After months of deliberation, I have decided to end my in-network provider status with insurance companies and transition to a self-pay practice. What does this mean? This means that I will be considered an out-of-network provider and will no longer bill your insurance directly. This change will take full effect in February 2022.
Here are a few reasons why I have considered making this change:
Privacy and Confidentiality: When a client uses a managed care plan to pay for services, their information (including diagnosis, treatment plan, progress notes, etc.) becomes part of a permanent record. When a claim is submitted to the insurance company, hundreds of people have access to the client’s personal information. With a self-pay practice, only the provider has access to a client’s information.
Conflicts of Interests: My primary concern is for my client’s well-being. Providers working under the constraints of managed care companies are sometimes put in a position of having to choose what is in their own best interest and what is in their client’s best interest. The bottom line is that the managed care company’s goal is to reduce costs and raise profits; it is not to increase the quality of care or quality of life for clients.
Flexibility with Care: Managed care companies essentially dictate how often, how long, and what type of care a client can receive. This can put limitations on the types of services a provider can offer. Having more flexibility with care means that clients can actually receive services that are tailored to fit their needs without any restraints. It also improves the quality of care which is very important.
Diagnosis and Stigma: Managed care companies require a diagnosis of mental illness in order to cover services. This diagnostic information also has the potential to follow a client as it becomes part of the client’s permanent medical record. I do not believe a diagnosis should be required for care nor do I believe that every client’s challenges are necessarily tied to a mental illness. Labeling clients with a diagnosis creates a stigma that can amplify their challenges even more. I am solution-focused on the quality of life for client’s rather than simply survival.
Values/Ethics: As a social worker, I have an ethical obligation to promote the well-being of those whom I serve. I also desire to provide care in the most authentic way possible. Unfortunately, being connected to manage care companies does not allow me to achieve that at the level I desire.
You may be thinking…what does this mean for me?
As a self-pay client, you will be responsible for the full session fee. However, if you choose to still utilize your insurance, check with your insurance company to see if out-of-network services for psychotherapy are covered and how much they will cover.
If your insurance does cover out-of-network services, a statement can be provided to you after each session to submit to your insurance company for potential reimbursement.
Also, FSA and HSA cards can still be used to pay for services.
While I do understand that not everyone is able to afford psychotherapy services at the full session rate, I will continue to create ways to make therapy accessible and affordable to the community through the use of referrals and other means. I am looking forward to being able to offer more diverse services and continue to provide quality care to those whom I have the pleasure of serving.
-Lakia