I often hear potential clients tell me how hard it is to get a therapist that accepts their insurance plan. I get it. I accepted insurance for over 20 years and when I moved to PA I was not allowed to stay on CA insurance plans so I decided I did not want to make the huge effort to get on PA panels. The trade-off was no longer worth it.
I suspect the general public does not understand this concept. Or they blame therapists for being greedy. I mean many of us have price points well above $100 a session and often above $200 in urban areas. They wonder why we need or deserve that much money a session. It is a fair question to some extent. And unfair in others. To become a Master Level therapist (which is the “lowest” level of education needed) you must go to graduate school. Then to get licensed you must do many hours (I had to do 3500) of supervised practice. In places like California, many people do those hours at little to no pay. After graduating with student debt, therapists have to work an additional two years with no real income. Then you have to choose between working for a non-profit, government program, group practice, or going out on your own. Non-profits do not pay well. Most people choose to do private practice. If you do that you are starting your own business with all the financial and emotional commitment that takes. Of course, they do not teach any of those aspects in graduate school. Many therapists are good a providing therapy but not so great at running a business and marketing.
I now spend several hours a week marketing my business through blog posting and social media interactions. When I started my practice in 2001 this was not at all how I expected my time to be spent. If you accept insurance there are additional hours spent on record keeping. If you have your own office you are often your own cleaning person too. I was. Then you need to spend time and money on consultation and additional training. Like the rest of the world the therapy world grows and changes and you need to stay relevant.
The biggest issue right now is it is a very hard job. For some of us, that level of hardship happened after the 2016 election. For others, it happened when COVID changed the world and our practice. Something we had to adapt to immediately. I moved to a telehealth practice over the weekend. That meant figuring out the rules, changing paperwork, and finding a secure platform to work on.
Then week after week I was mired in the same crisis as many of my clients. My capacity to see clients was diminished. I stopped taking new clients in March 2020 and have only taken a very few new clients since then. I do not know a therapist who is not looking at other ways to make money right now. Many of us have moved into consulting work also.
The VC world has also now taken an interest in what they believe is a money maker for them. We have seen platforms like Better Help pop up. Where the goal is not to help people but to instead make money by selling data. (This is not a dig at any therapist working there, like everywhere some are good and some are not). Better Help also encourages therapists to forget about things like you need to be licensed to work in any state their client lives in. Next, there are companies like Alma and Headway who are recruiting therapists to work through them. They get higher reimbursements from insurance companies and pass that money on. So how are they making money? Why can’t insurance companies just pay a living wage directly to therapists without a middle person?
I saw a post today that likened therapists at these companies to early Uber drivers who were promised the sky as far as earnings potential. We all know how well that is going.
For many of us then the choice is to stay out on our own and off of insurance companies that want to pay us nothing and tell us how to do our work.
This is why you cannot find a provider that takes your insurance. The ones who do have most likely been full since 2020. The rest of us have moved on.
Thank you for explaining this to the public. Some people think that we should not charge much, even though we have umpteen expenses and obligations, but it is our living. They don’t seem to mind paying for haircuts, nails, vets, CPAs, attorneys, etc. but for some reason therapists are supposed to work for very little. And I get it, that people are struggling economically. But instead of being mad at therapists, people could say to their insurance companies, “hey, why don’t you pay a reasonable/living hourly rate to your providers? Why do you limit how many therapists you take on your panel? Why do you do horrible things like reimbursement claw-backs and make it so difficult for therapists to resolve billing problems on the phone?” This is a very real struggle for those of us who take insurance.