Why I Don’t Take Insurance

4 Reasons Truth & Grace Counseling Only Accepts Private Pay

“What Insurance do you take?”

I receive this question often.  I know I’m not the only counselor that hears this question.  And this goes beyond the counseling field; it’s anything medically related.  The expectation is to use your insurance to help lessen the financial burden for the client.  

When I first started Truth & Grace Counseling, I had to think whether I would bill insurance or not.  I don’t relish answering the question above with “No.  I don’t take any insurance.”  It’s awkward and generally is an off-putting answer to potential clients.  However, I have put a lot of thought into this decision.  I have made this decision not only due to my experience as a provider but also due to my experience as a medical consumer.  I intend to outline four reasons I don’t accept insurance as a payment in counseling practice. 

Man putting hand on head with his hat on backwards
  1. Insurance is Confusing For the Consumer

We all spend money in different environments.  For instance, how we pay for groceries is different from how we pay for a car loan.  For groceries, there are a lot of variables in the amount we are going to pay.  What type of groceries are you going to buy?  Your bill will probably be low if you pick up a few fruits and vegetables.  If you believe a whole rack of ribs and decide to pick up the conveniently placed grill, your bill will be pretty high.  You also have to factor in if there are only sales going on, if you have coupons, and the overall market (never forget how high eggs got there for a bit.) 

An auto loan also has variables, but your payment is generally not paid in full at that moment.  You have to determine what type of vehicle you want, how many upgrades you would like (my wife loves the heated seats in our van), and if you’ll buy any extra warranties (I would advise against these.)  If you choose to get a loan, then your credit score and what bank you get your loan with will finally determine your end bill.  

However, you will know exactly how much you owe by the end of the grocery shopping trip and getting a new vehicle.  For a grocery bill, you pay it in full right there, and for an auto loan, you know exactly how much you owe per month.  There are no guessing games. 

Produce aisle with fruits and vegetables

Let’s take the example of going to your doctor’s office.  You show up to the office and go to the check-in desk.  They will take your card and look up your benefits if you have insurance.  You may or may not owe a copay that’s due then.  This copay is typically set for the office visit, not individual procedures.  Your plan also determines the copay.  Your co-pay may be higher than someone else; it may only be valid after meeting your deductible, or you might have no co-pay!  This all depends on the individual plan that you are on. 

However, your co-pay is only the first charge.  What if you get a new prescription, a shot, or some other type of intervention?  This may or may not be covered under your co-pay.  If you don’t have a copay or haven’t met your deductible, you don’t know your end bill.  You will walk out of that office without knowing your final bill total. Your doctor’s office doesn’t know the answer either.  Your insurance claim will have to be filed, and when the claim is finalized, your doctor’s office will send the final bill. 

When will you find out how much you truly know?  No one knows this answer either! This is anecdotal, but I have experienced receiving bills months after medical care was provided.  I have known people who got bills over a year after their medical service!  This makes it difficult for healthcare consumers to understand what to expect financially.  And this isn’t even factoring in the premiums that you pay every month!  

2. Insurance is Frustrating for the Provider

The insurance process isn’t only frustrating for the consumer, it’s also disappointing for the provider.  I assume most of those reading this have not been on an insurance panel before to provide medical care.  If you have experienced this, I would love your thoughts on the process!

Before medical providers can bill for insurance, they must be credentialed with individual insurance companies.  You must provide documentation of your credentials (college degrees, licensure, etc.) and information about your practice (what services you provide, your location, etc.)  By and large, providing the information is not all that difficult.  However, this process does take time.  It can be several months before you are fully credentialed with these insurance panels.  

Whenever you are finally credentialed, you get to start billing!  Hooray, it’s time to get all of that money!  How hard can it be for a provider to earn money from an insurance company?

This is where the frustration kicks in.  Providers with a high volume of clients almost always need administrative help.  It can be very long and challenging to ensure a claim gets accepted.  This takes both time and money.  Look at this quote from Fierce Healthcare.

“Researchers found that the cost of billing and insurance-related activities for a single primary-care doctor is $99,000 a year and represents roughly $1 in $7 collected. For emergency room billings, the proportion goes even higher—to 25% of all dollars collected.”

Think of that. You are paying $1 out of every $7 on your bill at your doctor’s office is going for administrative costs due to billing and insurance.  This is even higher at the ER!  Healthcare is complex, and I realize insurance isn’t the only reason for higher fees.  But insurance is highly costly for providers, too.  

3. Insurance Decides What (and What Not) to Cover

This frustration covers both the consumer and the provider.  A consumer might have an issue they need addressed that isn’t covered by their doctor.  Or, maybe the need can be covered, but the only doctor in network is hours away from you.  The provider can also be hamstrung due to restrictions from the insurance company.  The care you receive is ultimately determined by what the insurance decides to cover and not what you and your provider determine is best for you. 

This is a significant reason why I am not accepting insurance.  Quite simply, if you take insurance as a provider, you must play by their rules.  I do not intend to play by their governments in my counseling.  Insurance can dictate the number of sessions allowed, the variety of treatments permitted, and the required diagnosis.

When I diagnose a client, I try to give the least severe diagnosis possible.  Unfortunately, diagnosis can limit clients and cause a stigma for them not receiving care.  However, when billing insurance, you have to have a diagnosis and have to be at a level that the insurance company believes is necessary.  Essentially, this means a higher severity of diagnosis is generally required to have the claim accepted.  

You don’t need a diagnosis when you see me at Truth & Grace Counseling for Christian Counseling.  If you need a “superbill” for out-of-network coverage and your insurance company requires a diagnosis, I will provide one.  Otherwise, this is not a requirement.  Cash pay can be a great asset for some who find confidentiality very important. This includes police officers and those in the military.  These populations may be very concerned about having a diagnosis that would keep them from a job.  Unfortunately, this population often doesn’t seek care because of this.  

For more information about my “Firearm Friendly” services, click the below.

Firearm Friendly

I can better ensure confidentiality by not involving a third party, such as insurance.  When you come for my services, I am the only person looking at your information.  Your insurance company, employer, friends, and family will not have access to any of your information without your permission. 

4. Private Pay Has Less Stressed Providers

The insurance model for clinicians is volume-based.  In this model, receiving more income is simply by seeing more patients.  I’m sure you have experienced the importance of other patients in a doctor’s office.  You seem to be herded around from room to room like cattle.  After a long wait, you finally see the doctor for maybe 15 minutes, and then you are sent on your way.  You may or may not have more questions, but if your time is up, it’s up!

Most providers genuinely do care for their clients. However, the volume-based insurance model makes it necessary to fit as many patients as possible daily.  This helps the provider get compensated well, but is it great care? 

That is not very good care.  As a counselor, I know I am more effective if I see 5 or 6 clients daily instead of 8 or 9.  Providers are human, too, and seeing too many patients daily takes its toll. 

The reimbursement rates for providers from insurance companies depend on your location and the type of service provided.  However, generally, the reimbursement is on the low end.  Whereas in private pay, the provider and the market dictate that price.  Clients will choose not to go there if a provider’s rate is too high.  However, when providers have their prices at an acceptable level and provide value to the client, then both the client and provider are happy.  The client is happy they received good care, and the provider is comfortable helping their client and happy for being compensated well. 

More To Come

This post clarifies why I have chosen to be a private pay provider and not accept insurance.  I have discussed previously in this post ways you try to help afford my services.  I plan to do another post about alternatives to having insurance as well. I’d also love to hear about your experiences with insurance and private pay! Feel free to write me a comment down below.