Why I Don’t Take Health Insurance
Some might think this is really political, and, despite the fact that it shouldn't be, it ABSOLUTELY is! The foremothers of the feminist movement recognized, "The personal is political", and we need to address the personal issues that have become politicized. Health and healthcare are absolutely at the top of that list!
As far as I'm concerned, access to affordable healthcare is a basic human right. Period! No ifs, ands, or buts.
And yet, the US lags behind much of the developed world in providing this basic human right to all people living in this country regardless of economic status, employment status, health status, or citizenship status. Debates have been ongoing for the last 15-20 years about access to health care and there are continuous attempts to overturn the most comprehensive reforms to healthcare in my lifetime, the Affordable Care Act (ACA), which was passed in 2010. And while insurance coverage did get better under the ACA, we still have a long way to go to ensure every person has equal access to truly affordable healthcare.
To that end, I made the not-so-difficult decision to no longer take health insurance for the services I offer. Being in private practice allows me the freedom to develop a culture of equity within my practice that offers more equitable access to high-quality, mental health services than what health insurance can offer. The following are the top 5 reasons I don't take health insurance.
1. Treatment Flexibility
Under insurance contracts, the course of therapy is more often dictated by the terms of the insurance company, rather than what I, the provider, and you, the member, know to be what is best for you. You and I are in the therapy room, in real-time, making decisions about your needs, and the bureaucracy of an insurance company can upend those decisions at any time.
I've had these things happen one too many times and I'm over it! I want us to be able to make decisions about appropriate treatment interventions, session length, and duration of treatment and I don't want any of these things to be called into question because symptoms aren't deemed "medically necessary" by someone who has never even met you.
2. Autonomy
Having a contract with an insurance company means I need to abide by their conditions and often providers have little to no negotiating power. Your medical records are free for insurance companies to audit at any time and they can determine whether treatment is no longer needed…and stop payment for services without notice. Much of a provider's time can be taken up by following up with denied claims and hours of being on hold or arguing with the company for why that particular session should be paid for.
Having autonomy from insurance companies allows me to act solely as the therapist and not feel the pressure of whether services will be covered. Further, therapy is more collaborative between you and I when we don't need to worry about the conditions set by insurance. Moreover, autonomy offers the ability to develop a community where equity is at the forefront when it simply isn’t under the traditional insurance paradigm.
3. Unpredictability of Coverage
While this might not be apparent on the surface, health insurance is unpredictable and there are many factors that lead to it. Often, plans change at the first of the year (or at the renewal term), which means coverage can differ from the previous year, deductibles or co-pays may change, or we begin dealing with a new company altogether. I've had many clients leave therapy because their plan no longer covered it or their deductible reset at the beginning of the year, thus making therapy unaffordable quite literally overnight. Other events, such as "takebacks" or arbitrary claim denials, mean clients may get stuck with large, unanticipated bills that were initially not an issue.
Paying out-of-pocket means that none of this happens. There is a flat fee for which you are responsible, it gets paid at the time of services, and that's it. You can't be denied services due to plan or coverage changes or caught under the weight of a massive bill after insurance said, "Just kidding, we're not paying for that." It means the rug won't get pulled out from under you.
4. Privacy and Accountability
I want therapy to be between you and me only — and, of course, the licensing board/department. Most people don't realize that your medical records, even the sometimes sensitive nature of mental health records, are free to be requested any time you file a claim. Insurance company contracts require providers to release records, with the client’s assumed permission, whenever requested to review whether they should continue paying for services.
I take confidentiality, and your privacy, very seriously. I do not like releasing records if not expressly requested by the client because I cannot be assured what will happen to those records once they leave my possession. Not billing insurance ensures your privacy and, as discussed briefly above, allows us to be more collaborative and do what you and I believe is best for your therapy.
5. It’s an Unfair, Exploitative, and Oppressive System
AND...here's my soapbox.
The bottom line: the health insurance industry in this country is unfair, exploitative, and oppressive for all of us! Neither the best interests of the member, nor the provider are at the forefront of insurance companies' minds, but their profit margins and shareholders sure are! As far as I'm concerned, it's pretty gross that there is an entire industry devoted to making billions of dollars off of inevitable and accidental life circumstances (aka your health) that we have little to no control over.
Many people pay thousands of dollars each year in premiums, deductibles, and co-pays before they can access ANY benefit from the insurance company. Think about it: Say you pay a premium of $350 a month for an individual plan — that's $4200 a year — just for the PRIVILEGE of having health insurance should the need arise. Then you pay even more on top of that for deductibles and co-pays, and it often takes thousands more dollars or a catastrophic accident to get to the point where insurance pays 100%. Only then are you able to access the "benefits" of having health insurance . That's why so many people opt to not hold health insurance in the first place, it's just too damn expensive!
Speaking of...what about those who don't have health insurance? Often they go without because of cost or they don't have access to insurance plans, like those who are self-employed or students over the age of 26. It's not that people don't want health insurance — I mean, who wants to go bankrupt because they got sick and couldn't pay hospital bills? — it's a problem with affordability and accessibility.
Moreover, insurance plans are often chosen by a (full-time) employer and you have no say in the comprehensiveness of your plan. There may be a couple of options, but not anything to write home about. For example, there may be a difference between whether you choose the plan with a high deductible and a health savings account (HSA) or a plan with a high premium, but a lower co-pay at each visit. Either way, you're likely paying about the same, but does the plan actually cover what you need, like dental and vision? Usually not. Or what if you work for one of those companies who actively choose to not cover things like birth control because it’s “morally reprehensible” to some?
These are just a few of the ways the health insurance industry in the US is unfair, exploitative, and oppressive. I could go on and on about how this system works for nearly no one, but we don't have time for that.
Ultimately, I choose to divest from this system because it's not helpful for the vast majority of people in this country. Sure, it offers some conveniences and may lower what you might typically pay for a procedure, but what about the long-term cost? The arguments I've heard for the reason we don't overhaul our health insurance structure have all been less than convincing and only advocate for the status quo. But the status quo helps no one except massive insurance companies and their shareholders, and I for one will no longer contribute to the problem. Therefore, I choose to not take health insurance and offer equity pricing for those who cannot afford full fee. I may not be able to change the system on my own, but I can choose not to play the game!