Finding a therapist who takes your insurance can be nearly impossible

A PhD in psychology takes 6 years to complete plus another year for licensing. A PsyD is a little bit less, but typically you pay high tuition during that time, whereas most PhD programs are free (with a small stipend). So, you make little to no money (or pay money) for a long period of time and then you are presented with a choice to take or not take insurance. If you choose the former, you:

- Get paid half as much

- Have to deal with filing claims, which ultimately becomes an additional expense, since chances are you have to pay someone to do this for you.

- Get your money later instead of now.

- Have to keep meticulous notes in case you ever get audited by the insurance companies, who can refuse to issue payments if your notes don't meet their standards.

- Have to lose patients when their coverage runs out

Meanwhile, there's overwhelming demand for therapists in many cities and plenty of people who will pay cash. I truly believe that many therapists are not in it for the money... but if they are going to make less money, let's at least figure out a way to handle the bureaucracy so that their jobs are more enjoyable.

I wanted to get short term therapy for a mental health related thing this year, and made the mistake of switching from my PPO to Kaiser thinking that Kaiser would cover therapy sessions since they appeared to have thousands of therapists under their network.

It turns out that Kaiser will only cover you if you have a diagnosed mental condition (eg bi-polar / ADHD). If you don't, then you're completely out of luck. Instead, they refer you to use an app where you can get counseling via text message, and it's only for 90 days.

https://organizations.headspace.com/kp/faq

Both of the therapists I've seen made it clear up front that they refuse to deal with insurance companies, and expect payment up front. The health insurance industry would make Franz Kafka proud.

That said, I was surprised when I mailed a bunch of bills to my insurer, and requested reimbursement. I figured I was probably wasting my time, but why not see what happens.

Anyway, they mailed me a check. The bills were higher than what my insurance would cover, but my insurance decided to cover a substantial portion.

The key legal and economic goal of a privately owned health insurance company, is to become entrenched as a legally required intermediary between patients and the “medical cartel.” So functionally the optimal approach for an insurance org is to ensure that they are only required to reimburse for expenses that are mandated by law. Then the trick is to reduce the number of mandatory payments through regulatory capture and obfuscation. See: Medical Biller role at each hospital and lack of consistency transparency etc…

Therapists are not considered part of the medical cartel because they are not required to go to medical school or pass the licensing process for “Doctors.” They can’t increase the service costs unilaterally into longer term revenue. This is why it’s trivial to find a covered psychiatrist - because they legally prescribe medicine which is the best possible outcome for an insurance carrier - their equivalent to SaaS margins.

So therapists aren’t legally “Doctors” and as a result they do not have the legal avenues to create an invoice that a health insurance company would accept as mandatory to pay by law. So there’s only downside to an insurance provider for this.

I often wonder if therapy is "over prescribed" these days.

I've struggled with various problems and therapy has seemingly always made it worse. We would "explore" things which caused me to dwell and dedicate so much brain power to "untangling" ideas. Eventually, I would always be "cured" after some relentless distractions and not the therapy. I truly believe the therapists wanted to help, and our progress felt real... but looking back, it was probably worse than doing noting.

I bring this up because I believe some people need therapy, but many people are encouraged to seek it out for problems that could be overcome with other methods, causing a "therapist shortage." This has downstream effects, like the one posted here.

So let’s set aside for just a moment the notion of single payer healthcare as an answer to this. Why hasn’t a point of competitiveness between insurance companies ever been that they keep your workforce healthier, more productive, and easier to retain than the competition?

The biggest cost to an employer is always their roster. The fewer sick days people need, the less burnout causes them to churn, and the healthier and happier people are overall, the lower the training, recruiting, and redundant staffing cost.

It feels natural to me that in an employer paid healthcare system like the one we have in the us, the employer should demand the highest quality coverage possible by that metric as long as it reduces staffing overheads.

Cherry on the cake is - People start looking for therapists when they're struggling the most.

Navigating the Kafka-esque mess is hard enough when you're well. But if you're clinically depressed and struggling to get out of bed, booking an appointment can feel like an unsurmountable wall.

> Several insurers told ProPublica that they are committed to ensuring access to mental health providers, emphasizing that their plans are in compliance with state and federal laws. Insurers also said they have practices in place to make sure reimbursement rates reflect market value and to support and retain providers, for which they continually recruit.

Journalists could use an LLM to fetch the obligatory predictable responses from corporate spokespeople, to insulate the journalists' souls from that.

Healthcare (in the US) is insanely expensive for physical health, often with insurance being “difficult”. Hence not sure why anyone would be surprised that mental health is similar.

I got new insurance this year through my state's insurance marketplace. They said my existing therapist was in-network. This was news to her. I called and spoke to them. They insisted. She called and spoke to them. They insisted.

So they've been paying her $150 a week for me instead this year. She doesn't know how she ended up being considered in their network as she practices solo, but here we are.

The system is vastly more convoluted than I think anybody on any side actually realizes it is.

In every other respect, I have excellent insurance. But the shit they put my therapist through seriously makes me wonder why she even bothers. Every story in that article echoes her own experience with insurance.

Lawyers: where's the class action lawsuit on behalf of therapists alleging a pattern of denial of payment?

(Genuine Q) why do so many Americans [appear need to] have a therapist compared with - sorry, not sure how to put this - the rest of the planet?

Also hard to just find a therapist, let alone one you like. The simple fact is that there's plenty of demand and zero supply. This is why you see so many 'personal' and 'life' coaches now btw. It's an absolute cluster.

This is absolutely true, all of it. The insurance companies do not have the incentive to do what is best for the patient. I've been shocked at how little they were willing to cover, with very little justification, even when extreme depression and suicide was a possibility. Just think, they are willing to spent north of $1 million on a patient for complex cancer surgery, but are unwilling to spend 20k to pay for therapy that is proven to prevent a suicide.

This is not to be taken as mental health advice (merely an anecdote), but yesterday I was thinking about needing therapy to deal with my issues and I had the thought to use ChatGPT. Wow, it was absolutely incredible in providing me with what I needed.

I think therapy with a professional would be really useful if you have no idea what your problem is, but I think if you're able to put your problem into words then LLMs can be useful.

This is very true. My Wife has seen a therapist for dealing with her dad’s death and her mom’s new boyfriend situation as well as mom’s irrational behavior. Luckily I have been saving in an HSA for nearly ten years. Paying for it is no big deal. My company also had free sessions as part of our company provided employee assistance program.

Our current and our previous major insurance companies both have covered therapists listed along side other types of doctors on their website.

Made it super easy for us to find one. My wife saw one literally in walking distance from our house.

Your house is probably not going to burn down, but if it does the financial impact would ruinous. So we pay a little bit each month to insure against this rare outcome.

Some of health insurance looks like this, but many parts of it don’t.

Finding an insurer that pays therapists a rate in line with their level of education and specialization can be nearly impossible, and time spent filling out the billing paperwork (often only to be rejected for payment or even "clawed back" after the fact) isn't billable.

Many folks I know that have private clinical practices address the tension between this and ensuring that there's access for people that can't afford the full rate out of pocket by charging a really high rate for most patients and then doing sliding scale/pro bono work.

there is rula: https://www.rula.com

you put in your insurance and location, and they find you a provider.

also, some therapists don't take insurance (or recommend you don't use it) because supposedly if you do, then part of that agreement is that they tell the insurance company your treatment plan, which includes the diagnosis, that may be available to your employer. doctor/patient confidentiality seems like there are some exceptions here.

What does the business side of therapy look like ? How do they measure success ? I’ve seen patient surveys , but stated conditions are biased.

Therapy doesn’t seem like healthcare . People enter the system and receive care without recovery

It just seems like legitimized drug dealing. Just make the psychotropics over the counter and save the world hundreds of billions

Psychotherapy is easy to acquire overseas with online meeting software with a fraction of the cost.

The entire American Medical Industrial Complex is designed to extract as much money from customers as possible.

Fun fact, therapy is usually not covered by Medicare at all( and when it is you can literally have a year wait). So you have a system in which working class person just have to get through it, and anyone with means will be told they have dozens of things wrong with them.

Better Help sells user information. The venture capitalist tech bros have a new market.

When I was at my lowest, broke , without any health insurance at all, I had a friend who listened to me complain about my latest eviction for hours at a time. That did more for me that any therapist ( who almost always watch the clock to cut you off ).

I plan to pay for her children to go to college. I make a tech bro salary and it's not a lot of money to me.

The Quest For Community and Tribe are great books on what's wrong with modern society. In my grandma's time the average person attended church ( I'm am atheist, but I value the community aspects), at least one social club, and she was a member of a union.

How many community connections does the average person have today ?

My insurance just flat out says therapists are excluded from coverage.

>“The way to look at mental health care from an insurance perspective is: I don’t want to attract those people. I am never going to make money on them,”

Exactly why healthcare should be a human right and not a business. As someone who’s grown more conservative over the years, this is where I draw the line. Unfortunately since people will always see mental health as secondary to physical, this will always be overlooked.