A friend texted me this excellent article about why many therapists don't take insurance and asked "Is there a Decent solution to this?" Good question.
My response to him is below, with no edits except for cleanup. No one should ever "root for the insurance" - and we're not an insurance company, we administer self-funded plans for employers - but I think the more people hear different perspectives, the better healthcare can be.
1) Decent-administered plans cover unlimited in-network mental health visits, with $0 out of pocket cost to the member - both because it’s the right thing to do, and because of laws around mental health parity (if you cover unlimited physical health benefits, you need to provide comparable mental health benefits). This helps the member because they spend $0 and the therapist because they don’t have to chase down unpaid copays.
2) We also include Direct Primary Care (DPC) in all of our plans, again with $0 out of pocket cost to the member, and you’d be surprised how often those folks provide “therapy lite”. The heavy involvement of the DPC in our plans also reduces our incentive to interfere with care.
3) We are somewhat insulated from the negative risk selection of high utilizing individuals because we only sell to employers. It sucks, but it is also true that there are a number of individuals who sometimes need and consistently will get massive amounts of mental health care. Insurance is a math problem, so if you don’t limit the benefit, you have to pass that cost on to everyone else.
4) We do not attempt to “not have a great network”, because that is bull💩. But we also don’t cover every therapist charging whatever they want to charge. See above and below.
5) Many therapists opt out of accepting insurance because they don’t have to. Because there is a deficit of supply, they can charge more and make more money and deal with less hassle by going pure private. I would do the same thing. But I don’t and won’t play a tiny violin for them. They are making a sound business decision.
6) We run a clean, transparent, and effective shop, or do the best we can. We are not pieces of 💩. This is probably the closest thing we have for a “solve.” 😊
