The best therapists don't accept insurance?

A therapist said this to me and I realized that my best therapists didn't accept insurance.

What has your experience been?

How do we explain the difference in quality between therapists who accept insurance and those who don't, if there is one?

It is true. Once they get enough clients and a decent reputation it is not economically as lucrative to get third party payment. However, if you have decent insurance you can submit their invoices for reimbursement. Check your policy.

Well, since I just need a T to be consistent, professional, and do his job, I would disagree.

My T takes insurance and I've worked with him for a number of years. I had a counselor who didn't take insurance who I thought sucked because I didn't find her to be professional or able to keep her issues out of the room. I only worked with her for a few months so others may have had better success with her.

Good therapy can be subjective on some level.

I have read blogs by T's with the same thought. I get why insurance is such a pain in the ***, and the T's lose out in many ways--but I wouldn't be able to get therapy without insurance, and my T is (so far) a pretty great T. She once mentioned about how she can see why many T's don't accept insurance, but I am so glad she does. She went about two months without being paid by mine because of a stupid change they made.

I've also heard a corollary like "the best clients don't use insurance," meaning that someone who pays out of their own pocket has more incentive to progress quickly in therapy.

I don't believe either statement.

Hasn't been my experience at all. I've had those that did and those that didn't. Quality of therapy had absolutely zilch to do with whether they accepted insurance or not. We've actually run into this more often and more recently with psychiatrists, and honestly, the ones that took insurance were actually better and didn't have the god complex that the one who was just "too good to mess with insurance companies."

The first one I see takes insurance and the second one does not. I pay both in cash and don't use insurance. The second is better than the first but I don't think insurance is the key. The second one is just awful at paperwork.

To all, I agree that there may be excellent therapists who accept insurance and complete dolts who don't. Unfortunately, generally my initial response reflects my experience.

My T accepts insurance and she is wonderful. She's not perfect, but nobody is. Whether they accept insurance or not.

wow rouge ,
I still have my therapist today. she takes all kinds of insurance. she being paid by Medicaid and im able to afford her now . w/o Medicaid ,I wouldn't been able to see her as my counselor .her clientele is getting bigger and bigger and she handling more cases in her practice . she does office work too a top of her counseling her clients as well as teaching psycho educational classes .she also works at two different counseling services in the area .






Diagnosis: Anxiety and depression
meds : Cymbalta 60 mgs at night
Vistrail 2 25 mgs daily for anxiety prn
50 mgs at night for insomnia with an additional 25 mgs= 75 mgs at night when up past 1:00 in the morning

I don't know. I have never met a therapist who does not take insurance in my area. I have met an dealt with many through my work. I would also wonder if the wonderful T's who don't take insurance because they are in it for the money. While I understand they need to make a living to exclude people because they have insurance is greatly reducing who they are willing to help. My T is the opposite she is NOT in it to make a lot of money (enough to live off though). She excepts most forms of insurance even the ones many other therapists won't take due to low reimbursement rates. She will work with clients who can't pay their copays (for established patients I assume) even if they have one of the companies with a horrible reimbursement rate (like mine). I always pay my copay but during times where I have struggled financially she offered to wave my copay. She tells me that she isn't in this to make a lot of money. I have never taken her up on the offer though.

I agree that some therapists believe this statement, but I do not believe it is true. I think they say this to justify their own decision not to accept insurance. Where I live everyone has insurance, so it is rare for a T not to take it. They wouldn't have many clients if that were the case. The ones I've come across who don't accept insurance tended to be older psychiatrists with a small caseload due to time constraints.

I pay cash, no discount, but my therapist accepts insurance and is welcoming of those with low income. She's the best I've seen so far. If this is a thing, it's not her thing.

My former therapist does not except insurance and never has since she set up her private practice. Her reasoning, and other therapist she speaks about has nothing to do with money. Insurance companies put to many constraints on how they practice, especially diagnosis and amount of sessions, at least this was the case before Obamacare. She would rather spend her hours helping clients: extra sessions, email, and phone calls
— all included — rather than hassling with insurance companies. How many of you have had insurance issues that add stress to your life? It adds a lot of stress to many therapist that try to intervene on behalf of their clients or to get paid for services previously rendered. I am willing to bet 1/4 my ex therapist clients are on a sliding scale. I know she has seen clients for as little as what their copay was if they have insurance. One couple paid $20.00/month for almost a year because husband lost his job, and wife wanted to be home with the baby. Her goal was helping them keep their marriage together which is what they wanted for the sake of their infant daughter. She has also bartered with a client for a haircut. Same cut at Supercuts would cost $13.00.

I don't think it is true whether a therapist takes insurance or doesn't says anything about the kind of therapist they are.

I've had two really good therapists in my life. One accepted insurance, and the other didn't.

I really like the therapist who didn't accept insurance, but my rent is way higher now, and I can't afford $175 a session! lol

Here in the DC area, the surreal land of politicians, lawyers and shrinks, everybody is rich and nobody gives a flying F about the folks who are not able to pay top dollar. The struggling middle class is as respected as lice. I really need therapy, it could save my life. But there is no spirit of community or empathy. No soul. I just want to get healthy and stable enough to flee.

My T never processed insurance, but always provided a receipt that I could file with my insurance company, when I had insurance. When I was uninsured and/or couldn't afford therapy, he lowered his fee considerably. He didn't want the interference of insurance adjusters with his clinical decisions, nor the paperwork, and as a client, I preferred the privacy of cash payment. But I think much of this is market driven: in my area, only new Ts and practices that provide EAP process insurance. There are a handful who process Medicaid, but not private insurances. It may also depend upon which insurance companies dominate in your area, as some are easier to deal with than others. Sliding scales are very common here, and would not be allowed by insurance. It's the same with dentists here, except they don't offer sliding scales!

After informing me that she would not be continuing her contract with insurance companies, my ex-T told me she was never paid by the insurance company at all for a patient she worked with for several years. Current T doesn't take it either. I understand why they don't. Paying over $700 a month up front sucks but I get most of it back after I submit the claim....after my insurance company takes their own sweet time, of course.

Because of an unrelated matter, I eventually ended up needing a referral to a new T and none of the names from either ex-T or second degree referrals [from one of her referrals] took insurance either. This "trend" has really taken hold in my city, in particular. It would never fly in my home city. I am wondering if they take the risk in wealthier cities because they know people have the money to pay the entire fee up front.

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I don't think one can assess the quality of a therapist by insurance acceptance criteria alone, but it is an interesting question.

Factors that influence insurance acceptance include supply/demand in the area, insurance markets in the area, median household income, ethics, social responsibility, etc. Some insurance markets dictate managed 'behavorial health' while others do not. These managed plans can really be detrimental to a clinicians' autonomy. If I was a therapist, I don't think I'd take insurance.

Personal ethics contribute too. Some therapists don't take insurance because insurance companies can require therapists to take patients they don't want to treat and may require therapists to submit personal notes and other documentation that can be violating or add to legal risks.

I see a T in private practice and pay cash. He does not take notes. I went to a group practice recently, and the therapist asked me intrusive questions about suicidal thoughts and other extremely sensitive material at the first session. Everything was documented and I had to complete extensive forms that included personal history that was way too sensitive. In hindsight, I wish I did not answer the questions asked on these forms. Uh-I don't want my sexual abuse details and many other things transferred from business to entity to individuals. Too much potential for information security risks...The safest way is to document nothing...

One consideration--I think the maximum insurance payment for a psychotherapy session is $80 or so in the U.S. (varies by market but is similar around the U.S.). It seems that therapists could benefit by collecting fees similar to the amount insurance will reimburse. Most therapist fees seem to be way higher than that; if they take insurance, however, they likely will not recoup even close to what they charge considering $80 per session is about the going rate...

My therapist offers a sliding scale, and I pay him at least what he'd get from insurance anyway. Why take insurance if you can get the same or more reimbursement from cash paying clients? I know not everyone can afford $80 a session, but some do take less money if income doesn't support the higher fees. It's also about social responsibility. Some therapists who don't take insurance also want to ensure access to care. I support those therapists. I question those who turn down so many people in need. I think good therapists will take some low-income patients or waive fees altogether to do their part.

Of course those who get many referrals can charge whatever they can get. And the new therapist on the block who is hurting for patients will likely take insurance to get more clients until they get established.

I think the win-win is for therapists to not take insurance, but to offer a sliding scale.

I should add that although the market is much the same in my area today, my experience began almost 30 years ago, so this is nothing new.

The interesting thing is that in today's world, once a therapist is accepted into a particular medical insurance panel, they can file their claims by computer. Easy, peasy! In the old days, they had to juggle huge amounts of paper work. He/she usually had to hire an outside billing agency to do the billing and keep track of things. If a therapist is in private practice, all she has to do is set up her computer to be connected to the client's insurance company's computer billing site, and then once the session is done, she inputs the date and time and any other info the company requires and hits send (much of the additional information can be pre-programed into the form that is generated for each client so the time spent on the form is pretty minor). My therapist does her billing right after I walk out the door. She doesn't have to fill out an insurance form. No copying of the form for the client's record. No making a note on a tracking form (for those times that the insurance company "loses" the billing form). No mailing the form.

It's actually easier for therapists in individual practice to do this than a huge agency/clinic. Individual therapists will find out what is the most common insurances in their area of practice and they'll work to get admitted to those insurance panels. It's why if you search a particular therapist and inquire what insurances he/she accepts, you won't see all insurances. It's a bit hard to take the time to get accepted as a provider for ALL the different types of insurance.

My therapist, who has 30 plus years of experience, has a PhD and supervises other therapists and medical students (psychiatric), surprisingly accepts my insurance. She was willing to accept my insurance company's fee of $70.00 a session. I freely admit that that news astounded me. We didn't talk about the issue in-depth, but I did bring up my surprise at her willingness to accept such a low fee. She simply smiled and said that at this point in her life, she simply loves doing what she does and she would continue to do it for whatever fee the insurance companies offered. I know that she does charge a good fee for the therapist she supervises so maybe she makes up for it there. Fine with me

I don't agree. I might understand that thought because there's some connection to the client "paying for therapy" and not, but just off the top of my head, if the therapist's primary goal is to help people improve their lives, s/he should find 'client payment' to be a minor issue in the therapeutic process. There are a number of reasons why therapists (the best or worst) would accept other party payment, the first being client base or population of where the therapist practices. (All of this, again, just off the top of my head...) I live in what used to be known as 'the psychiatric capital' of the U.S, or the world, I can't recall. We have some amazing, cutting-edge, competent therapists taking insurance. Quality in therapists needs to be evaluated using other criteria; using only insurance as the bar of excellence is a bit short-sighted and self-serving.

I disagree.
Who does the therapist want to help? Only rich clients who have the type of disposable income necessary to pay for their services?
I'd rather have someone who's more interested in helping others than making money.

People here have made some very convincing arguments to the contrary, but my gut still says that it wouldn't surprise me at all if the "best" therapists didn't take insurance. I mean, doesn't the "best" of anything cost a bloody fortune? I know therapists aren't exactly antique furniture or fine bottles of wine, but I'd still be surprised to find The Premier Poobah of Therapists Who Wrote The Book On DBT (or whatever) sitting at a community health clinic accepting $50 medicaid reimbursements.

That said, I don't exactly sit around wallowing in despair that I'll never get good care because I'm not independently wealthy. Not everybody needs to see The Premier Poobah and I think it's very possible to find the right match from an insurance company's list of approved providers.

I don't think you can make such a broad, sweeping judgement. A desire to help others has nothing to do with taking insurance or not. You also can't know whether the fee of the therapist who doesn't take insurance is lesser than, greater than, or the same as the therapist who gets X amount of money per session from an insurance company and perhaps a co-pay as well. And many therapists who don't take insurance use sliding scales for clients. Which would kind of suggest they are interested in helping others.

Even if the therapists I saw took insurance, I would not use it because I don't want insurance companies to have access to my mental health records. Amazingly, I trust them even less than therapists.

And I am not by any stretch of the imagination rich.