Why I Don’t Accept Insurance

All patients should be informed about how insurance affects mental health practices. The biggest thing to know is that when you see a provider through insurance, the provider is required to diagnose you with something. In order to understand whether or not that makes sense, it might be useful to think about what diagnoses are and how they work. 

Here’s the thing: the definition of mental illness has expanded to the point where anyone can be diagnosed with something. A lot of therapists have a problem with that because they feel like it pathologizes normal human behavior. On the other side, being able to get diagnosed with something means you can get insurance coverage, and arguably everyone is entitled to access mental healthcare.

Not all diagnoses receive the same amount of coverage through insurance. For example, most people come into therapy with an adjustment disorder. In the Diagnostic and Statistical Manual of Mental Disorders (DSM), an adjustment disorder is a disorder in which the patient experiences “marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.” 

The criteria here are so broad that almost anyone has met them. In my experience, many insurance companies will only cover several sessions for an adjustment disorder. This incentivizes the therapist to diagnose you with something else. Other disorders, like Major Depressive Disorder (MDD), can get an unlimited number of sessions. MDD is considered a serious mental illness (SMI). Unless the diagnosis for an SMI is warranted, it’s not necessarily ethical to diagnose someone with it just to make sure they are covered. At the same time, is it ethical to deny coverage to someone who is suffering just because they do not fit the box that the DSM provides? 

Personally, I don’t accept insurance because I don’t want to play this game with insurance companies. I am partial to the idea that you can need treatment without displaying symptoms found in the DSM. “Just as healthy cardiac functioning cannot be defined as an absence of chest pain, healthy mental functioning is more than the absence of observable symptoms of psychopathology. Attempts to depict deficiencies in mental health must consider deficits in many different capacities, including some that are not overt sources of dysfunction.”

In other words, I strive to take a more holistic view of a patient and their goals than simply making sure symptoms “go away.” If you have questions about my rates and how to make therapy more efficient or effective, you can book a consultation or a session here.

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