Ravi Coutinho bought a health insurance plan thinking it would deliver on its promise of access to mental health providers. But even after 21 phone calls and multiple hospitalizations, no one could find him a therapist.
am a mental health provider, am listed in several insurance directories that I either no longer take or never took to begin with
It’s linked to another article but they describe why therapists stop taking insurance as a matter of complexity. This is true but another aspect is that some insurances simply pay significantly less than others. It’s a difficult thing to discuss because the low ones typically still pay like $60-80 an hour and on a surface level that sounds like a lot (because it is). But the reality is that doing therapy is complex. For one I typically lose about 30-50% of the good rates just to overhead (lower side is telehealth or home office, higher side is if you rent an office and can go even higher). More so if you’re actually planning for retirement and sick time, which a lot of therapists just ignore. Then you have to figure that we only get that rate for billable hours, which is 20-30 hours a week depending on how good you are. The rest of the time is admin bullshit, case collabs, screening new clients, etc all of which is unpaid.
So I can take the $70/hr insurance that barely covers my day to day, or I can limit myself to private pay and the ones that pay $100-140/hr. Even with the 100-140/hr ones I’m still probably making 60-70k on average because of stuff like no shows and cancellations (which is why more and more therapists are charging very high cancel fees)
But their main point of the complexity is a big one too. In my experience the insurances that pay low are the ones that are most likely to give me grief over payment. They’ll pay me very late (but if I submit billing 10 seconds late they’ll deny), they’ll clawback payments for the dumbest reasons and be the most aggressive about clawbacks (potentially meaning that I’ll suddenly get a note from them that I have to return $1000+ because they decided after paying me they shouldn’t have), and they’ll have the worst systems for submitting billing (requiring me to have hours of wasted time on hold with their shitty customer service)
It’s terrible that this person died and it’s worse that they spent almost $400/month for care that was never able to be delivered. It’s worse that this will probably result in no changes whatsoever. Even if harris’ Medicare for all prop passes it will take ages and the design is that there will still be a “two lane” system, where private supplementary insurance is still available for the rich. This will likely result in tons of providers that don’t bother taking Medicare because it’s more of a pain in the ass and pays less. So the government will finally give you insurance if you have none but it will be functionally useless like this article describes. End commercial insurance altogether
am a mental health provider, am listed in several insurance directories that I either no longer take or never took to begin with
It’s linked to another article but they describe why therapists stop taking insurance as a matter of complexity. This is true but another aspect is that some insurances simply pay significantly less than others. It’s a difficult thing to discuss because the low ones typically still pay like $60-80 an hour and on a surface level that sounds like a lot (because it is). But the reality is that doing therapy is complex. For one I typically lose about 30-50% of the good rates just to overhead (lower side is telehealth or home office, higher side is if you rent an office and can go even higher). More so if you’re actually planning for retirement and sick time, which a lot of therapists just ignore. Then you have to figure that we only get that rate for billable hours, which is 20-30 hours a week depending on how good you are. The rest of the time is admin bullshit, case collabs, screening new clients, etc all of which is unpaid.
So I can take the $70/hr insurance that barely covers my day to day, or I can limit myself to private pay and the ones that pay $100-140/hr. Even with the 100-140/hr ones I’m still probably making 60-70k on average because of stuff like no shows and cancellations (which is why more and more therapists are charging very high cancel fees)
But their main point of the complexity is a big one too. In my experience the insurances that pay low are the ones that are most likely to give me grief over payment. They’ll pay me very late (but if I submit billing 10 seconds late they’ll deny), they’ll clawback payments for the dumbest reasons and be the most aggressive about clawbacks (potentially meaning that I’ll suddenly get a note from them that I have to return $1000+ because they decided after paying me they shouldn’t have), and they’ll have the worst systems for submitting billing (requiring me to have hours of wasted time on hold with their shitty customer service)
It’s terrible that this person died and it’s worse that they spent almost $400/month for care that was never able to be delivered. It’s worse that this will probably result in no changes whatsoever. Even if harris’ Medicare for all prop passes it will take ages and the design is that there will still be a “two lane” system, where private supplementary insurance is still available for the rich. This will likely result in tons of providers that don’t bother taking Medicare because it’s more of a pain in the ass and pays less. So the government will finally give you insurance if you have none but it will be functionally useless like this article describes. End commercial insurance altogether