Why it’s so hard to find
by Yuri Tomikawa
Many therapists choose not to be in-network with health insurances due to low reimbursement rates from health insurance companies, logistical issues, and privacy concerns. Here are some reasons why therapists choose not to contact with health insurance companies.
1. Low reimbursement rates
Therapists in large cities, such as New York City and Boston, have living costs just like the rest of the cities' dwellers, and most health insurance plans don’t pay them enough to cover their office rent, overhead, and living costs.
While health insurance companies may only pay a therapist $50 - $120 per session, clinicians in large cities can typically charge $125 - $250+ per session if they set their own fees. Because paperwork to receive reimbursement takes up additional time, the therapists' hourly wage ends up being even lower.
2. Logistical challenges of seeking reimbursement
Many therapists choose not to be in-network with health insurances, or drop their contracts with health insurances, because of the logistical nightmare they need to go through to get paid.
Therapists spend hours every week submitting claims or on hold with health insurance company representatives. This takes away from time reviewing session notes, advocating on behalf of clients, and attending trainings to improve their practice. It’s also common for health insurance companies to pay therapists months after the therapy session occurs, and this lag in payout can add financial stress to the therapist’s practice.
3. Privacy and autonomy
Finally, therapists may choose not to be in-network with health insurances to preserve autonomy over patient care and privacy.
In order for health insurances to cover sessions as medical costs, clinicians are required to submit detailed information regarding the services provided. This includes a formal mental health diagnosis such as anxiety or major depression, as a valid reason for the sessions to have occurred. If clients are, for example, seeking therapy due to struggles adjusting to NYC life and feeling lost in their career, therapists still have to give a formal mental health diagnosis like “adjustment disorder” in order for the insurance company to pay for sessions. Therapists may also have to make a case to health insurance companies that their client requires ongoing care, so that sessions aren’t abruptly terminated because the insurance company deems the treatment sufficient.
Therapists may decide not to contract with health insurance companies to avoid these situations and to offer services above and beyond what health insurance plans would cover.
For all these factors, many of the best therapists in large cities are not in-network with health insurance companies, and those who are in-network are consistently not accepting new patients because their services are so in-demand.
While finding an in-network therapist is often the default choice, including out-of-network therapists can help expand your therapist search. Learn the benefits of seeing an out-of-network therapist and how to use out-of-network benefits.
Yuri Tomikawa is the Founder & CEO of Zencare. She was selected MedTech Boston's 40 Under 40 Healthcare Innovators for her work in improving patient access to mental healthcare and has appeared as a keynote speaker on entrepreneurship, mental health, and female empowerment. She is a graduate of Brown University and former management consultant at McKinsey & Company.