Why I No Longer Accept Insurance for My Services

Posted on June 2, 2020 by


Be a success! Change your life!

Why I No Longer Accept Insurance for Psychotherapy/Counseling Services

June 2020

 The psychotherapy practice of Janice Della Badia LCSW, LLC does not accept health insurance.

I want to be very clear that this decision is based on the best interests of my clients.  Being successful in achieving your goal in psychotherapy by a therapist who accepts third party payment (a/k/a insurance) would be ideal, I know.  But, in today’s world, nearly 50-60% of private practitioners of psychotherapy do not accept insurance any longer.  Many of us started our practices accepting many insurance carriers, especially the larger ones, you know who they are.  Unfortunately, for many of us, that is no longer feasible.

Here’s why

Health insurance companies reimburse psychotherapists for client visits under a system known as “managed care.” Managed care allows your insurance company to dictate the care that you receive.  Instead of focusing solely on the care you need, many therapists are forced to pay attention to strict documentation requirements and complex billing and reimbursement processes. This results in (1) therapists having less time to focus on you and (2) your care being partially influenced by a health insurance company policy. This environment is the exact opposite of what healthcare is supposed to be.  These policies on the part of the insurance carriers is antithetical to the reasons I came to be in this profession.

My psychotherapy practice puts the quality of your care first by creating the best therapeutic environment for you. My decision not to accept insurance directly enhances your care.   Indeed, you have a choice to choose your therapist, and not have one chosen for you simply because the carrier has negotiated a discounted rate with large groups of psychotherapists.  Large groups that may require the therapist, numerous clients, in one day to “achieve the numbers” necessary to maintain the practice.  There are many more differences you’ll see:

No long waits in my waiting room.  I strive to be on time and to give you the time you deserve.  Of course, everyone has a “glitch” now and then, but no one has ever waited more than ten minutes.  If I am running a few minutes behind, I personally come to the waiting room to tell you, and not leave you sitting wondering.

You have access to me between visits via phone and/or text message.  If we meet on a Monday, and you have a question on Tuesday, it’s no problem.  Eliminating time-consuming insurance requirements means I can speak with you and answer your question.[1]

I will consult and collaborate with your physician or psychiatrist (with your written permission, of course).  You deserve to have the best of both professions working for you and/or your family.  Unfortunately, insurance carriers do not reimburse for consultation with other professionals involved in your case.  Such consultations can (if necessary) occur regularly and can last at least 20 minutes or more.

Insurance carriers do not reimburse for correspondence or report writing – if you or your adolescent needed a report or a letter from me for any reason, we will discuss what it is you need and, if I am able to do so, I will write it for you.  Brief letters or status reports generally take me approximately 30 minutes, and I will not charge you for that service.   Because insurance carriers discount fees so severely, accepting insurance would either prohibit me from assisting you or require I charge you separate and apart from your “co-pay” or “co-insurance” payment.

Because insurance carriers do not reimburse professionals for the important thorough assessment appointment, many therapists are forced to abbreviate this important meeting and are unable to spend the time with you necessary during your first visit to assess your needs properly.

If you are scheduling your first appointment with me, you will be advised that the appointment will likely last at least 90 minutes. It is my professional opinion a skilled therapist requires at least 90 minutes to discuss with you your needs, your expectations of therapy, and answer whatever questions you may have.

Individual appointments are at least 50 minutes in length.  If there is something urgent you may need to discuss with me, I am generally able to extend our time a bit or to schedule an appointment within 24 hours so we may conclude the urgent matter.   Unfortunately, most insurance carriers will not reimburse for anything more than 45 minutes, and generally discourage and even deny reimbursement for multiple appointments in a one-week period (claiming it is the carrier’s policy that it is not “medically necessary.”)

Couples/family sessions are always at least 60 minutes in length.  These types of sessions are generally reimbursable by the carrier for only 45 minutes and are seriously discounted by the carrier.

I know that even with the benefits stated above, the biggest barrier to accessing this kind of care is financial. I’m sure many of you reading this are thinking ….

“I can’t afford it.” 

I completely understand paying out of pocket fees for professional services for a visit with a skilled experienced psychotherapist represents a significant amount of money, so it’s understandable that might be your first thought. But here’s what I believe your second thought might be …

“What if my work with Janice helps me to understand myself better, helps me manage my feelings and emotions, and learn that I am indeed a resourceful, resilient individual who can be a success!”

What if our work together helped to relieve your anxiety, your worry, your grief, your sadness?  What if our work together resulted in your feeling more fulfilled?  What if you were able to reduce your weekly appointments (ultimately) to twice a month and then perhaps monthly…rather than an indeterminate period of time, or too brief a time because that is only what the insurance carrier will authorize?

After our first 90-minute appointment we will discuss fees per appointment and frequency of appointments.[2]   My fees for your individual appointments are $130-140/meeting.   Couples/family appointments are charged at a reasonable fee of $175/meeting.  Think about it, how much have you spent on buying items you didn’t need just to fill that space within you; or how much have you spent on vacations – vacations that were not as wonderful as they could be if you were only less anxious, less depressed, but energized and able to organize and enjoy your getaway with friends and/or family.

All things considered, paying out of pocket for therapy/counseling may be more affordable and more cost-effective than you may have originally thought!

Last, but certainly not least, I am happy to offer you the ability to remit payment using your debit, credit, or even your HSA card.  You will, of course, be provided with a receipt adequate for you to submit to your insurance carrier for out of network reimbursement directly to you.[3]

We all pick and choose how to spend our hard-earned money and decide whether something is expensive and/or worthwhile.   Spending your hard-earned dollars on quality strength building, positive therapy can provide benefits that can change your life.

I believe in offering you the best of my skill, training, and experience – after all, realizing you can achieve your goal, be a success…well, that’s priceless, isn’t it?

 

Janice Della Badia, LCSW

Board Certified Diplomate

Certified Divorce Coach

Life/Transitional Coach

 

 

 

[1] Telephone calls lasting more than 10 minutes are subject to a supplemental charge.  However, you are always advised of this.  Good psychotherapy practice also encourages you to set good limits and boundaries and process these things during our next session.

[2] I ask most clients to meet weekly for at least the first two to three months and then re-evaluate what is necessary from that point on.

[3] Not all insurance policies offer out of network benefits; also, some deductible rates may be higher than others.  Check with your carrier for information concerning your coverage.