.  While I do need to get paid so that I can feed myself and keep a roof over my head, I don't want money to be my primary focus. Taking the task of billing each insurance company out of the picture means that I can keep my caseload small, leaving more time for meeting with clients and for professional development. It also leaves me with more mental and emotional energy, so that I can be fully present in session. 

4) Flexibility for Treatment - Insurance companies can be picky about what type of therapeutic interventions they will cover, how often clients can be seen, and for how many sessions.  Without insurance calling the shots, I have more freedom to work with the client to design the right treatment plan for individual clients, and to make adjustments to the plan along the way.