Do you take insurance?

This is one of the questions I get most often.

And I hear it from both potential clients and therapists in the field.

The simple answer is that I do not take insurance. I have never taken insurance…and at this point in my practice I have no plans to take insurance. In fact, I have other options I have outlined first before I would take insurance.

The decision to take or not take insurance is obviously neither right or wrong as a therapist. It’s just a personal decision that I have made. And the decision goes back a ways to a conversation I had with a former supervisor and mentor in the therapy field. As I was sitting in his office one day he said to me, “Rhett, if I had to do it all over again, I never would have taken insurance. It has ruined my love of doing therapy.” As I pressed for more insight into his answer he stated how he often spent countless amounts of time tracking down payment from insurance companies, filling out forms, waiting on hold with them. And then often the payment would be so low that he often felt taken advantage of.

I know that with the surge of technological tools, collecting insurance payment has become much easier than before. But I have held on to his words and made a decision at that point to not take insurance. Instead I made a decision to not rely upon insurance companies for my referral base, but instead put my time and energy into marketing and networking through writing, speaking and more. I also decided that rather than take insurance I would carve out a percentage of my practice for pro bono slots and sliding scale fees to meet the needs of those who may not be able to afford a full-fee. I also am an out of network provider who provides a superbill with clients at the end of session that they can submit themselves to their insurance company if they choose to do so. Many of my client do this. I also try and give back to the community a lot in terms of speaking, holding workshops, and helping those who can’t afford counseling. As I mentioned in an earlier post, I am always holding in tension my passion for helping people, but also running a viable therapy practice.

Part of my decision in coming to this conclusion is also about the number of hours I want to see clients each week. I know that I’m really good with about 20-25 clients each week. After that, I feel like I’m no longer emotionally available or have the energy that I would like to have, not only for my clients….but also my other pursuits (writing, speaking, online groups)…. as well as my family. And I know that for me to take insurance and to create the income that I need to run a viable private practice, I would instead need to see 45-55 clients each week. I believe that for me to do therapy long term, take care of myself, and not become burned out….seeing 20-25 clients a week Monday through Thursday is key. So I set out to craft a practice around that number of clients.

And another part of my decision to not take insurance is my resistance to continually have to diagnose people with a code from the DSM-5 in order for people to submit to their insurance company. I have many clients who pay out of pocket because they don’t want to have a diagnosis code on their health records. Also, much of the way I was trained early as a therapist was to not see people strictly from some diagnostic code and treat them accordingly. If a client wants to submit to insurance I will diagnose them with an appropriate code, but I tend to look at my work with clients beyond just some code in a diagnostic manual.

Sometimes other therapists have told me that it’s not possible to have a private practice without taking insurance. But I have never found that to be true. And in fact, most of the colleagues I meet with and refer to don’t take insurance either. But in case a referral does need someone to take insurance, I have a list of therapist to refer to.

Making this decision is never easy, and you might change your mind over time. But as you make the decision take a couple of factors into consideration. Here are some questions to think about.

How much income must you make each month to have a viable private practice?

How many clients do you feel comfortable seeing each week, knowing that you are giving them the best you have?

What rate would you have to charge each of those clients to come up with the number you need to run your practice?

And will taking insurance allow you to do that?

How have you answered the insurance question for yourself?