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  • Naaz Eshtehardi

The Healthcare Trap


Once upon a time, focusing on mental health was considered "rich people problems."


Then came school shootings, a national opioid crisis, increased suicide rates, surges in homelessness, depression rates and over half the country walking around with anxiety.


And here we are, not facing a mental health pandemic, but deep in one, and it will likely get worse.


One of the most common questions I get asked from potential clients, friends and family members is "Why don’t most therapists accept insurance?"


I will start by saying, most therapist want to accept insurance. Here is why insurance companies make it almost impossible to do so and earn a living.


I remember starting out and wanting my reach to meet as many as possible. If someone wanted help, I wanted to be able to give it to them. Against the advise of my colleagues, I decided I would accept insurance.


As advised by insurance companies, I would call them first, get approval to see the client, find out the reimbursement rate, and then start seeing the patient. One disappointment after another left me eating costs and spending hours on the phone with people giving me different information and insurance companies blatantly lying about reimbursement rates. So I decided, I too will never do this again.


Health insurance companies in the US have created a situation that makes it almost completely impossible for functioning folks to get access to affordable mental health treatment. It becomes a luxury reserved for a handful of people who can spend $200-$300 a week.


That’s a problem.


My last attempt to accept insurance from a patient who was in a bad place and I knew could not afford out of pocket sessions, left me eating over $2500 worth of costs. After many phone calls, appeals, and the company admitting they have on a recorded phone call that I was promised a certain rate and got 1/8th of that rate, their suggestion to me was “you can always bill the patient.”


In what world is it ethical to bill a patient after relaying to them what their insurance provider communicated to you, that they are covered?


In the health insurance world.


I swallowed the cost and was thankful that at the time I had a good deal on my office rent.


This is small example of why most therapists do not accept insurance. I often hear friends of different medical professions talk about how they are “eating costs” all the time because of health insurance denials, challenges and manipulation. The providers lose, the patients lose, and the insurance companies win.


Mid-pandemic I got a memo from an insurance company preparing providers to go back to in-person visits because the reimbursement rate for tele-health visits will soon no longer be the same as in-person which was the temporary adjustment they made at the start of the pandemic.


Why the eagerness to go back I thought? We are in the heart of this thing; at that point there was no talk of the vaccine anytime soon. How can it be safe for elder and vulnerable people to go back to in person visits now?


It wasn’t safe. But that older women who in the past could only make her in-person appointments when someone could go with her to the doctor was making all of her tele-health appointments. The disabled folks, who previously had to rely on access a ride to make their appointments, were making all of their tele-health appointments. People having increased access to healthcare appointments meant more bills to pay for insurance companies and less profit.


This system is broken. There is no accountability or repercussions for it and most of us (including myself) continue to pay into it because…we don’t have a better option- this is unsustainable.