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  • Writer's pictureSarah Santiago

Why I Broke Up With Insurance

Mental health therapist walks on beach. This photo is intended to represent why therapists may not take insurance.

One of the many things that I love about my job as a mental health therapist is that my work encourages me to "practice what I preach". I am intentional about applying the skills that I encourage my clients to use, to my own life. I often find myself empowering my clients to let go of things that no longer work for them, and recently I decided to do this myself; insurance was not working for me in my practice so I made the decision to break up with them.

I'd like to add a quick disclaimer here. I wholeheartedly recognize that this topic is extremely complex and I do not want this post to come across as anti insurance. I am not trying to talk anyone out of using insurance if that's what's best for them. I am very familiar with the pros and cons of using insurance and my intentions with this post are to highlight many aspects of using insurance that tend to not be known pertaining to mental health services. I sincerely want my readers to feel informed so that they can make the decision that is best for them.

Deciding to no longer accept insurance was one of the most challenging decisions I've had to make in my practice. I know that access to mental health care in our country is a major issue, and I know that for many people insurance helps make therapy more accessible.

I accepted insurance for nearly 5 years and it was painful. I tried so hard to make it work. I spent too many unpaid hours on hold trying to get insurance companies to pay for my client's services that insurance promised to pay only to refuse to pay after the appointment had happened. My stomach would fill with dread every time another problem arose and I had to call an insurance company. I was so frustrated that insurance companies felt that they knew what was best for my clients despite not being licensed mental health providers. I was sick of watching insurance companies gatekeep necessary mental health care for my clients.

One day I realized that I always tell my clients that if something isn't working for them, that they have the power to make a change. That's when I realized that I needed to break up with insurance.

I wholeheartedly believe that every human can benefit from therapy. Insurance does not believe that. In fact, insurance will only cover mental health services if a mental health diagnosis is given; and they don't even cover all mental health diagnosis! Not everyone who goes to therapy qualifies for a mental health diagnosis. In fact, many people seek therapy to prevent an issue from growing bigger and more problematic. Many insurance companies also believe that they get to decide how often you go to therapy, how long you are in therapy, and how long each individual appointment is. These are all decisions that I believe should only be made by the client and their therapist.

I want my clients to know their worth and stand for it; I realized that I needed to do that too. Insurance companies are notorious for underpaying mental health clinicians. This means that therapists then have to take on more clients to make a livable wage. The mental health profession is notorious for burnout due to the heavy nature of our work. We deeply care for our clients and their wellbeing and it's important that we don't take on more than we can emotionally handle. While it may seem like a lot of money per hour, we spend several hours per week on notes, trainings, education, reading research, following state licensure guidelines, completing reports and assessments, consulting with other licensed professionals to ensure we're giving our clients the best care. All of this is "unpaid". We also have lots of bills to pay to maintain HIPAA compliant practices, educational expenses to ensure that we are providing the highest quality of care, licensure fees, and professional organization memberships to pay for. When mental health professionals are paid fairly they don't have to overfill their schedules and can invest more time into high quality trainings and consultation to deliver exceptional care to our clients. Therapists who aren't burned out can provide better care; I know this because I've been an overworked, underpaid, burnt out therapist before.

I also believe that clients have the right to confidential mental health care. When you use insurance to pay for therapy, your insurance company has the right to request your therapy records at any time. When you apply to get life insurance, or even certain jobs, they have the right to request your medical records from your insurance company and gain access to your mental health records and diagnosis (because remember they require a mental health diagnosis in order to pay for services in the first place).

Lastly, it infuriates me that insurance companies have profited billions over the past years- which have been extremely challenging and mental health needs have increased significantly- yet they continue to gatekeep access to mental health services for their members. I no longer wanted to be part of a broken system. Instead, I plan to continue to donate to organizations that make the world a better place for people in need and marginalized groups. I have spent time volunteering in my community with organizations that support mental health and I plan to continue to give back to my community in meaningful and impactful ways.

Insurance wasn't working for me in my practice and I realized that the best decision was to break up with them, so that's what I did.

What aspects of your life are not working for you? Where do you feel trapped or stuck? What changes can you implement to better meet your needs?

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