I get an average of five calls a week for people who want me to see them and have Insurance X. I can’t take most of these people and often they ask me for a referral. I have to say I don’t have one. I have no therapist on Insurance X I can refer to. What I don’t get into with them is why. Insurance X hasn’t taken new providers in my area for at least ten years. In fact, when I applied to get on them they turned me down several times. I actually got on their panel when they took over Insurance W and just absorbed all of their providers. didn’t even know I was on their referral list until I started getting phone calls from prospective clients.Insurance X maintains that they have an adequate number of providers in their network and therefore will not accept new providers. Now the people that call me and say I am literally the 20th person they have called (and that is not an exaggeration) would probably beg to differ.
The second issue with Insurance X is that they have not given a raise to providers for at least ten years and I have heard it has been more like twenty or more years. Their rates are at least 10% under other companies rates. As a therapist we can only see a certain number of clients a week and remain effective. We can’t just add more clients to make more money and do good ethical work. So if the opportunity exists for a provider to take clients with Insurance Z that pays more which clients do you think they will accept first?
In fact last year one of the providers sent out contracts with a provision buried in it where providers would accept rates 30% lower than the already low rates. I actually almost missed that provision and the ability to opt out of that plan. This year I dropped two of the plans I am on and I am moving towards getting off of Insurance X. I am one of the only area providers that takes this insurance and has the expertise in gender identity and is also EMDR trained. I want to work with people that want to use their insurance for their treatment. I recognize that out of pocket therapy services are pretty costly. But I can’t work until retirement without any increase in my income.
This is the dilemma that psychotherapists that take insurance face. In my area there are a substantial number of providers that refuse to take insurance. They will provide a superbill for clients to submit and then fight out with their plans. Insurance X has a higher deductible for members that use providers out of network so essentially that means unless you have high medical bills you have no out of network coverage. My guess is that this dilemma with insurance affects other providers as well which is why your doctors visits now are only ten minutes. They compensate by adding more patients. We can’t.
So if you have experienced the inability to find a provider that is on your plan perhaps this is why. I encourage people to complain to their state managed care departments, their HR departments, and the insurance companies. Until people say no more the companies will continue to do what they can to keep their profit margins.
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