Do We Accept Insurance?
Unfortunately we do not accept insurance at this time. Continue reading to find out why.
WHy don’t We accept insurance?
Lack of Confidentiality and Privacy
In short no, we do not accept insurance. When an insurance company pays for your treatment, it also denotes that their employees (doctors or not) get to audit my treatment plans and read what we have discussed in my session notes. These insurance company employees are then paid to save the insurance companies money by searching for fraud; while also determining if you are overusing your insurance coverage. Hence, the insurance company may decline additional sessions because they deem that you aren’t progressing fast enough (most insurance companies only cover an adjustment a month which doesn’t benefit you). I believe that you have a right to confidentiality of your medical records (not having insurance company employees {doctor or not} looking through your medical records). This therefor gives you the opportunity to heal and recover at a pace that best suites you.
Why don’t We accept insurance?
Presumption of Illness
In order for insurance companies to operate, they require that a diagnosis must be established to prove that you have a “medical necessity” to seek care. Because every individual is different, there may or may not be a “diagnosis” for your individual problem/problems. For example, insurance companies don’t cover for personal development, self improvement, therapies, and certain traumas because they deem that those conditions aren’t debilitating enough to pay for. I could upcharge your diagnosis to something that would be charged. However, that is unlawful on my end and it could potentially hurt you.
Why don’t we accept insurance?
Fraud
As a provider, if I engaged in up-charging/down-charging a diagnosis, I would be committing insurance fraud. Some providers out there are willing to walk the grey line and risk getting caught. Personally, we try to stay clear of that gray line because we believe insurance fraud is a big deal and not worth our license or potential jail time.
Why don’t We accept insurance?
Potential Consequences for You?
Lying about your diagnosis could hurt you because it would become a part of your medical record. It may not be a big deal at the moment; but it could affect you later on when attempting to acquire firearms, getting insurance, or seeking employment into certain sectors (when decision making is called into question due to current emotional/physical state). We believe that you should be able to get help without fear of putting your personal growth as a priority.
Why don’t we accept insurance?
Low Rates
An insurance company requires that you be “in network” with them in order to accept their coverages. That means that I would be forced to accept a lower fee in exchange to show up “in network” on their website; for a potential of more referrals. To be honest, a dinner for two (without alcohol and dessert) costs more than what insurance companies are willing to pay per session.
An example of what insurance companies (IC) pay: For first time patients, my fee is $175. But in order to join IC network i have to agree to their reimbursement rate of $60. The patient would also be responsible for the co pay of ~$40, bringing the total to $100. That means that I am relinquishing $75 (around 43%) of wages. Would you be willing to tolerate losing 43% of wages to accept insurance?
Furthermore, insurance companies have been raising their members’ deductibles, premiums, and co-pays in past couple years; claiming rising costs of care. One would think that increasing the rates translates to insurance companies paying higher reimbursements and lower costs on the patient? However it doesn’t and in fact, insurance companies have been decreasing their reimbursed rates.
Why don’t we accept insurance?
Burnout and Exhaustion
But how do other clinics and professions accept insurance and still survive? They survive by focusing on the quantity of patients and not the quality. (Seeing as many patients as possible regardless on if patients need extra care.) But focusing on quantity instead of quality can lead to another problem called burnout.
By accepting insurance, providers overbook their schedules in order to make a modest profit and be able to afford utilities, malpractice insurance, rent, and other miscellaneous expenses.
Why don’t we accept insurance?
Delayed Payments
Even though insurance companies agreed to a set reimbursement rate, they still require physicians and other therapists to jump through hoops in order to get paid. Thus, forcing clinicians to spend hours a day calling insurance companies (in their free time) contesting unpaid claims, and drowning in insurance paperwork. In general, it takes an additional 2 hours of UNPAID work outside our patient-doctor visits in-order to get paid by these Insurance companies.
For example, it would cost me $350 of my time ($175X2hrs) in order to be reimbursed the $60 from the insurance company. Even after fighting tooth and nail getting the claim approved, it could take 3-6 months after the session in order for that reimbursement to arrive at the bank.
Why don’t we accept insurance?
Retroactive Claim Denials
Imagine if your employer sent you a bill, requesting you to pay a portion of your income that you had earned 3 years ago. Does that seem fair or possible? It isn’t fair and it is possible with insurance companies.
Unfortunately, it happens to be a common practice for insurance companies to audit our claims and paperwork from the past several years. What this means is that if they find any mistakes, inconstancies in paperwork (including punctuation, grammar, etc.) that they missed from the originally approved claims; then they request the physician to return the reimbursement fees. These retroactive audits can bankrupt a small business.
Why don’t we accept insurance?
Benefits of Privately Paying for Health Care
Some of the benefits is that there isn’t a need to carry an unnecessary (and sometimes inaccurate) diagnosis on your medical record. You as the patient get to chose who you disclose information to. (insurance companies don’t get to read our notes) The best care can be provided because insurance companies don’t get to dictate how many times you can/want to be treated and what for.