Why I Try to Avoid Insurance

Not Cutting Corners

I’m writing this article to address one of the top questions I get from prospective patients: “Why do you try to avoid insurance?” It’s a good question. After all, we all typically pay an arm and a leg for health insurance, so of course people want to use their coverage.

My goal with this article is to demonstrate how insurance companies force therapists to cut corners and why the benefits of paying for treatment far outweigh the costs.

Profit over Quality Care

Unfortunately, the insurance industry has become a runaway profit machine, rather than a helpful way to protect ourselves in case of illness. The insurance industry used to be conducted from a “risk pool” model where a bunch of people put their money together to cover needed medical expenses. Sadly, the model has now shifted to that of maximally extracting money from its clients without giving much back.

To extract that money, insurance companies hire entire teams of people whose entire job is to deny claims or reduce the care below needed levels. Here’s how this looks in Psychotherapy: let’s say someone comes in for treatment because they feel suicidal. Insurance will generally pay for the first few sessions of therapy, but they force sessions to be short (45 minutes), even if someone requires more time. I once worked at a practice where we received a letter from insurance threatening that if too many of our sessions went longer than 45 minutes, they would kick us out of their network!

Even with shorter time, if the person starts feeling less suicidal (great!) the insurance companies often stop covering treatment because the problem is “solved” (not so great.) All too often, this means that patients start to feel better, only to have their coverage prematurely dropped and the problems return. They’ll then go back to therapy and experience the same issue. This leads to patients being stuck in “revolving door therapy” where the cause of their suffering is never truly addressed. The pressure to end treatment too early is relentless and turns the goal of therapy from real healing to more of a “first aid/emergency care” exercise. That’s just not how good therapy works, but insurance companies don’t seem to care.

Paperwork Doesn’t Help Patients

Another way that insurance messes up treatment is by requiring ever-more-complicated paperwork and administrative work (phone calls, audits, etc.) The amount of time that Psychologists have to spend doing these tasks can add up to hours per day, which is time that could be much better spent seeing patients, coordinating care with other medical professionals, and researching or attending trainings to better themselves. Even after spending all of this time, insurance companies try to claw back money (sometimes from years ago!) using dirty tricks. For example, I once had an insurance company try to claim that our medical notes were incorrect only because the date was at the top of the page instead of the bottom. No, that’s not an exaggeration. That really happened.

Halfway Isn’t Enough

Lastly, insurance companies will also deny coverage for proper Psychological Testing, my specialty. For example, when I’m testing someone for ADHD, I always add testing for anxiety, depression, trauma, and more. This way, I’m not giving the wrong diagnosis and I can help them as best I can. But insurance companies say, “you can’t do that!” and will only cover the ADHD portion. When insurance companies only cover 1/3 of the needed testing, the testing is forced to be incomplete, low-quality, and potentially harmful to patients. I just won’t do that to people, so then testing doesn’t happen at all.

For all these reasons (and more), I don’t take insurance. When insurance companies get involved in treatment, the treatment suffers badly. Therapy is shortened and ends too early. Quality goes down. Time spent with patients shortens dramatically. And testing can’t happen at all.

Doing Things the Right Way

When you work with me, the saying “you get what you pay for” really is true. I spend much more time with patients than average. I engage in a treatment process that lasts as long as it needs to in order to help patients get better and stay better. I do Psychological Testing that is complete and comprehensive. You will get better care here because insurance doesn’t get to interfere.

If insurance simply paid what was necessary for patients to get better, I would happily recommend it to patients. But that’s not expected to happen anytime soon. For now, I’ve made the decision to strongly recommend that patients work with me with a cash rate, even if we have to negotiate a lower fee. If you choose to move ahead with insurance, that’s okay too—now that you know the risks.

-Dr. Husick