What’s New in Psychology
The Insurance Reimbursement Blues
Jim Windell
Do psychologists and other mental health therapists like dealing with insurance companies?
Based on my own experience and what I’ve heard from other therapists, the answer is a resounding "No!"
The reasons are well known among clinicians. Dealing with insurance companies to get paid for your services is by and large frustrating and time-consuming. The paperwork, justifying treatment, being put on hold forever, reimbursement delays, and limitations on what treatments are covered all add stress to a job that is already demanding and stressful enough.
As a result, some therapists just give up in frustration and refuse to deal with insurance companies. Some elect to operate outside of insurance networks altogether, preferring to work directly with clients for payment. Others opt to hire online platforms that handle insurance reimbursement for them.
While many, if not most, therapists acknowledge that insurance makes mental health care more accessible to clients who might not otherwise be able to afford counseling, still many clinicians reason that the headaches are not just worth trying to accommodate their clients.
Online platforms can streamline insurance-related tasks for mental health therapists. For instance, platforms that are specifically designed to help therapists manage the complexities of insurance billing and credentialing include Headway, Alma and Grow Therapy. But while these platforms may make some aspects of life easier, they come with their own challenges.
Some common drawbacks include cost, complexity, limited customization, and data security concerns.
Recently, therapist Melissa Flanagan, LCSW, writing in Medium, an online blog, shared her personal experiences about the challenges that therapists face when using these platforms.
When she first opened her private practice some three years ago, she was overwhelmed by how to bill insurance plans and alarmed by their lack of interest in helping a confused therapist get her questions answered. She writes: “I was spending hours on the phone, waiting on hold, anxious to close the gaps in my knowledge, only to hang up wanting to punch a wall. Many times, my calls were disconnected during pivotal switchboard transfers to someone who allegedly knew more. The math didn’t compute: If I’m spending hours on hold trying to get a single question answered, how can I build and run my therapy business?”
That led her to sign up with Alma. In a little more than two months her caseload was full and money was pouring into her business account. She finally had cashflow.
But before she knew it, as she writes, “I became part of the problem.”
The problem, as Flanagan writes, is, first, many therapists who join big mental health platforms have no idea that the same insurance plans they are fighting with for better rates, clearer communication, and transparency around audits and payments are also investors in those platforms via venture capital funding “that helped bring companies like Alma to its estimated valuation of at least $500 million as of 2022, after its big fundraising windfall that year.”
Flanagan says that the investment arms of United Health Group-Optum (Optum Ventures) and Cigna (Cigna Ventures) helped build Alma “as a way to get richer in ways that have not yet been revealed to us beyond speculation.” It may be, she speculates, that it is more cost effective for insurance plans to streamline claims processing under one large group practice, but “the darker theories involve investor interest in the massive amounts of easily accessible — and lucrative — consumer data that will drive American healthcare deeper into sadism and mediocrity.”
Then, Flanagan decided to learn the skills she didn’t need with Alma on her own. “I had no idea how to do this on my own until I committed to teaching myself how to contract with insurance plans under my own National Provider Identifier, how to bill them, and how to receive payments,” Flangan writes. She first piloted this on a small scale for clients whose plans were not billable through Alma. Then, when she began to detach herself from Alma, her practice went into a freefall. She was no longer able to rely on the weekly income from Alma.
As she quickly discovered, she faced a dramatic drop in income without Alma’s higher reimbursement rates. Under her own contracts, the same claims started paying out at 20% to almost 30% less.
Flanagan indicates that mental health platforms know how much it will hurt therapists when they try to go it on their own. That, she says, makes it hard to say goodbye. “Looking at therapist chatter on Alma’s Community Hub, many therapists don’t know how to contract, file claims or receive payments on their own because Alma has always done it for them, or they tried and gave up in frustration,” she writes. “The complex learning curve, unresponsive insurance staff, long delays in contracting for therapists doing it alone, and the reality of lost income create a culture of fear that make some clinicians hang on longer than we’d like, and longer than our values might otherwise dictate.”
She concludes her article by saying: “For American therapists, there is now one way – and one way only – to get reimbursed at rates that are 20%, 30%, or 35% higher than your current contracts, and that is to join a venture capital-backed mental health platform. As independent billers, we offer no added value to insurance companies anymore. Building their networks therapist by therapist is so 2019, when they can now cast one wide net and fill their directories with 1099 contractors who are dependent on their business partners.
“To stop the perversion, it’s going to take therapy seekers who want their mental healthcare to be tethered only to the comparative safety of a small business. It’s going to take therapists believing that if it looks too good to be true, it will be, soon, when these platforms pivot so abruptly toward emerging investor agendas that there’s no time for us to jump off and avoid an unwanted new direction without destabilizing our businesses financially and administratively. And finally, it’s going to take our government regulators to recognize these platforms as predatory rate-breakers who might be violating anti-trust laws by preventing us from competing freely in the therapy space.”
To read the complete article by Flanagan, find it at: https://medium.com/@melissaflanaganLCSW/lets-run-away-together-i-m-a-therapist-leaving-venture-capital-backed-mental-health-85dacf3ebfc7
