GUEST POST from Don: Theraping For Dollars


There are some subjects in which I find little levity.  When pushed by government or big business and allowed little recourse or ability to resist, it becomes impossible to respond with lightness.  Yet, we need to understand these situations for what they are.

This post is specifically about therapists and mental health counselors, but some doctors are moving this direction, too.  I went to a doctor who did not bill insurances.  Maybe you have, as well.  

DEADBEAT INSURANCE COMPANIES.  Margaret*, a busy counselor who helps people deal with immense life issues, had spent over two hours in the past week trying to receive payment for ONE client (4 sessions over 5 weeks).  That was last week.  This week she had to do it all over again.  The insurance company was making it hard to receive contractual payments.  (*Not the actual name of the therapist quoted.)

The client had paid all of her premiums (the insurance company had made that very easy), had a valid insurance card, all of the information on the bill was correct.  Further, the therapist’s biller had electronically billed using the portal the insurance company provided.  Yet it was again rejected.

Five hours on the phone over two weeks (now 5 unpaid invoices) and the problem was still not resolved.  The therapist texted the client that she could not schedule her again until the insurance problem was resolved.  Margaret said, “I only have so much time to spend on ZEROs.  It isn’t the fault of the client, but I have no choice.”

That was only ONE insurance company.  For this therapist, seeing 30 clients a week and having a census of over 60, there was not a lot of “free” time to waste this way.  More and more frequently she had to close appointment slots (see fewer clients) to deal with deadbeat insurance companies.  Those are hours and hours of ZERO payments.  Her overhead expenses were the same, but the gross income had been dropping year over year due to deadbeats.

HOOPS.  If that were not bad enough, they also had her jumping though hoops just to stay “in network.”  Every 90-180 days she had to “attest” that NOTHING HAD CHANGED.  You read right.  Each insurance (she was “in-network” with over 20) made her spend 20 minutes running through their labyrinth menu system to confirm that she still was doing business at the same location, same hours, with same license number in order to stay “in-network.”  Understand that there is a single source for all of this info that the insurance company could check any time.  They couldn’t be bothered.  The more insurances the therapist maintains “in-network” the more hours she spends doing worthless “attestations.”  Those, again, are hours with ZERO payment.  That means Margaret takes off a whole day every 6 months for this singular stupidity.  It would make sense if she had moved or changed something significant about her practice, but to waste time for THIS??

REDUCED PAYMENTS.  The patients pay higher and higher premiums every year (sometimes as much as 19% increases), but the amount the insurance company was “approving” for the same type of therapy has not increased over the last 3 years.  In fact, some had decreased “approved” payments.  Guess who got the 19% increase in pay.  Not your therapist.

AUDIT.  There is always the risk of random audit, where an insurance company looks at every session note and procedure in the last 2 years, looking for a way to claw back money from the therapist.  One such audit cost another therapist almost $20,000.  The “costly mistake” could have been from a mere clerical error, such as one wrong letter (10:54 P.m. instead of 10:54 A.m.).  Or something actually serious, like the wrong client listed on the form.  Either way, those claims were retroactively “denied.”  More ZEROs.  And, it was too late to submit a corrected form.

RESULT:  More and more therapists and counselors are refusing to accept insurance.  One can only be pushed so far.  As independent business people, they don’t have the money to hire lawyers to fight back.  Insurance tells THEM what they will receive for their work, if they pay at all.  

Example: So, imagine going shopping with your “grocery insurance.”  You buy milk.  The price of is $3 per gallon, but because you have “insurance” the store only receives $1.48.  That’s only 13 cents over cost.  They can’t even pay the cooler electric bill out of that.

Another example: Your employer has “employee insurance,” so you receive $7.82 per hour (6 weeks after you earned your wage) and you have to accept that as “payment in full” even though they quoted you an hourly wage of $18.50.  Yup!  It does not have to make any sense.  It is insurance.

That’s hardy the end of the story.  There’s also the fact that Medicare, Medicaid, or other forms of government-based insurance may pay sub-par amounts (sometimes pennies over overhead).  You can’t make a livable-wage with those clients alone.

You may be thinking, “How much can it cost to sit and talk for an hour?”  More than you can imagine.  First, you have to be educated; a minimum of $100,000 just for the Master’s degree, not including the 4 years of college before that.  Then there are the months of practicum (you receive no income) and continuing education (required for your license).  Rent an office (low end is $750 for a small room and a community bathroom).  Computer, phone, copier/scanner, office supplies, website, a biller (big money), and liability insurance.  (List shortened for your benefit).  It is not unusual to have an overhead of over $30,000/year before you make a dime.  One more thing, since you are self-employed you have to pay ALL of your own Social Security and Medicare taxes out of your “profits.”  (7.65% as an employee, and 7.65% employer portion on top of your federal, state and local taxes).  So, you are lucky to keep 65% of your “profits” after taxes.  So, when the insurance company decides to pay half of your “fee” and you have to say “Thank you, Master!” clearly you will feel (and are) cheated.

So the next therapist you see may not take your insurance.  Instead they will charge you a fee-for-service.  The median cost per session in this metro-area is $110 per hour (Some charge over $200).You can try to get your insurance to reimburse YOU, but don’t expect them to be any more responsive to you than they are to therapists.

Some therapists may give you a “superbill.”  If you had insurance prior to 1990 you may remember submitting bills for reimbursement.  That is how superbills work.  You pay the therapist and the therapist gives you a reimbursable receipt.  

Thank you for making the process so difficult, insurance executives!  Technology was supposed to improve service, but it has become an excuse for not being responsible.  Maybe insurance company execs should see therapists??

Copyright 2023 Donald Whelpley

[PLEASE NOTE that Don is always open to discussing the thoughts and opinions he shares here and welcomes comments as shared in the comment section. He doesn’t use other social media platforms, as I do, and won’t see whatever you’d like to share with him if you post it elsewhere. ~ Sherry]


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2 thoughts on “GUEST POST from Don: Theraping For Dollars

  1. Thanks, E!

    This was one of those posts where there was more left out, just to make it “fit.” than left in.

    Thanks for reading.

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