Hi, my name is Piper Harris and welcome to the Untangled Mind podcast. On today's episode, I discuss with you why I will never take insurance as a mental health counselor. I'm not being a curmudgeon or trying to make your life difficult. In fact, listen in as I share to you the very good reasons why I will never take insurance to ensure that you get the very best care and mental health counseling from me. Thanks again for joining the Untangled Mind podcast. Hello, hello, everybody. So I am not only recording this as a video, but I'll also post this on my podcast. Thank you for joining me. I am Piper Harris of Entangled Mind, and I partner with Dynamic Growth Counseling and Consulting Services. We are a new counseling and consulting service. We are located in East Cobb, uh, Georgia, in Marietta, Georgia. We love our new office space. This is it. And we are trying to share all of these new things that we're trying to bring to the counseling industry, the counseling field to you as our clients. So be sure to stay on top of our podcasts andor our video casts. I will make sure to drop links in our show notes for that. So today, I really wanted just to take a few moments. This is not going to be my typical long podcast or video cast, but I wanted to talk about something that has really come up really for months and months and months prior to Dr. Susan Belangie and I working together. And that is the discussion surrounding therapists that accept insurance and therapists that do not accept insurance. I had a wonderful conversation with a long-standing client the other day, and um he is so dear to me, and we were discussing that our rates here are going to be increasing in January. A lot of my clients, I've been fortunate to be with them for a long time, and they started with me as a student. Well, I'm no longer a student, and so rates do increase with that. And so he and I were having a discussion about rate increases, what that looked like for him. And he said to me, When will you start accepting insurance? And I said to him, That day will never come. And we had a really great conversation about it. And I thought that it was so very important for me to explain why I will never work with an insurance company, why I won't go to get my boards to be a therapist that is allowed to take, say, Blue Cross, Blue Shield, or Cigna or whatever it is. Um but he and I's conversation really did provide an opportunity for me to really think about this and think about, you know, this is a really important conversation for you to have. So you're not just like, oh, Piper's just being terrible. She won't take it. Number one, I can't take it because I'm still in my residency years. But two, I it's not because I'm being a curmudgeon. It's not because I'm trying to make your life more difficult as a therapy client. There's actually reasons behind it. So let's talk about why we will never ever take insurance at dynamic growth counseling and consulting services or untangled mind. First and foremost, the big one that I think a lot of therapists are running into is that when we take insurance, you lose your privacy and confidentiality. Now, HIPAA, that doesn't mean we're sharing things outside of the therapy room. However, when you take insurance, insurance companies have a requirement that we have specific treatment plans based on a medical model. Now, if you're a current client of us, we do provide you a treatment plan based on a medical diagnosis, simply because what we're hearing now is even our clients that get a super bill, they're being asked for a treatment plan. So we want to cover all our basis. But here's the thing: when an insurance company, when we're paneled with an insurance company, they take all of your information. It's yours, but it is theirs. So they have to decide how much insurance coverage you get. They have to decide if they're going to authorize what kind of coverage you're going to receive. They have to tell you what kind of treatment that you're allowed to have. It has to be evidence-based. Sometimes they'll code it for short term and they say, you get six sessions. That's all you get. Sometimes they're going to say, Well, maybe we'll let you have 12 sessions. Here's the problem when insurance providers kind of put this blanket idea of how many sessions you're worth. And this is what I said to my client that day. I said, I will never accept insurance because they tell you what you're worth and what your work in here is worth. Here's the thing. So often my clients do stay with me a long period of time. We have gone through and reached most of their goals. And often they come in for what we call booster sessions. It's kind of like taking the car to get the oil changed. It's preventative. But here's the other thing, too. For example, if I have a client that comes in to me with like a complex trauma history, they absolutely require more than 12 sessions because evidence shows us when it comes to a complex trauma history, exposure therapy or like EMDR is highly effective. But based on the distress levels of that complex trauma, I'm telling you, 12 sessions is not going to do the trick. It's not going to do the trick. So insurance is essentially saying, we don't, you know, you're just going to have to figure it out. This is how many sessions that you get. So that's a problem when we get boarded, is you lose your privacy because number one, we have to put a diagnosis in your medical file. You use lose your confidentiality because all of your information is therefore at the insurance, because we have to prove to the insurance provider that we're doing evidence-based treatment, that we're diagnosing you correctly. And here's the kicker. Here's the kicker. This is the second reason. There's an assumption of illness when you're working with an insurance provider, meaning there are only certain illnesses that they are going to cover. There are only certain diagnoses that they are going to cover. For example, did you know insurance doesn't cover family or couples therapy? I bet you didn't. Because if you've gone to other practices, often what they do is they bill insurance as an individual to ensure that you receive treatment. Here's the problem with doing that too. Those counselors have a wonderful heart and they want to ensure your treatment, but they're actually taking place in insurance fraud. Do you hear that? It's because they want to give you the treatment, but insurance providers will not cover our work with couples or families. Or I have also heard that they will cut they will cover family therapy at a reduced rate. Why is that? So there are certain illnesses, certain diagnoses that insurance companies will only reimburse for. But here's the thing. Oftentimes, for example, going back to trauma, I specifically focus on anxiety and stress-related disorders, which is trauma and grief. Oftentimes, say I have an individual come in with PTSD. We've got our work cut out for us, we're going to, we're going to keep going through. I have to document what we're seeing. What are the symptomologies that we're seeing? Sometimes we see anger and rage. Sometimes we see an increase in alcohol use. All of that is in the medical file. But say after you've done your prolonged exposure, you're doing great, all your clinical levels have decreased, the rage is gone, the alcohol use is gone, all of these things, these outward reflections or symptoms of the trauma that you went through are gone. But the things that may have been negative byproducts of their symptoms are still in your medical record. What if you got a DUI? And we can really see that your alcohol increased after the PTSD. What if you got into a huge brawl? It's in your medical record. Even that simp, even though that symptomology is gone, you've done the hard work, it is still a matter of your medical record. So that could have a potential negative consequence still for you. So that's another reason why a lot of us don't like insurance. I touched a little bit on the truth fending that a lot of therapists take or do. And it's it is essentially committing insurance fraud. And these providers are truly taking a risk for you. They're taking a risk to ensure you get the care you need, and they are taking a risk with all those years, all those years of schooling, of residency, of our continuing education credits, they are taking a real, real risk of having penalties and really losing, losing our license to ensure that you receive care. That's scary. That's really scary. The biggest reason, these are big reasons, right? But this is one of the biggest reasons. And going back to what I said to this wonderful gentleman in session, I said, number one, insurance tells you what you are worth, and that's not okay. And I said, number two, they tell me what I'm worth. So I explained it like this insurance as a whole does not pay at acceptable rates. The rates are so incredibly low. In fact, it's well known in the mental health industry that we are the most highly educated and the lowest paid. I think too, I have a hard time with this because so often people think, well, if you're a mental health counselor, it's bad for you to talk about money. No, it's not. I can't be a good therapist for you if I can't put food on the table. I can't pay my $60,000 back in student loans. I can't be a good therapist for you if I take insurance. And here's why. Here's an example. For example, I was working at an agency. I had no say in my rate. They gave me an extraordinarily low rate at $60. So that's what the client paid was $60. In addition to that $60, the agency took their cut. At the time, it was 40% of those $60. See where I'm going with this? Most agencies do not have W-2 employees. Most agencies have 1099 or contractors. So then as a contractor, I receive my payment. $60 was paid by the client. I take 40% out, and that goes directly to the agency. And then as a 1099 contractor, I have to pay my own taxes. I take an additional 30 to 33% out to ensure that I cover my taxes. So let's do the math. Let's do the math on this just based on the $60. So we have $60. That's what you pay out of pocket. We take out 40%. That's another $24 out. So we're looking at $36. Then as a 1099 contractor, I'm going to take out 30, or say 30%. So what did I say 24? 60 times 0.40 24. 60 minus 24. Sorry, $36 times 0.30, $36 minus $11. We are $25 for one client hour. In addition to this, if you're at an agency, guess what? Insurance takes their cut from this as well. And here's the other thing. For every hour that we spend with you in session, it requires another one to one and a half additional hours for us to write treatment plans, for us to write clinical notes to do all of the things. So the one hour or 45 minutes, if you're with me, you receive for treatment, it takes another hour to an hour and a half. So your one session is essentially two and a half to three hours of work for us. So if I get a fee of $25 for seeing you for that one hour, and we divide it by three, can you see that? You see why I refuse to allow insurance to tell me where I'm worthy? Because insurance as a whole pay low rates. For example, like this agency, very much like that. Very much like that. So if you go in and you pay your $40, $30 copay, it's easy for you, right? It feels okay. It's it's not so it's not so hard in your bank account. We get that. We all use our insurance as well. So we understand that. But on the back end, what happens is that these insurers are saying, you know what? We don't think that you're really worth um, you know, $100 an hour. We're gonna give you 60. And again, I just showed you that math. It is not 60. I know so many times when you go in and you pay your co-insurance, your co-pay, or you pay out of pocket, you think, oh my gosh, these therapists are just raking in the dough. We're not. We are the highest educated and lowest paid industry. And here's the problem, too. When we accept insurance or we continue to have this conversation in the counseling industry, which really drives me crazy that we are worth more, or that we're we're not allowed to talk about money with our clients, we are perpetuating burnout and exhaustion. And this is the third point that I made with this dear man when we were having this conversation. I explained to him, before you saw me, how many sessions did you get with other therapists? And he said, Yeah, I think I got like five. I said, Right, because they weren't allowed to do more than that. And I said, How how many would they have allowed for you and me? And he and I have seen each other for over a year. And I said, Second of all, what did you notice out of that last therapist? And he said, Well, he was great, but he was just constantly rushing me in out. And I said to him, So I showed him the math. I said, if he's honestly only making $8 an hour, therefore, just to make a living, just to barely make a living, he needs to see eight to ten sessions per day. Per day. So we're talking eight to ten hours straight with our therapy clients. That does not mean he's gotten his notes done, he's gotten treatment plans done, he's done his continuing education credits. So his typical eight hours, we'll just say eight sessions a day. Let's tell say we're gonna have 40 clients a week. That's a that's a full-time work week, right? No, remember, you need to add on another hour and a half to that one hour. So what happens? And my client said, you know, he was just so he wasn't as engaged like you are, he wasn't able to focus, and I just felt like he wasn't hearing me. And I said, Can you blame him? Can you blame him? Because at the root, he's making eight dollars and thirty cents an hour, an hour for one hour, and he knows he still has to go do clinical notes, he still has to do those things by law so he doesn't get paid. How is he gonna be good for you? He's worrying about paying his bills, he's worried about helping his family, he's worried about sending his kids to sports or just bringing food home, paying the rent, paying the power bill. This idea of accepting insurance promotes burnout exhaustion and poor counseling. And I'm telling you, I don't think it's a counselor's fault. I think it is the fault of this industry and insurance providers not paying us what our our worth is. And then you in turn get subpar counseling, and then we get a bad rap. But is it fair? I I don't think so. Here's some other reasons why I will never ever accept insurance is oftentimes the insurance providers they agree to like a certain reimbursement rate, right? And these require these insurance companies require therapists to jump through so many hoops to get paid. I mean, so many hoops. The common practice really with insurance companies is most times they reject the submitted paperwork and then they delay payments. So not only have people worked these crazy hours, right, at $8.30 an hour, waiting, waiting for their reimbursement, then the insurance providers say, We don't like the paperwork. We're gonna reject this and we're gonna delay your payment. Or we're just not gonna pay you right now, we're not gonna pay you at all. That's crazy. That's crazy that the insurance companies can say, Yeah, we just don't like it. We're we've changed the rules again. We don't like what we see in the notes, we don't like what we're seeing. So we're just gonna delay payment, we're just not gonna pay you because we've decided, right? What the therapist is worth. So then the therapist is to go into session and have session with you, and they're not supposed to worry about how they're gonna pay their bills. We're human, we can't help it. So another thing that happens that's really ugly and insidious, and actually is a very common practice with insurance providers, is called retroactive claims denial. They call them clawbacks. So essentially, the insurance company at the end of the year, and I bet you you've seen this, you probably went to the doctor. I've seen this. You go to the doctor, and a year later you get a bill, and you're like, Why did I get a bill? I paid my copay. Why am I getting a bill for another $60? Well, they decided you didn't pay enough. You didn't pay enough. They do the same thing to therapists. They say, you know, uh, we think you need to give that money back. We've decided that we don't like your documentation. So even though it's been two or three years, we want a couple thousand dollars back from you or more. Isn't that disgusting? And how stressful is that? We want to be here and be present with our clients and do everything that we can for them, but these insurance providers are ruining it. So that is why. So many reasons, right? Why I'll never accept insurance. It's not because I'm a chromatic, it's not because I'm trying to make your life miserable. It is because they make it miserable. And I just thought it was so very important for you to hear this from me. And I had this great conversation, and thank you to the client for really spurring this. Um, it is so important for us to have this conversation. I think it's really important too, as clinicians, that we have a conversation about the perpetuation of burnout and exhaustion, and that um, you know, we can't have this dialogue with our clients about our pay. The the world goes around by paying for services, by paying for products. It just how is how it is. Now, for myself, I provide four sliding scale fees. So, what that means is I have fees that are Very, very, very under my rate. And I allow four of those. And so when one opens and I have someone that's in need, I offer it to them. But I afford, I allow for four. So again, it's not that I'm a curmudgeon, but it is that I have to look toward my future. How do I pay for this, you know, beautiful process that we're doing? Am I continuing education credits and letting my kids go experience fun stuff? But I do provide a sliding scale fee at for four clients. In addition, I give my time outside of the therapy room. I volunteer for different organizations. I provide luncheon learns. There's so many different things that I provide pro bono. So I'm not a curmudgeon. I'm not. It's just that insurance providers really, really perpetuate this burnout exhaustion, and I refuse to take part in it. So keep in mind, the reasons why I don't accept insurance is it's a lack of privacy and confidentiality. There's an assumption of illness, and they'll decide if you're ill enough if they like it. There's potential negative consequences based on what's been written in your documentation. There is the fraud component that so many good-hearted therapists kind of fudge the truth, but ooh, uh-uh, I don't want to do that. And really, it's the low rates. It's the low rates of this is how much we'll reimburse you because we think you're worth that piper. And it's also the low um ability of like, oh, you can have six sessions, that's all it's gonna take. How do they know? They're not medical professionals. And keep in mind too, insurance doesn't want you to use insurance, that's how they make money, so they make it difficult on us. Okay, so this sounds very dour, very, very terrible, all of those things. And I think this is at the top of my mind, too, because we are going into a new season in 2024 and our rates are increasing. What we've done here is we've come up with a two-prong plan. The first plan is as an agency, we are moving away from the stereotypical mental health counseling model for pay, in the sense that most of the time you're used to just paying every session, right? Well, we know because our fee is increasing, that's gonna be tough. We get it. So, what we are moving toward is a packages model. What that means is we'll assess you because we're good clinicians and that's what we'll do. And we'll say, hey, we think you'll do great with 12 sessions, 14 sessions, 16 sessions, whatever it is. Here's how much it's gonna cost. And you buy an entire package. There's two reasons we're doing that. Number one, it holds you accountable to your goals. We know insurance is wrong when they say it only takes six sessions. They're not in the field, they have no idea, but we do. So it holds you accountable to your goals. You pay for the package up front and you are set. Here's the second reason we do packages. When we allow packages, when we're going to this package model, we create lower than the normal hourly fee. So when you purchase into a package, you're gonna save up to up to 30% off each hourly fee. So we're not curmudgeons. We really are thinking about you. We are, we want to hold you accountable to your goals. We want us to be accountable to your goals. So we believe by creating packages, it holds you to that. And in addition, these packages are not at our new hourly rate that's increasing, it's actually below or slightly above where you're at today. So we're not curmudgents. A second resource that I want to share with you, I have not used this resource because, again, I don't want to get my hands into this insurance world, but I am starting to recommend this to my clients to find out what they think of it. And I've done the research, and so far, reviews are really good. It's called Mentana M-E-N-T-A-Y-A. Essentially, this is a company that goes in and they work with the insurance companies to help you get reimbursed for a very nominal fee. They charge 5% per session. So, say a session is $200, you pay $10 for them to go to your insurance provider and get reimbursement. And here's the thing, too, if they can't get the reimbursement for you, they won't take the fee. And you talk with them beforehand. They've got a phone number that you can call, you can talk to um them and find out more about the service, but it really is a wonderful out of all alternative, excuse me, for you to use your out-of-network benefits. Because here's the thing insurance doesn't want you to use your out-of-network benefits because actually, sometimes out of network benefits afford you better care. They don't want you to know that. So, out of network benefits. So, this company comes in and they go to your insurance provider. So you don't have the headache of like, well, I need a reimbursement. Here's my super bill. This is what they say. You don't have to do that, you don't have to wait on hold, you don't have to do all of those things. This company goes in and does it for you. So meant yeah, I yeah, I don't know how to say it, M-E-N-T-A-Y-A. You can call them at 650-440-5078, or you can go to their website at www.m-e-n-t-a-ya dot com slash patients, slash patient. So that's another really great resource for when you run into a therapist like me who does not accept insurance. Again, it's not because we hate you, it's not because we're just these, you know, money hungry curmudgeons. It has nothing to do with that. It has to do with that insurance providers are not here to take care of us, they perpetuate burnout and exhaustion and poor counseling for you. And frankly, I think they perpetuate this idea that you're broken. If you go to a counselor, you're you're ill and you're broken. Well, we don't believe that here at Dynamic Growth Counseling and Consult Consulting Services and Untangled Mind. We don't believe that. In fact, when you come to us, we provide you an entire treatment plan. Yeah, like here's your form. We show you how we have to diagnostically get to where we're at. But then guess what we do? We show you a holistic approach to how are we caring for you. We look at your attachment systems, we look at your whole physical body, we partner with a PCP because we believe in the whole person, we do not believe you're broken. Then we bring Adlerian psychology into it and we talk about your strength and how they show up, and how maybe sometimes they can be our Achilles heel. And then we bring that into therapy session. We do not believe you're broken, we do not believe you are ill. We believe in the wholeness of you, and we are going to fight to be the very best therapist for you. And to do that, we have to say no to insurance. So thanks so much for joining me today. If you have any questions, feel free to reach out to me. I would love to talk with you more about this. There's a lot of information online about why people don't um take insurance anymore. Um, so it's it's becoming more and more something that we talk about. But again, if you have any questions, please let me know. I would love to hear from you. Um, and we're just so grateful. We're so grateful for you following us, taking part in our growth and this excitement of building this dynamic mind approach here in East Cobb Marietta. Um, gosh, we're so we're so blessed and so grateful for all of you. So thanks again, and I will talk with you next time. That brings us to the end of this episode. Thanks so much for joining me. I hope you learned some tools that can equip you to continue to untangle life's challenges. If you're curious about working with me for anxiety or stress-related disorders, head on over to my website at untangledmind.net to connect with me and schedule a counseling session. If you've enjoyed the show, please rate and review me on your podcast listening platform and share it with your friends and family. As always, thank you so much for listening to the Untangled Mind the podcast. I appreciate you, and I will talk to you next time.