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Why Dont Therapists Take Insurance

    Therapists and clients are placed in a binding ethical dilemma at the hands of insurance companies. To take insurance is to remain accessible to some who might otherwise not  be able to afford treatment, and as a therapist, I feel an ethical obligation to provide accessible treatment. But working with insurance requires therapists to compromise confidentiality, client agency in their own treatment,  it compromises my ability to tailor unique treatment to my clients. Insurance can deny services to clients who desperately need them and deny payment to therapists. Not mention the cost of working with insurance, not only do they pay far below market value, requiring therapists to take on unsustainable caseloads, but I have spent hours on the phone advocating for client services, hours that I am not paid for and hours, hours that could be used to meet with clients or to advance my ability to continue to strive to be the best therapist I can to my clients.

Lets delve a little deeper into the issue of confidentiality and insurance. Confidentiality is the cornerstone of effective therapy. For clients to feel safe sharing their most personal thoughts and experiences, they must trust that their privacy will be protected. Unfortunately, when insurance companies are involved, this confidentiality is compromised. Insurance providers often audit our notes about therapy sessions in order to to justify coverage, which may include sensitive personal information. These notes can be audited and accessed by insurance employees, creating a risk of exposure that undermines the sacred trust of the therapeutic process.

Not only do insurance companies have the right to review session notes, but they often use those notes to dictate the type, frequency, and duration of therapy sessions. This interference can prevent me from tailoring treatment to your unique needs and goals. Insurance may approve only a limited number of sessions or require a specific diagnosis, even when those restrictions do not align with best practices for your care. I believe therapy should be guided by clinical expertise and your personal journey, not by external constraints imposed by a third party for a profit.

Working with insurance also means colluding and engaging with unethical business practices. Practices that are in direct opposition with the ethical principles of therapy. These companies routinely delay and deny claims, then defend their denial. This creates significant stress for both clients and therapists. Such practices can disrupt the continuity of care, leaving clients without the support they need at critical times. By not working with insurance, I avoid these obstacles and can provide consistent, uninterrupted care.

Finally, insurance reimbursement rates for therapy are often far below the value of the services provided. This forces many therapists to take on an unsustainably high caseload just to make ends meet. A heavy workload can lead to burnout, reducing a therapist’s ability to be fully present and effective for their clients. By setting fair and sustainable rates, I can maintain a manageable caseload and provide the high-quality care you deserve. As I previously mentioned,  insurance companies frequently delay and deny payments to therapists and even rescind payment for services, creating financial strain for therapists and uncertainty for clients. Therapists spend hours on the phone with insurance companies advocating for care. These delays can impact the therapeutic relationship and add unnecessary stress to the process.

As a therapist, I believe that the negatives of working with insurance companies far outweighs the positives. However, I still find it my ethical obligation to provide accessible treatment by providing alternatives to insurance



Alternatives to Insurance

I strive to make therapy accessible by offering sliding-scale fees or providing documentation (known as a superbill) for clients who wish to seek reimbursement directly from their insurance provider. This approach allows you to retain control over your confidential information while still benefiting from some insurance coverage if your plan includes out-of-network benefits.

My decision not to accept insurance is rooted in a commitment to providing ethical, effective, and confidential care. Therapy is a deeply personal process, and it’s essential that it remains focused on your needs, free from external interference. By working together without the constraints of insurance companies, we can create a therapeutic relationship that prioritizes your well-being, respects your privacy, and supports your growth.

If you have any questions or concerns about this approach, I’m happy to discuss them further and help you explore options that align with your needs
 

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