If you're living with a chronic illness, you're in the right place.

Sunday, October 21, 2012

Insurance- to take or not to take?

12:10 PM Posted by Stephanie Horgan , , ,
Since Tiffany recently mentioned insurance in her post on October 14th, I figured I would chime in with my perspective as well. Insurance is a tricky topic. Why do so many therapists refuse to take insurance? Well, as you may know from being a patient, insurance companies are not always the easiest to deal with. When a therapist accepts insurance, they are basically saying they are willing to take a large pay-cut (because of the current rates the insurance companies pay), as well as also deal with the details that come along with submitting the billing and advocating for their patients. This is extra time that therapists are not paid for, and something that can be quite time-consuming.

As I was researching this, I found a great explanation in a blog stating that "different insurance policies by the same company can have different payment rates, so someone has to call for each patient, verify the insurance, find out the terms, co-pays, deductibles, and this involves sitting on hold and dealing with assorted prompting menus. And if the insurance company finds a reason not to pay, the doc (or therapist) is stuck- he/she can't bill the patient, he/she's just out the money." So instead of taking insurance and getting paid less, many therapists decide to leave that burden to the client. It is up to the client to pay out of pocket for each session, and then submit their sessions to their insurance company to see what kind of out-of-network benefits they will reimburse.

And that is how many therapists choose to operate. Makes sense, right? Well, not really. This means that the only people getting to go to therapy are the ones that are able to pay up front, and ones that have the follow-through to fight with their insurance company about reimbursement. Not only this, but since the patient's therapist is out-of-network, he/she is likely to have a higher copay and higher deductible, making this even more expensive for the patient. Here is where the ethical dilemma comes in- there are many, many patients that cannot afford to pay out of pocket, and would only be able to afford therapy if they use their insurance.

And it is for that reason, why we at Oak Park Behavioral Medicine, LLC are getting on insurance panels so that more and more people will have access to our services. We want as many patients as possible to have the opportunity to come to our practice and get help with their illness, leaving with tools to live a full life, instead of large bills on top of their potentially already large medical bills. In the case that patients want to skip the insurance process and pay out of pocket, we gladly welcome them! It allows greater freedom to not have to put a diagnosis label on them, or be confined to a certain number of sessions. But we realize this is a rarity, and we want to make sure we are reaching out to all who are needing help, not just a privileged few. So there is my Sunday soapbox. I'll kindly step down now.

Last but not least, I want to encourage you to sign up for our November 14th Patient Education talk in Oak Park, as it is filling up fast! Hope to see you all there!