My Love-Hate (Mostly Hate) Relationship with Health Insurance

Hate is a strong word, but in the case of health insurance companies, it fits. Love is also a strong word, but that doesn’t really describe my experience with them either. I tolerate them. Here’s why…

The Conditional Nature of Coverage

Yes, insurance helps grant access to care, but it’s conditional. It’s the difference between unconditional love and conditional love: they’ll help you heal or maintain your health, as long as you pay them a lot of money every month. And if something happens—which, let’s face it, all of us mortals fall ill—they expect to charge you substantially to cover the services you need through a deductible. As providers, we can charge less, but many of us are still paying back our student loans. Everybody’s getting squeezed somewhere along the way.

A Twisted Web

My office has contracted with health insurance providers at all levels, including Medicaid, Medicare, state and federal programs, as well as commercial insurance through employers. The system is a twisted web. I’ve visited other countries, and friends and colleagues there laugh at how we do things here. It’s sad, it’s inefficient, and sometimes it’s just pathetic.

Why I Play the Game

That said, I play the game because I want to help people. I was in graduate school when Obamacare was rolling out, and I didn’t even have healthcare coverage myself, so I know the struggle. I also know that insurance can help people who might otherwise be unable to afford therapy. But from the provider side, it’s complicated. It can feel like a third-party middleman putting a cap on your work, challenging your sense of self-worth, and turning navigating care into a labyrinth for patients.

Balancing Act

There’s a lot to balance. Clients sometimes misinterpret coverage rules, and providers have to learn how to properly value their time and services. Insurance both helps and hinders, depending on where you’re standing.

Checking Your Benefits

So if you have healthcare coverage and are thinking about starting therapy, here’s a tip: check your benefits. Plans often change at the end of the year. If you have a PPO, you can typically see providers in and out of network. HMOs usually require staying in-network and may require referrals. Your insurance card has a customer care number. So call and ask for a benefits explanation from a human. Many plans also have online portals with the same information.

In-Network vs. Out-of-Network

At the time of this post, my office is in-network with Medicare, UnitedHealthcare/Optum, and Aetna. If you’re not covered by these plans but still want to work together, you can go out of network. That means you pay out of pocket, and I’ll provide a receipt or “superbill” for you to submit to your insurance for partial reimbursement.

Getting Started

It can feel confusing, but taking a few minutes to check your benefits can save a lot of stress. If you’d like help navigating this system or would like to get started with therapy, please visit the footer at the bottom of this page to schedule a consultation.