How is it ok that no therapists take insurance?

[Anonymous]

Anonymous wrote: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.

+1. What is the VA equivalent of HEAU?

[Anonymous]

Insurance companies like treatments with measurable results, and which will save them from further costs. Talk therapy has a dubious track record, to put it charitably.

[Anonymous]

It’s terrible.

While dealing with crippling grief and depression, I managed to do paperwork to get reimbursements and the insurance company said no.

Now, I look for people in network.

[Anonymous]

Anonymous wrote:Insurance companies like treatments with measurable results, and which will save them from further costs. Talk therapy has a dubious track record, to put it charitably.

IME the insurance companies really aren't looking that closely at evidence for specific types of mental health or behavioral therapy. They just don't want to pay for it period. I mean, the benefits of therapy for kids are long term. Corporations are often bad at long-term thinking and prioritize short term savings. Plus, with insurance, there's no guarantee the child will have the same insurer when those benefits materialize.

With other health care, insurance companies absolutely pay for things that don't have benefits and may even harm patients. Some of this is "defensive healthcare" to prevent lawsuits. E.g. when the nurse advice line tells you to rush your kid to urgent care for a runny nose.

[Anonymous]

I balked at paying OON for all sorts of therapies when I started my SN journey long ago. But over time I realized that I don’t have an option. We are lucky that we have OON benefits and that even OON we are usually reimbursed about 60-70%. But it adds up as pointed out when you need OT and speech and psychotherapy and for many there simple isn’t a way to make that work. What helped us in the early years is that because we needed so many therapies, we hit the maximum out of pocket and eventually it was free by November. But over the years our deductibles have gone up significantly and now our maximum out of pocket is unreachable. DD’s therapist charges $240 a session. The psychiatrist a little more. We cut back her therapy sessions to 30 minutes to cut the cost. For reference, I am currently looking to return to work and I will make about $30/hour. If not for DH’s income, she would be untreated. But I don’t believe the issue is greed on the part of providers. They have years of education and specialized training beyond college. Then they have to pay for insurance and operating expenses. They can’t see 40 clients a week because there’s behind the scenes work for each client. The issue is insurance companies are cheap and greedy. They do not have your best interests at heart.

[Anonymous]

[quote=Anonymous][quote=Anonymous][quote=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.
[/quote]


The people who earn $250/hr[/quote]

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.[/quote]

I’m a highly skilled DBT therapist and my fee is $275 plus. I see about 15 clients a week so I can be present and attentive and helpful for the ones I have. I don’t take people who aren’t a good fit. Clients see improvement and their lives improve for the better.

[Anonymous]

Anonymous wrote:

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.

I’m a highly skilled DBT therapist and my fee is $275 plus. I see about 15 clients a week so I can be present and attentive and helpful for the ones I have. I don’t take people who aren’t a good fit. Clients see improvement and their lives improve for the better.

[Anonymous]

I pay out of pocket and submit as out of network. It gets applied to the deductible and eventually I start to get a little money back. It's not much, but it's better than nothing.

[Anonymous]

I don't blame them for not bothering with insurance. I had a plan that caused weeks of back and forth between me, my provider, and insurance. The end result was the claim was denied because of an undisclosed rule that anything over 30 minutes would not be reimbursed and my appointments were 45 minutes long. Why would providers spend their time with this crap when they could use it to see patients?

[Anonymous]

Anonymous wrote:

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.

Most therapists don’t take insurance. Why would they?

[Anonymous]

Anonymous wrote:I don't blame them for not bothering with insurance. I had a plan that caused weeks of back and forth between me, my provider, and insurance. The end result was the claim was denied because of an undisclosed rule that anything over 30 minutes would not be reimbursed and my appointments were 45 minutes long. Why would providers spend their time with this crap when they could use it to see patients?

This.

After a similar experience I have a newfound understanding of how awful our health care system is. Providers have to hire people to deal with this stuff. With the low reimbursements for therapists I just can't blame them for not taking insurance.

[Anonymous]

Because if therapists were all covered by insurance, nearly every American would be in therapy every week. The best way they can ration it is by making it not covered by insurance.

[Anonymous]

Anonymous wrote:Because if therapists were all covered by insurance, nearly every American would be in therapy every week. The best way they can ration it is by making it not covered by insurance.

In other words, you believe the best way to ration therapy for children is based on who can pay for it. I disagree. I think this system excludes the children who most need the therapy. And society pays the costs. I think we could provide that care, but we are not willing to pay for it though premiums or taxes.

Anyway, I disagree with the notion that "nearly every American would be in therapy every week". That's absurd. Most people can't/won't make the time for a weekly appointment. A not insignificant portion of the population is uninterested in therapy (some may actually need it, many do not).

[Anonymous]

They have overhead. Rent for office space, insurance, staff salaries, utilities, etc. etc.

[Anonymous]

Insurance creates too much red tape.