The providers here at InnerSourced Solutions, Inc. pay for insurance just like you do, and it’s great to use it for all kinds of things, including seeing our Primary Care Provider (PCP) and urgent care or emergency room visits. However, using your health insurance for therapy /counseling comes with risk and a headaches to say the very least.
There are reasons why more and more therapists are moving away from taking insurance and we want you to understand why, so here’s the deal:
Currently, we are only on one commercial insurance panel: Blue Cross Blue Shield /Carefirst. We also accept the many variations of Maryland Medicaid.
Insurance only pays if you’re sick:
Actually, what I should have said is, we ONLY get paid IF you are sick because if you aren't they wont pay. The operative word here is "YOU", a living breathing person, not your relationship / marriage. However, if your "mental illness" impacts your family, they may cover it depending on your policy coverages. In order for our clinicians to treat you, we have to tell them why they should pay for treatment. We have to let them know why your therapy is “medically necessary” and each insurance company gets to define what “medically necessary” means to them. Even then, as you may already know, there are often restrictions on what kind and how much therapy you get.
We let your insurance company know how sick you are by providing them with a diagnosis based on the “International Classification of Diseases”. So, you seek out therapy because you had a terrible break-up and now we need to tell your insurance company what mental health illness you have. The truth is, not everyone seeking therapy or counseling has a mental health problem and if you have no mental illness, your insurance company will NOT pay for services. Contrary to popular belief, insurance companies do not cover life coaching or pay for therapy for individuals who simply need someone to talk to to figure out their life.
We are very transparent about the process because we want you to know how insurance really works. We would love to tell you that your health insurance will pay for you to come to therapy so you can work on personal growth but that is not the case. Quite frankly, insurance companies do not care about or pay for personal development. We also cannot tell you that HIPAA compliance ensures that no one will ever know about your illness/disease or that you sought counseling, but that’s not guaranteed. Your medical records are seen by multiple people at the insurance company, and can also come up (as some of you know) when you try to apply for life insurance, or health insurance in the future, or apply for a job with another company. Some employers also request this information from your insurance company.
Speaking of medical records, it is also nearly impossible to erase any records held by your insurance company once they are on file. Several insurance companies have had recent privacy breaches as well. By not using your insurance, you privacy and confidentiality are protected.
How Insurance Companies Sometimes Prevent Us From Doing Our Job:
Most insurances have limitations on how many visits you get, and often this is based on what kind of mental illness/disease you have. For instance, your terrible trauma experience may only get you eight sessions. Then we have to argue with your insurance company give us more sessions, which they may or may not do..... But eventually they will stop paying whether you are better (by yours or our standard) or not.
Basically, we have to continue to make you sick on paper, even though you might be getting better, in order to continue seeing you and get paid for our work. Not only do insurance companies limit how much therapy you get, but also the type of therapy they will pay for. So, to clarify, someone who has never met you is deciding when and how you will best be healed, based on their financial bottom line.
A word about fees:
Therapy isn’t cheap. Especially good therapy. But it’s cheaper than a divorce and it’s cheaper losing your job because you’re so stressed out you can’t get out of bed for a couple / few months. Therapy is in an investment in yourself and if you are like us, you invest in the things you care about. What is your healing worth to you?
Okay, so let's do some basic math! Our fee is $255 for the first initial session (for a diagnosis assessment) and $160 for every individual session after that. (Why is that first session so expensive? Because we have to write a lengthy report for your insurance company on our findings and justify the diagnosis you have so we can start treatment).
What do these numbers really mean? $160 per session would be awesome, if that was what the insurance company actually paid. In fact, that’s lower than many of the fees in the DC Metro area for therapy. Although we charge your insurance company $160, this is not what we get paid from them. In fact, we have separate contracts with each insurance company where they have negotiated with the us about what therapists should be paid to have the privilege of being on their panel and having access to their patients. On average, this is around $85, plus your $10-40 copay; which leaves us with approximately a $60-90 deficit depending on the service. It is illegal for us (or any therapist for that matter) to “back bill” or charge you the $60-90 that is uncovered. So we eat that cost.
What’s more, while many employers give raises every year, insurance companies often cut the fee they are giving therapists every year while simultaneously raising your premium and covering less and less.
Why does all this matter? Because honestly, we would much rather not “play the game” of keeping you sick to get paid pennies. We want you to heal, we want you to be invested in doing it, and we want your privacy respected and confidentiality upheld. All the records that we keep belong to YOU, and if you do not use your insurance, we commit to the following:
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You have access to your record at any time and they are yours-they do not get shared with anyone (exceptions to this rule are explained in the limits of confidentiality, but basically are outlined as if you plan to hurt yourself or hurt someone else)
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You do not have to carry a diagnosis if you don’t actually have one
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Clinical decisions, like how much therapy you should get and what kind of therapy you should get are up to You & Your therapist or psychiatrist
Our clinicians love what they do. We love working with you, working on your goals, helping you move towards the life your desire. We’ve worked hard for the appropriate education and credentials to provide you with the most competent care available. We would rather not have to spend our time negotiating on the phone with insurance companies, fighting to get what you should have as a right, or doing hours of paperwork that we are not reimbursed for.
Even if we are not an in network provider with your insurance company, this DOES NOT mean they will not pay for care. "Out of Network" Benefits means you pay our full fee up front, and then your insurance company reimburses YOU directly for the payment. Not every plan has out of network benefits, but some insurance companies are more willing if you have a prior relationship with a therapist, or if there are very few "in network" providers that offer the same kind/type of therapy or specialization in your area.
We accept assignment of insurance benefits after confirming coverage. However, confirmation or authorization of benefits is not a guarantee of payment for services. In the event that your insurance company rejects the claim or does not pay in full (or contracted rate) for all services rendered, YOU are responsible for payment in full (or contracted rate). You are also responsible for non-covered services such as late cancellation and no show fee's, deductible amounts, co-insurance and co-payments.
You are also responsible for notifying us if your insurance coverage changes, or of any secondary insurance coverage. Failing to notify us may result in owing payment in full.
More info on Out Of Network Benefits:
Services may be covered in full or in part by your health insurance even if we are not a contracted provider for your plan. You are responsible for any copay or deductible at the time of your session, check with your insurance to find out what your payment responsibilities will be.
You can check with your insurance carrier about "Out Of Network Benefits" by asking them:
• Do I have mental health benefits?
• What is my deductible? Has it been met? When does it reset?
• How many sessions per calendar year does my plan cover?
• How much will you cover for an out-of-network provider?
• What is the coverage amount per therapy session?
• Do I need approval or prior authorization from my PCP?
You may also utilize a health savings plan for your copay, if you have one.
We are happy to answer questions for you about this process. Please let us know if you want to talk more about this and how we can help. We hope this explains a little more about the process and risks of using your health insurance for therapy. Some of our clients choose to use their insurance, and we fully support their choice once they have all the facts and have made an informed decision.