The author of this blog has asked to remain anonymous over the sensitive nature of the topic.
Why Can’t I Find a Therapist That Takes my Insurance?
If you follow any parent Facebook groups, you will see many parents desperately searching for a therapist for themselves, their partner, or their children. This post often mentions that they “must take insurance!” In the comments, you'll see parents venting about the high costs of therapy and expressing frustration over therapists who don't accept insurance. It's understandable why parents feel this way. Providers who accept insurance usually have long waiting lists or aren't accepting new clients. Most of us who pay a premium for health insurance would prefer to use our benefits rather than pay out-of-pocket fees.
So before jumping to the conclusion that therapists are taking advantage of clients if they do not take insurance, here is some insight into the careful consideration and calculations that factor into these business decisions. I thought that it was important to “pull the curtain back” on how health insurance works for providers because it’s one of those things that you would never know the details of unless you are on the other side.
Imagine working in a job where you never get an annual “cost-of-living” increase...
But your expenses go up exponentially annually. Imagine never knowing if you are getting a raise and if you do, you’re lucky if it’s a 1% raise. You make a plea annually for more money and get denied every time with the reason being “there are enough people who are willing to take what you are getting and are fine with it.” Imagine someone with no experience making the same amount as you do. Imagine working for someone for 12 years and only making $8 more an hour than when you started. Imagine hearing that in the 80’s, people got paid more for the same service that you are providing. Imagine a job where you have no benefits, no paid vacation, no sick leave, or no retirement plan unless you pay for it yourself.
Imagine not being paid for a service that you provided, or being told by your boss that they made an error, and you have to return a large sum of money. Imagine having to wait at least 3 weeks before you get paid for any service you provide and sometimes having to chase down your boss to pay you. This is certainly a job that most people would consider quitting. This, unfortunately, is what it’s like when you are in-network with insurance.
In 2011, I started my private practice and was thrilled to go “hang my own shingle” and be my own boss.
It was absolutely the right move and I never looked back. At the time, I debated whether to take insurance. The major PRO of taking insurance is that you attract clients quickly and steadily. Since I was eager to shift my career as soon as possible, I opted to take insurance. This also had the added benefit of making my services more accessible and affordable to those seeking them.
I assumed that surely, insurance companies had their own dedicated customer service team for providers and that they were treated with more consideration than consumers. However, my assumption was proven wrong as I had to endure being put on hold for hours and being transferred from one person to another before getting the answer I needed.
Getting credentialed with insurance can be a lengthy process that may take up to 6 months for approval. When I applied, I submitted my paperwork via both snail mail and fax. Somehow, my paperwork was lost THREE TIMES by the insurance company. Finally, 8 months later, I became a participating provider. I was thrilled and was ready to start my practice!
At the time I started my practice, electronic filing of claims was just beginning. I had to pay for proprietary software to submit claims online. I also had to pay for an online “Electronic Health Record” to be compliant with HIPAA laws. Then there was the initial start-up cost of a website, business cards and general materials. I was lucky to find a furnished office at a relatively inexpensive rent. I continued working at my day job until I had enough clients to make the switch to full-time practice.
As an insurance provider, you are a 1099 contractor. That means that you are responsible for all of your withholding of taxes. The Federal tax rate for a 1099 contractor is approximately 15%. The state tax rate for Maryland is approximately 5.75%. Then there are annual fees associated with filing insurance claims from the Federal Government and you pay per claim that you file. Along with rent, supplies, marketing and advertising costs, accountant and attorney fees, paying for a skilled insurance biller, phone and cable bills, utilities, license renewal, malpractice insurance, business liability insurance, continuing education, etc. It is said that the average expense of running a private practice is approximately 50% of your income. If you take credit cards, there is a 3% fee.
So, for example, say you make $100 per session from insurance (this is a high estimation). 3% goes to a credit card fee, 20% of that goes to the Government, and 50% of that goes to expenses. After all is said and done, you make about $37 an hour per client that you see. Even if you see up to 30 clients a week (10 unpaid hours for administrative work), you end up making about $55,500 a year after expenses if you work 50 weeks a year. That’s assuming you have enough clients to fill your summer hours, you never take a sick day, none of your clients cancel and all of them pay their bills.
Many people would be extremely grateful for making $55,500 a year. The problem is this is the max take home you will ever get. This is compared to the median household income of approximately $90,000 in the DC Metro area.
For a clinician Social Worker, one needs to attend graduate school and work for two years before they are able to be fully licensed and practice on their own. If fortunate enough to be debt-free and have a partner with a high income, $55,000 may suffice. However, for most individuals, this amount is inadequate to support their families.
Talking about money can be a sensitive topic.
However, as a private practice owner, it's important to acknowledge that it is a business. While it is a helping profession, it still requires financial considerations. I made the difficult financial decision to leave insurance panels in March of 2023. It was terrifying, but I know it was the right decision for my business. People should be compensated for their skills and their time and I believe that my clinicians deserve to be paid what they are worth. They certainly deserve more than $38 an hour. As a therapist, I encourage my clients to advocate for themselves and recognize their own worth. It was time for me to take my own advice and make a change.