We’re all trying to save money. We’re also all trying to address our mental health. That is why it is not uncommon to find a therapist that will take your insurance – someone that can provide you with excellent mental health support, but ideally with less out of pocket.
The problem is that is much easier said than done.
We accept NYSHIP here at Long Island Counseling, and we work with other carriers in various ways as well (more on this in a moment). But even with all the therapists we have available, we also tend to avoid insurance, and there are many reasons why:
- Very Low Reimbursement Rate – NYSHIP is an amazing exception, but the vast majority of health insurance providers reimburse at extraordinarily low rates. Most have not raised their reimbursement rate in decades, and do not adjust for experienced therapists or those with advanced degrees.
- Getting that Reimbursement is Challenging – It can take hours of time trying to file paperwork and track down payments, through systems that may take several months to complete. That is unpaid time, so if you imagine a low reimbursement rate for one hour of service, then add at least one or two more hours for administrative work, it is easy to see why this is unsustainable.
- It Limits Treatment – But it’s not all related to payments. Most insurance agencies are extremely strict about approving treatment. They require specific therapies only, and for a specific timeframe. Every individual is different. If a client needs something slightly different or longer, insurance may not cover it.
- Privacy – Insurance also means that you both most have a diagnosis and that diagnosis must be made public to the insurance agency. We may work with someone that has depression symptoms, for example, but either doesn’t quality for a depression diagnosis or does not want their workplace to know. But, if you use insurance, you have to have a diagnosis and that diagnosis must be shared with the insurance agency, and anyone else that is allowed access to that data.
- Higher Demand – Therapists tend to prefer to keep caseloads manageable so that they can both have more availability to their existing patients, and also so they can manage their patients’ needs with more individual care. But because reimbursement is low and because many insurance agencies require availability, many therapists that use insurance have to take on an excess of patients in order to pay their own bills and be available for the insurance company.
These are only a few reasons that many therapists have chosen not to accept insurance at all, at least not directly.
Out of Network Benefits
However, it is important to note that, even if you’re working with someone not in your insurance network, you may still qualify for reimbursement.
Many insurance plans offer what’s known as “out of network benefits.” In these situations, a bill is submitted on your behalf to the insurance company, and then your plan covers a percentage of that bill. Long Island Counseling can help you submit those payments, and in some ways it’s actually less work to do so.
This allows for many more therapy options – and access to far more therapists – but without the strict rules of in-network.
Does My Insurance Provide Out of Network Benefits?
That is the big question, and one that varies on a case by case basis. Most of the time the answer is yes, but the reimbursement amount may vary between 30% to 50% to 80%. So, you will need to find out what your out of network benefits are. We are welcome to help you with this, so please feel free and reach out to Long Island Counseling with your questions.
It’s also important to realize that you can calculate this as part of your decision making for future insurance. Open enrollment is soon, for example. This may be a time when you can switch to a new insurance plan that provides better out of network benefits.
Overall, the limitations set by most insurance agencies are the reason that so few therapists are available. But you don’t necessarily have to let that limit you. Out of network and cash options exist, and these can be a great way to get the therapy you deserve.