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Forum -> Working Women
Why will a therapist decide to stop taking insurance?



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amother
OP


 

Post Fri, Feb 07 2020, 7:58 am
My therapist is stopping to take insurance, so I will have to stop seeing her since I cant afford it.
Anyway im curious from a financial point of view why would someone do this, they are still billing the insurance company the same 200$.

Am I missing something.?
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amother
Beige


 

Post Fri, Feb 07 2020, 8:00 am
amother [ OP ] wrote:
My therapist is stopping to take insurance, so I will have to stop seeing her since I cant afford it.
Anyway im curious from a financial point of view why would someone do this, they are still billing the insurance company the same 200$.

Am I missing something.?


Because many insurance companies don't pay and most don't pay the full amount.
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amother
OP


 

Post Fri, Feb 07 2020, 8:06 am
Ok im curious. What do you mean they don't pay?
And how much of the 200$ do they pay?
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amother
Beige


 

Post Fri, Feb 07 2020, 8:11 am
amother [ OP ] wrote:
Ok im curious. What do you mean they don't pay?
And how much of the 200$ do they pay?


Maybe 1/2. Therapists charge how much they like. Insurance decides how much it's worth to pay them.
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amother
Coffee


 

Post Fri, Feb 07 2020, 8:11 am
You are lucky if insurance covered you 100% until now.

In my experience, I never found a therapist who was in a network and paid by insurance. To the extent, I had insurance coverage for a therapist, I paid the therapist and then submitted the bills. I would be paid at most 50% of what he/she billed.

In order for insurance to fully cover a therapist, the therapist needs to be in the insurance company's network and the networks are generally small and limited to therapists who are willing to accept very low reimbursement from an insurance company. Most therapists - especially those are are "recommended" - have a large enough practice so they can afford to take only private patients. This is true in my personal experience with dentists as well. I have never gone to a successful dentist who was in an insurance network.

Consider it from the therapist's point of view. A therapist can only see one person an hour. Selling his/her time is the only way to make money. A doctor can see multiple patients in an hour and have many people in the waiting room. A therapist can't have people in a waiting room thinking they can be squeezed in.
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amother
Rose


 

Post Fri, Feb 07 2020, 8:12 am
amother [ OP ] wrote:
Ok im curious. What do you mean they don't pay?
And how much of the 200$ do they pay?


I've had more than 1 insurance that pays out of network.. (so they pay the same amount as they would pay in network... and I had to pay the rest..)
One paid a therapist $50 for a couples session and one paid $85 for the one my therapist charges $175.
(For reference..I think my billing code was 90834)
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amother
Taupe


 

Post Fri, Feb 07 2020, 8:35 am
Insurance companies are tough to deal with and definitely don’t reimburse that well (though to be honest- when I submitted myself to B c b s I received back 125 out of the 150 I paid but that’s unusual) also- if your therapist is working at a clinic or under someone there may be more costs
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amother
Babypink


 

Post Fri, Feb 07 2020, 8:59 am
Also, submitting to an insurance company is a LOT of extra work, and claims can be denied for seemingly capricious reasons but actually because of minute details in the billing process.
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amother
Slateblue


 

Post Fri, Feb 07 2020, 11:59 am
It’s interesting because if my therapist would be in network with my insurance I would only have to pay a standard copay and the therapist would get the total amount billed (over $200). I’m assuming that most insurances don’t have such high allowances and also billing takes time and claims can be denied etc so it’s not worth it for the therapist..
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ra_mom




 
 
    
 

Post Fri, Feb 07 2020, 12:29 pm
amother [ OP ] wrote:
Ok im curious. What do you mean they don't pay?
And how much of the 200$ do they pay?

About $75. Plus they therapist needs to hire a medical biller to put through the claims, otherwise they have to put in many hours to do it themselves and deal with various rejections and changes to billing codes.
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amother
Cobalt


 

Post Fri, Feb 07 2020, 1:06 pm
I'm not mental health professional, but I am a different type of therapist. I am in network with some insurance plans. The insurance pays me about half (at most) of what I charge patients who are self pay. Plus I have to deal with a lot of paperwork such as authorizations, providing documentation for my biller to submit claims, reviewing claims to make sure I'm paid, resubmitting, sending in lots of files when they audit me. Etc. It takes a lot of time and energy, and the reimbursement is lousy.
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seeker




 
 
    
 

Post Sat, Feb 08 2020, 6:54 pm
Same reason a lot of doctors and dentists are dropping out of certain insurance networks... not only do they pay below market rate, they now make the doctors/therapists jump through a whole obstacle course to get paid, and it's just not worth it. Consumers are losing out big time.
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amother
Babyblue


 

Post Sat, Feb 08 2020, 11:33 pm
For the person that had couples therapy covered- how?? Couples therapy isn't covered by MEDICAL insurance as it isn't a medical need. Sometimes they will do a collaborative session where it is still focused on their patient but the spouse comes in for advice/insight on how to help with the patients's depression, addiction, anxiety etc but it isn't classic couples therapy.

And insurances pay lousy reimbursement with huge overhead costs. Plus they can stop covering you at any time but your therapist still has to be in touch with you for closing/referrals if a new private pay rate cannot be set. So that extra time won't necessarily be paid for- not even at the discounted insurance rate. Oh and at any time they can audit the charts and demand payment back if you forgot to chart something exactly as required.
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