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  • Autumn Quiles, LCSW

Do I Take Insurance?

Updated: Jan 24, 2020

The short answer is: no.

But, the long answer is a bit more complicated and I think families who are considering work with a therapist, especially a child/teen therapist, should consider this reasoning when they choose a provider. Not just me, but any provider who will be working with their child.

Many people assume that my primary reason for not taking insurance is because I am a snooty therapist who is too bourgeois to do paperwork or work for families who don't have loads of dispensable cash floating around. This is not the case. I keep clinical records, as is legally required, on all of my work. And most of my families have to make sacrifices in their monthly budget to pay my bill. Doing our work, without the oversight of an insurance company, is something that me and my families choose together.

Insurance companies require that I diagnose a child to justify the "need" for services, and the "need" for me to be reimbursed for services. If my diagnosis is not severe enough to "warrant" treatment, I have to offer a diagnosis that is more debilitating (and stigmatizing) to justify treatment.

In the past, I have spent hours providing more and more detailed, confidential (confidentiality that is waived when it comes to getting paid by insurance) information about my kids/teens to justify treatment. If the insurance person on the other end of the email (who is almost always not clinically trained) doesn't think the problem is significant enough, I spend more and more hours on scheduled phone calls, justifying the need for the work.

Then, the insurance company determines (by what means, I don't know) exactly how many treatment sessions should "fix" that particular diagnosis. If the therapeutic pace of the child/family doesn't fit that time-frame, I have to start those emails and phone calls again to explain exactly why the child/family's issue was not resolved in that time-frame and I have to incrementally ask permission for a few more sessions at a time.

This process of pleading with insurance companies is clinically intrusive and, many times, only results in me being reimbursed less than half of my fee. As a professional, I feel my work is fairly valued and I do not provide less than 100% quality care, so it is not fair for me to be compensated less than 100% of my fee.

Additionally, insurance only pays for the one hour I sit with your child per week. If our hour runs long, I do not get paid. Insurance doesn't pay for the research I do to make sure you have the latest cutting-edge parenting tools to use in the upcoming week. It doesn't pay for all of the professional training that I pursue, to make sure I am doing innovative work. It doesn't pay for time I spend, outside of our hour together, helping parents in crisis manage the daily emergency. I spend at least two extra hours a week, per family, preparing for the one magical hour that we get to sit down together.

But, the biggest, most important reason to me, that I don't take insurance is the stigma that it attaches to your child/teen/family. I battle stigma daily, but it is still very real and very prevalent in today's society. And, with the increased focus on mental health treatment for our kids/teens, there are more and more laypeople (or at least not-clinical people) who are interested in knowing about our kids' mental health issues. These people, as of yet, are still carrying around a lot of judgment about the symptoms of depression, anxiety and behavioral disorders.

Schools in our county are now tracking kids with mental health issues- ostensibly for the purpose of justifying funding (sound familiar? like insurance companies?) and ensuring that kids get help (to prevent another mass crisis like a shooting). I have also heard of private schools and colleges that review a person's mental health history for admission purposes. Employers, particularly in specific industries, are very cautious about hiring people with mental health issues. This trend, toward making mental health issues more transparent, is not necessarily consistent with a decrease in stigmatizing children/families who are working through a mental health issue.

I have read article upon article, written by people with a mental health history, who talk about how they were discriminated against because of their history. They have been denied admission... denied jobs... denied opportunities to pursue their own happiness because, at some point in time in their past, they needed help to get through a tough period. I do not want to put the kids/teens I work with in the position of being denied a future happiness because I had to document their diagnosis to get paid.

I have no idea what kinds of amazing feats and accomplishments your child/teen will want to pursue later in life. I have no idea how intrusive institutions will be allowed to become in the future, when it comes to accessing and acting upon the information kept in insurance records. I, unfortunately, have no control over how the sensitive clinical information about your child or family will be used, or misused, in the future- I only have control over whether or not I am comfortable creating that paper trail at this time.

Some families may be comfortable with all of this and may still want to pursue paying for therapy through insurance. For these families, there are other providers I can suggest who are willing to work with your insurance.

For families who are not comfortable and still want to work with me, there are options! I accept credit cards and families often seek reimbursement through their HSA accounts. We can schedule sessions in a more financially feasible way- maybe every two weeks, instead of weekly. We could contract for short-term work. There are many possibilities. I understand that the cost of my services are a serious financial commitment to my families and discussing this pragmatic aspect of treatment is something with which I am very comfortable.

Ultimately, regardless of whether or not you get help from me or from another provider, I am deeply committed to supporting every family I meet who wants to get help. Please don't allow your valid concerns about the cost of treatment prevent you from contacting me about how to pursue your goal. Therapy is a possibility for every family, and if you are Ready, I want to help you make it happen.

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