It’s time to invest in your well-being

Seeing fewer clients and accepting out-of-pocket fees encourages more scheduling flexibility, increased responsiveness, opportunities to develop new interventions, workshops, groups, and other therapeutic activities for clients, and more time to consult with colleagues to deliver the highest quality care.

Out-of-network providers are able to specialize more, meaning you are more likely to find a therapist who has focused experience, education, and training to address your specific issues vs. a generalist. They have greater freedom to use innovative approaches and interventions that are based on data from current research.

Insurance companies only cover what is “medically necessary.” So, paying for therapy with insurance likely entails placing a pre-existing condition permanently on your health records. Often, the reasons for starting therapy (e.g., personal growth, relationship issues, self-esteem, etc.) are not diagnosable disorders. Nevertheless, insurance will require one to cover services. For example, if you’re struggling with anxiety because you lost your job, your therapist would have to diagnose you with a mental health disorder in order for your sessions to be covered.

Many insurance carriers cap the frequency and number of sessions or total amount they will pay for therapy. They have the right to audit your diagnosis, treatment plan, and progress notes to determine medical necessity and may demand this information directly from your therapist. They also may revoke your coverage if they disagree with your treatment plan.

Insurance companies reimburse therapists at rates unreasonably below (and often less than 50% of) typical session fees, making them unaffordable to accept given business expenses and investment in specialized education and training. Many insurance carriers have outdated reimbursement rates, in spite of the fact that the costs of running a private practice are increasing. Insurance companies also aren’t progressive in their treatment of mental health vs. physical health. On average, therapists are reimbursed 20% less than primary care physicians to treat the exact same mental health conditions, even though therapists often are more specifically educated and trained to do so.

It’s remarkably difficult to get on insurance panels—therapists often encounter long waitlists, sometimes spanning several months if not years. Once accepted by a panel, therapists spend an inordinate amount of time on paperwork, particularly when there are payment delays. Therapists typically have to resolve these issues without any billing or administrative support, and the process to verify benefits, submit/resubmit claims, resolve unpaid balances, and provide diagnostic explanations, treatment plans, and status updates can be convoluted, inconvenient, and requires time and energy that could be better spent supporting clients.

Many carriers take several weeks to months to pay claims, or they reimburse on an unpredictable schedule, which adversely affects the cash flow for small businesses and the ability to reliably compensate staff.

If you’re interested in starting therapy, hopefully you won’t walk away because of insurance challenges. Some PPO (not HMO) insurance plans will cover 50-80% of the cost for out-of-network mental health services, and we do what other private practices generally DON’T do: We file claims on your behalf!

Please remember that Spark Center therapists do offer reduced fees, meaning they will work with you to set an affordable price for a reasonably limited number of sessions. If you identify a therapist who is uniquely qualified to support you, it’s worth setting up a free consultation and discussing your options.