The Truth Behind Insurance and Mental Health
Seeking mental health help in this day and age is incredibly difficult.
As a therapist, it almost makes me sick to see how difficult the process really is. For those of you who have followed some of my work, you know that I am a systemic therapist. For those that just joined us, systemic therapy is based on a belief that everything…emotions, actions, people, things…happen within the constraints of a bigger system.
If you think of a school student, you can see that the basic system they are in is the school itself comprised of the teachers, other students, the classrooms, access to textbooks, etc. All of these immediate things have a direct impact on this one student.
There are bigger systems at play though.
A school falls into a district. That district is made up of other schools, of board members, of parents, of neighbors, etc. Suddenly, there are a lot of people not directly involved with the student, but that can impact that student by decisions made. An even more overarching piece of the system has to do with the government and national testing.
It is my job as a systems therapist to think about all of these outstanding factors that are impacting this one student.
It is also my job as a systems therapist to point out the systems at play in the mental health field. I have gone “through the ranks” so to speak in my training as a therapist. I started as an intern in a family based program. I did not get paid for the year I interned, but I learned a lot about life and about the system of mental health and insurance.
I continued working for that same company in family based services once I completed my internship. I got paid hourly and did not have benefits (independent contractor life). I worked with a case load of between 8-10 clients for a span of nine months each.
We only worked with one insurance provider and they were tough. From the clinician stand point, I just want to help a child and their family. From an insurance standpoint, they want me to prove this family actually needs help.
How do I do that?
I have calls with the insurance provider who asks specific questions of how I implemented therapy. I have the minutes of my sessions tallied and should that family need more support or less, I have to make that request through the insurance company (they would allocate a certain amount of units aka minutes to certain families).
I have my charts audited. I have someone pull me into a room and ask me specific questions about treatment goals. I have to make sure each of the three required goals are measurable and I have to make sure the steps I have listed tie directly to those treatment goals.
At the time, this was a ton of work for all of which I did not get paid. I see now how important these steps are.
Unfortunately, this field is subjective to a degree and in order to justify spending money, it makes sense to audit and check in so frequently.
The family base program brought in the most money for the company, but most clinicians were underpaid. You could earn the most amount of money in a family based program only by working even more than we already did.
I have such admiration for the people who do this work, because it is truly the battlegrounds. At times, your safety gets compromised.
I moved to an agency where I worked in outpatient services for children.
My caseload shifted tremendously from 8-10 families to 40.
I made a few extra dollars an hour, but was still an independent contractor with no benefits. At this company, we used one insurance company who also did audits. Treatment plans needed to updated every 20 days or something crazy like that.
We had to diagnose 2 year olds in order to justify treatment.
I became completely burnt out in this job mainly because of the amount of paperwork required for each child and with a caseload that large, I was spending all of my free time doing treatment plans, intake paperwork, and progress notes.
Leaving the agency world full of systemic issues, I joined a private practice. I learned that insurance companies still want information, just not nearly as much.
I learned that paperwork needs to be helpful, not useless. With private insurance, it is easier to communicate how treatment can/should go. There is still a major downside: you will have to get a diagnosis. There will be a paper trail that follows you with this diagnosis on it.
Another downside I have noticed is that insurance companies are not upfront about what exactly they will pay.
While I understand the idea of not wanting to pay out of pocket for sessions, I also have seen incredibly high copays ($80/$90) and very high deductibles, some that renew yearly for mental health services.
Our culture does not support mental health treatment, so it is not totally surprising that insurance companies make paying for services difficult.
All in all, seeking mental help can be tricky, but I ask you to not limit yourself to the providers who accept insurance unless you have done ALL the research on exactly how much you will need to pay out of pocket.
Coming from someone who has seen all of the sides of this industry, it is not black and white.
Additionally, keep in mind that the therapists you see are humans. As humans, much like teachers, we are in a low paying job. Obviously, the onus of how much therapists make is not on the client, but systemically it speaks to the higher level of issues in the mental health industry.
Again, all the pieces of the system eventually trickle down so there is no way that being underpaid with no paid days off or benefits could NOT impact a therapist and what the therapist can give to his or her job.
A private pay clinician is able to see much more of the fee than they ever would if that fee is given by insurance.
I implore everyone to try to understand the systems at play here if you are seeking mental health help. The most important thing to look for in my opinion is a licensed therapist (anyone with an “L” before PC or MFT).
They are the most qualified and trained in working with individuals and couples/families. They are held to the standards set by the state and have had to achieve a lot in order to get the license. The second most important thing to look into is what exactly your insurance will cover.
I hope this helps! Let me know your thoughts!