How is it ok that no therapists take insurance?

[Anonymous]

It seems so ridiculous to me. Who are these people who can afford to shell out $250 once a week? My insurance covers barely anything.

[Anonymous]

We pay out of pocket, but get 70% reimbursed. So more expensive than in network, but not $250.

I agree that the low reimbursement rates for mental health care are criminal. I have clients on medicaid and they either can't find therapists at all or the turnover is so high that forming a relationship is impossible.

[Anonymous]

Dining out? Vacations? Summer camp? Too many missed to count.

[Anonymous]

We did it in 2021-22. Had Kaiser for insurance with no out of network benefits and they had put us on a wait-list for some program that seemed appropriate. In the meantime we started working with a therapist specialized in my DD's condition. It was stressful financially. But no regrets because DD got so much better.

It turned out that the program that we were on a wait-list for was not appropriate. When they admitted that, Kaiser agreed to pay for the private therapy as though it were in network. We paid $5 for each session after that. If there are no appropriate therapists with availability that take insurance, try to make the argument that they need to cover it as in network. I think they are required to. Your state may have an office that helps with this kind of thing - in MD it is the HEAU and they will help you file appeals/make complaints.

It's an awful situation. We now have a plan with great out of network benefits but even so CareFirst has made my life miserable trying to get them. Insurance companies ration care by trying to get people to give up trying to get claims paid out. They do this to everyone - people like us trying to get out of network claims paid out, as well as in network providers that take insurance. The reimbursement rates for therapists are not high enough to justify this massive headache. It makes me so angry that our health care costs are inflated by this Kafkaesque system.

[Anonymous]

I mean, what’re you going to do about it?

[Anonymous]

Anonymous wrote:It seems so ridiculous to me. Who are these people who can afford to shell out $250 once a week? My insurance covers barely anything.

The people who earn $250/hr

[Anonymous]

Anonymous wrote:

Anonymous wrote:It seems so ridiculous to me. Who are these people who can afford to shell out $250 once a week? My insurance covers barely anything.

The people who earn $250/hr

Disagree. A full time salary of $250 per hour is about $500k. First of all, a therapist that charges $250 per hour is unlikely to be billing 40 hours per week, so even they are bringing in less than that. And they have costs that eat into that.

We have an HHI of $270k and can pretty comfortably pay for $250 per week of therapy. Do we want to? Of course not. But we can, and we've made it a priority because it really helps our daughter. That being said, $270k is well above the median income on the DMV.

So I agree this is really hard for most families, but I don't agree that only the super rich can afford this.

[Anonymous]

The insurance companies need to be required to reimburse mental health at the same level as physical health. Not holding my breath.

[Anonymous]

The problem is if you have a kid who needs all the therapies, like speech and OT and then you add mental health on top.

[Anonymous]

Take it up with your health insurance. Insurance companies do not pay therapists (mental, SLP, OT etc...) fair compensation this wouldn't be a problem. However, what they are reimbursing you is all they offer a therapist.

[Anonymous]

By the time you add in (Metro DC $) office space along with either a billing company or a secretary, that $250 an hour doesn't go so far.

[Anonymous]

An insurance company might decide to only pay $150 of the $250 and then you spend so much time and money getting the other $100 from the patient. Leave that to the patient to get form their insurance company and you see more patients, less overhead and better therapist.

[Anonymous]

If this is something your insurance covers and they only have in-network, go to them and ask for a list of covered providers. If none of those are feasible, you can ask them to help you find someone. If they can't find anyone that will work, they may do a "single case agreement" to cover a usually out of network provider. When they give you the list of potential providers, make sure they are being reasonable with geography. They don't always understand that in the DMV, something 7 miles away can take 2 hours to get to.

[Anonymous]

Anonymous wrote:An insurance company might decide to only pay $150 of the $250 and then you spend so much time and money getting the other $100 from the patient. Leave that to the patient to get form their insurance company and you see more patients, less overhead and better therapist.

If you are in network, you aren't allowed to collect that additional $100.

[Anonymous]

Anonymous wrote:We pay out of pocket, but get 70% reimbursed. So more expensive than in network, but not $250.

I agree that the low reimbursement rates for mental health care are criminal. I have clients on medicaid and they either can't find therapists at all or the turnover is so high that forming a relationship is impossible.

Same, at 80% plus after we spend out of pocket max everything is covered. OP, you you need insurance plan with out of network benefits with a realistic out of pocket max for your situation. Review the plans that your job offers, don't go for the cheapest one, usually it's the most limited one.