04/27/2024
There is a shortage of mental health counselors in the USA. There's an even greater shortage of mental health counselors who take insurance. The number of mental health counselors who take insurance AND specialize in treating anxiety and OCD is even smaller. Why is that?
Reason 1: Because when you have put in the time, money & effort to get the extra training required to truly understand how to use evidence based, empirically supported treatment methods effectively, there is no recognition (as in higher reimbursement rates) from insurance companies.
Reason 2: Billing issues take up an inordinate amount of time & money -even if the provider outsources billing. See below.
Reason 3: In network Providers are required to file claims within a certain time period -- typically somewhere between 1 - 3 months, but insurance companies will do claw backs (I.e. Denying payment for a claim they already paid out) up to 2-5 YEARS after the claim was made. And the clinician is FORCED to return that money to the insurance company, even if the decision is appealed. Often the client involved has been discharged already — and how would you feel if your doctor sent you a bill 2 - 5 years after a date of service saying oops, you or your insurance company made a mistake and now you have to pay the full fee for the service you recieved? Most clinicians I know eat the cost as a COB — and add it up to another reason to think about going private pay only.
Reason 4: Insurance companies rarely raise reimbursement rates - & Medicare has actually LOWERED reimbursement rates. Rarely do the rate increases match the inflation rate.
This means for someone like me, who does take some insurance, that my yearly income has stayed around the same level for the past FOURTEEN years while the cost of doing business has increased every single year.
Reason 5: Providers are required to stay Hipaa compliant. It costs a substantial amount of money to meet those requirements. Whether you are in network or out of network doesn’t matter. But if you are private pay only, you can pass that and other costs along to the client in your fee schedules.
Reason 6: It costs the provider money to submit claims through a clearinghouse (an option for many EHR companies) - admittedly not much per claim, but when you add that up over time, it adds up very quickly.
One clearinghouse (Office Ally) charges an additional $39 per month if they handle claims for insurance companies that have not contracted with them. So, let's say, for instance, that the largest clearinghouse in the country (& the one your EHR company used to use) gets hacked, shuts down, & your EHR recommends signing up with another clearinghouse temporarily so that you can submit claims (because, you know, you have to submit claims within a timely filing period or risk not getting paid at all), but that clearinghouse (Office Ally) has this $39 fee in the fine print that you don’t catch before submitting 5 claims that turn out to be with an insurance company they don’t work with, then whammy — an electronic claim submission that used to cost perhaps $2 now cost you $39.
Reason 7: New federal rules now mandate that the onus is on the clinician to update their information with every insurance company they are in network with every 30 days. It USED to be that there was a central organization that you could use to do this (CAQH), but now that is not sufficient (but also still required!) and the provider is now required to go to every individual insurance company, all of which have different systems and procedures in place for how to prove you are who you say you are every single damn month.
Reason 8: Even when you follow their contractual rules and send a letter to an insurance company (or fill out a form on an obscure part of their website that at first glance does not even look like a “I want to resign” form) stating that you no longer wish to be an in-network provider, the company is so big that that communication gets lost and you find yourself disenrolling multiple times over the next 5 years (and in one instance was re-enrolled as an in network provider without my permission).
Reason 9: I am TIRED of dealing with bu****it from insurance companies. I JUST want to be able to treat clients without it constantly being a fight between me and the insurance company — or my client and their insurance company.
So why am I still in-network with a now extremely limited number of insurance providers (the number of which is getting less and less every time yet another insurance company does something to p**s me off)? Because there are clients who genuinely cannot afford to pay someone out of network fees who suffer tremendously. And they deserve to be able to find someone who has the training and knowledge to provide effective, empirically supported, evidence based treatment.
Why should good, effective treatment in this country only be reserved for the well off? Why is health care, and particularly mental health care, not a basic right for every human being?
