I accept traditional Medicare also known as “straight Medicare” (i.e. not managed by a commercial insurance).
For all other insurances – I am an Out of Network Provider. Some policies have “Out of Network Benefits” – please check with your insurance company if your policy includes this benefit.
What does in means to have “Out of Network Benefits”?
Having Out of Network benefits means that the insurance will reimburse you for services rendered from an “Out of Network Provider” after the provider has been paid and a claim was submitted. As a courtesy for clients who have this benefit, I will submit a claim to the insurance for direct reimbursement to you.
Why don’t I accept any commercial insurance? Well, I used to accept commercial insurances, and was baffled by the gap between rates, not only between companies, but also within the same insurance company under different plans. Sometimes the difference was double the rate. I would question myself if that meant that insurance companies expected me to provide half the service?
Typically, insurance companies will pay for a 45 minutes session, and for many clients this is not sufficient. Most commonly, I would have to request insurance preauthorization for any session expected to last over 45 minutes. In my view, having the insurance company make clinical decisions like this can be a barrier to good care.
I found myself frustrated by the policies of insurance companies, and decided that in order to be a better clinician, I needed to have control over my compensation, as well as the time that I get to spend with each client.
Lastly, insurance companies fail to recognize in their rates the quality of a therapist’s continued training. Maintaining a certain number of Continuing Education Units (CEUs) is required for licensing and certification renewal, but these can be on-line courses that sincerely don’t do much to educate a therapist. Instead, I take this requirement very seriously and attend seminars led by top researchers in the field. These seminars keep me updated on the latest research and best practices, which directly translate into better care and better results for my clients.
