I am a therapist. I take insurance but it’s a goddamn nightmare

You either join a group practice (goodbye at least 40% of earnings) or you try to go it alone

If you go it alone: hello navigating the maze of bureaucracy that is insurance credentialing and billing. Good luck! No real guidance here. There are some “tutorials” online but they’re super generalized because everything is very different on a regional level. Aetna in Atlanta is entirely different from Aetna in New Jersey. Then you can also play the game of “guess how much money I will make?” Because none of them tell you until you’re about to sign the contract (and some don’t tell you until after!). Or you can pay someone to do all this for you for like $1000. Also it takes months. Then you have to figure it all out again to figure out how to bill. Then you have to figure it all out again to figure out how to bill electronically because you bill on paper the first few times to get payments and then use the payment numbers to set up accounts to actually bill the normal way. Or again you can pay someone to bill for you for like 5-10% of your earnings.

And all of this is while you’re a 1099 worker so no health insurance, paid time off, retirement, etc

Alternatively you can in some places join a hospital system. These will sometimes pay you a salary and benefits but will usually pay a shit salary, crappy benefits, and give you a nightmare quota and ask you to supervise interns. Or work someplace like an IOP and run groups but again you’ll make like 40-50k tops with crappy benefits (and the student loan debt of someone with a masters degree). Plus a lot of those places will still keep you as a 1099, at least around here.

So then the community mental health/medicaid agencies cry about why they can’t keep staff and the mental health crisis facing low ses communities (hint: it’s because you pay $30/hr as contract workers to people with 100k+ student loan debt)

Then people run from those places to group practices and stay there for a bit but eventually bail because they take 40% of earnings

Then they go independent and panel with insurers and it’s okay but also a fucking headache. They work 25 hours a week seeing clients and 15 hours a week unpaid doing paperwork to bill for said clients. All well and good except what the article wrote is all true, eventually you get a clawback where an insurance company is like “you wrote 90847 and you meant 90837, you could just correct and resubmit but we won’t allow that. You did it 15 times so we are demanding you return $8,000 thanks” also your quarterly tax payment is due tomorrow. Oh and your insurance billing has to be submitted timely but Aetna is 3 months late in paying you and owes you 6k. It will come, eventually, probably

Also all that admin stuff they refuse to pay you to do? They pay grow and headway and alma and all those other vc backed tech bro companies that started during Covid to “revolutionize mental health” lmao. They pay them $30-40 a session to do it. Shoulda made a website milking off other therapists with a sob story about how you were depressed and had trouble finding a therapist bro, you could’ve been a multimillionaire instead of some dipshit making 65k with no retirement savings

Short answer: making it deliberately hard to collect disincentives trying to collect.

The USA government stole a rent payment money transfer to my former landlord. It was the Office of Foreign Assets Control that took it, I guess because my landlord’s name sounded Muslim (terrorist). I petitioned them for the money, filling out a long form and including the case number they told my bank. They said the had no record of it. I concluded that it wasn’t worth my time for the amount I might get back and gave up.

These systems are designed this way for a reason.

The reimbursement rates for therapists is insane. When I look at my EOB, my psychiatrist gets paid just under $100 for a 25 minute medication maintenance session.

According to insurance rules, this includes any administrative work like filing the claim, booking appointments, office staff, etc. And if I email my doctor, that’s covered under that $100.

I’d have to double check this but I don’t think his reimbursement rate has gone up since I started seeing him 5 years ago.

And this is for a medical doctor. I imagine a talk therapist the reimbursement rate is lower.

I’ve seen therapists both in and out of network and the ones out of network are more attentive. I don’t feel as rushed to get out the door and they don’t overbook. It sucks that this basically means only rich people can see them.

We really need to reform healthcare in this country.

It took months to find a new therapist for my daughter when her old one had to quit her job for health reasons. Meanwhile, her anxiety got worse and worse. We were just super lucky a new counseling center opened in town and got in right away. Thankfully, she really likes the therapist too.

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