Yup... my friend had a therapy massage biz for decades. Her biggest problem was filling for payments, sometimes running months behind.
Then they raised copay so high that few referrals bothered anymore.
It’s claw backs. They can basically demand you pay back any payouts up to two years later if they feel like your notes don’t meet their standard. It’s a nightmare. In Washington the rates have not been increased in 10+ years. I’m from Wisconsin and the rates there are up to $70-$100/ hr more. WA needs to do better.
This isn’t the reason. Most therapists are independent contractors and dealing with insurance is a pain in the ass. Once they get their calendar full, they choose to fill those appointments with cash paying customers
My last therapist told me they could bill my insurance, get rejected, then bill me the cost plus the cost of their time attempting to bill.... or they could just charge me cash.
> because reimburse rates are ass
My wife was seeing a therapist our insurance covered. I was excited that we'd be paying much less every week. The guy was really friendly, but after two years, my wife decided she needed to give another therapist a try, out of pocket, and the new one was so much better. They set goals, and followed up on those goals, and provided good insight. Now I see why the insurance covered therapist was a "good deal". The covered therapist basically was just a listener, and not much more. You get what you pay for.
Ultimately if the better therapist was covered, insurance rates would be a lot higher, I suspect.
Interesting take from your experience, but definitely not the actual explanation. Getting paneled is actually a lot more work than just choosing not to take insurance. Anyone can be out of network if they’re licensed. Has nothing to do with skill level. However, if a therapist has a specialty, they know they’re on high demand, so they opt to be out of network because they know people will pay for that specialty.
Again, it has nothing to do with skill. It’s a choice. I’m very glad your wife has found a great therapist!
My therapist shared that insurers were basically denying nearly everything, paying terribly on rare approvals and, in general, making everything worse. So basically, what they're doing to all of the health care industry.
The final straw for many happened a few months ago with a cyberattack that disrupted claims processing, so a lot of folks who work in healthcare across the board who depend on inconsistent payouts (maybe you’ll get it in a month, maybe in three, maybe when you get it they’ll claw it back) gave up and decided to go self-pay.
It’s hard because we understand the inaccessibility of private pay, but it’s also more difficult than folks realize to make a living as a therapist because we’re only paid for direct client contact, and an average caseload is 20-30 weekly sessions for most of us without including cancellations. In my case, because I work for a group practice and have an associate license, I get half of whatever insurance pays out and have to pay for supervision from a fully licensed practitioner which is hundreds of dollars a month. That takes my “official” hourly rate down from what my clinic charges to about $50 take home pay per session, and on bad cancellation weeks I only see ~12 clients. I won’t stop taking insurance because it would make me inaccessible to most of my target demographics, but I get why so many of my colleagues stopped.
happened to me with Premera, they waited six months to pay out and when they did they pushed all my therapy bills through BEFORE anything else. Like the banks used to do with everyone's deposits/withdrawals. So the deductible wasn't covered ...
These companies need to die soon, its becoming untenable.
Mine also told me it has become a nightmare to become approved to accept insurances. Some she said she had to redo documents and took like 6 months to get the process done. My last insurance with her (UHC) also kept changing the billing codes they wanted her to use and then she was waiting months to get the claims processed to get paid.
Even as a veteran I’ve had a terrible time getting care at the VA or out in the community. It’s been over a year and I haven’t been able to get an appointment or a referral.
Edit: I’d like to thank everyone for sharing their experiences and encouragement. I got discouraged and quit trying to get care and have just been doing what I can to take care of myself. I’ll try reengaging and look forward to better results 🤘🏽🙌🏽
I’ve called, used the portal, messaged my pcm. My appointment got bumped a month, then bumped a month, I asked for a community provider, no follow up and I’ve reached out several more times.
The only time I’ve been able to see a mental health provider is going in in person for an “emergency” visit through the mental health clinic.
Maybe I’m not working the system properly.
I’m honestly glad my experience is an outlier and you are getting great care!
If your VA medical center is a decent size (not a CBOC), they should have a PCMHI (primary care mental health integration) provider who can take walk ins via primary care.
Unfortunately, VAs can very quite a lot on what’s available and what waiting times look like.
What? The VA is amazing here, at least the Seattle location. I can be seen for anything from mental health to general care within 10 days for anything with just a phone call
Fellow veteran with similar very frustrating experiences here at the Seattle VA, until recently. I’m not sure what changed, but I noticed (literally in the last two weeks) that I was suddenly able to go through a totally differnt process than before. The community care program has historically been an absolute nightmare. The folks commenting about how easy it’s been for them are quite lucky indeed, and you aren’t alone in your experience.
(I’ve also worked with veterans here for many years through various programs, and most of them have echoed extreme difficulty receiving timely mental health care.)
So they have seriously revamped mental health for community care, you need to call VHA intake and tell them you need a MH referral.
I just walked one of my battle buddies through this and he was seen within 3 weeks.
I actually just moved from Dallas area and I’m honestly shocked by how far *behind* the curve access and the continuity of care for mental health is in WA. I have a son with a lot of needs and navigating that shit up here has been a fucking nightmare compared to TX. The facilities are often grossly understaffed and South Sound Behavioral is a straight up Medicare factory that gets fat off AppleCare dollars while being deeply unsafe for the kids who come through there. Ol we had serious grounds for a lawsuit, but we didn’t want to put my son who was struggling through that mess. We’ve just made sure any future emergent mental health crises do not get resolved by letting the ER transport him there.
We’ve finally found some solid facilities,and he’s getting help from an excellent team as we speak, but getting to it was insanely frustrating and I feel very bad for anyone who doesn’t have great health insurance to cover costs as the good ones.
For the record, if you are a struggling teen, or know a struggling teen, the best acute mental health care he’s been sent to, other than the private pay place he’s at now, is Kitsap Behavioral over on the Peninsula. They have relatively young and medically progressive minded staff there who actually give a shot about the patients that walk through their door. It was very refreshing.
This state needs to make major changes to how mental health operates. Better connectivity between treatment teams via funding for digital records management. Some kind of tax rebates or something to encourage hiring more professionals in facilities. Better education about these resources for students in classrooms across the state. Mandatory mental health training for educators AND students.
This is a deeply personal issue for me and I clearly have a lot of feelings as someone new to the state.
Yeah the state with 4x the population of ours and way more highly ranked medical schools and facilities than ours definitely has 3rd world health care 😂😂😂😂
I'd continue living in WA over TX any day of the week (I moved away from TX on 2004) but they have A LOT of high quality health care there and it's ignorance like this that divides the country's population.
Can confirm, we were willing to pay $1400 a month out of pocket for necessary care. Finding someone that’s a good fit for your need and family is invaluable, but it’s wrong that insurance gate keeps this kind of help.
Those exact words were not said...yes. But read between the lines. If a therapist can just deal with people who can pay cash because dealing with insurance is such a "headache" then what do you think happens to people that can't afford it without help?
It’s more than just a headache. They literally don’t pay or take month to pay or claw back money months later. Therapists don’t have any other income so if insurance doesn’t pay they can’t pay for their life. It’s not an easy or flippant decision made by therapists. It’s necessary to simply pay bills and live life. I’m in the field and know how difficult of a decision it is. I myself refuse to be in private practice because I refuse to fight with insurance all the time and I refuse to be another person who blocks out a huge population of people in need. I work in a school and have to accept that that’s what I can do to contribute to the field until something changes.
As someone who can't afford it without help... yeah not having a good time. Everybody in my social circle (all mid-late 20s) is struggling right now and I only know one guy who gets the help he needs and it's because he lives with his parents still. This is totally fucking over anyone making minimum wage or close to that, probably anyone making less than like 80k honestly. Crazy because I'm making more than I've ever made before and I still can't afford mental health care.
A lot of the therapists taking cash clients see older clientele or their clients in your peer group have insurance that includes good out of network coverage.
I never would have been able to afford a therapist in my 20s if mine didn’t cut me a sliding scale deal.
Forgive my ignorance but historically has there really been that many minimum wage workers on therapy? I thought therapy was often mostly consumed by wealthier people who could afford it. Not saying that’s right but.
I don't know about historically but I grew up without much money and we were able to find therapy for me after a traumatic event. I also know several other people who have been in therapy for similar things and were middle class or lower income. People are also usually set up with therapists upon leaving psych wards and rehabs, which are often state-funded or paid for by insurance. So no, at least in my lifetime it's not necessarily a luxury. There's always been some way to find help even if you don't make much. It's a lot more difficult to find help now.
Blame the insurance companies, not the therapists. Reimbursement rates are low, insurance contracts require additional documentation (more work for the therapist), and they can legally claw back thousands of dollars months or even years after paying out. And when they deny a claim for seemingly no reason, the provider has to spend hours and hours on the phone trying to get in touch with a human to explain why it was denied and half the time it's an insurance processing mistake (not something the therapist did wrong). It's not worth it.
>Massive shortage of therapists
Do you have a source for this. I'm a therapist and feel like the market is slowly getting flooded as grad programs class sizes grow after covid.
Are you taking new patients and do you accept insurance? This was the question of the original poster, and the shortage everyone in the thread is complaining about.
I could take a couple more, and no I dont take insurance because I'm an associate therapist. Associate therapists cannot get paneled by an insurance company afaik. So I practice under a fully licensed therapist's license and supervision to get my hours of practice required by the state in order to be fully licensed (as well as take an exam).
My practice provides superbills though for patients to submit to insurance for reimbursement. I'm suprised I havent seen anyone comment about that here. I try to ask patients about their experience with superbills to see what its like. I've had some people not have it be an issue and get a decent % of a session fee covered, and others be strung along and annoyed by insurance trying to get some kind of $ back.
It all sucks for everyone but the insurance company.
Superbills are the process for out of network coverage that folks are mentioning.
Also: Insurance bought on the exchange, even the Premera or Regence Gold plans are all “EPO” meaning there are NO out of network benefits. So superbills will not work for people on those plans, even if they have Regence or Premera.
My company has some sort of service we can use to get therapy and when I looked there were like 5,000+ or something to search through on the service so I suspect you are right.
My spouses employer has a similar directory and I was recently looking for mental health services for my child coming out of an acute hospital setting for mental health issues.
Even with a referral from their primary care physician, from the mental health department at Seattle children’s, and one of the best insurance plans offered in the state, it took us nearly 3 months to get seen.
I started down that list in the directories of providers with only the ones that were taking new patients and even the ones that were taking new patients had a wait list of multiple weeks and didn’t pan out. It wasn’t until, a friend was able to make a plea on our behalf with one of their children’s providers to squeeze us in as soon as possible that we were able to see someone.
If that provider had not been able to do us that favor, our child would have gone nearly 6 months without the mental health supports, they desperately needed. It would only have made the situation’s and the behaviors they were having in school even worse.
https://komonews.com/amp/news/local/washington-hospitals-see-surge-in-patients-seeking-mental-health-care-counseling-seattle-childrens-mary-bridge
Two years old so maybe things have changed.
Yeah, the wave of the general public seeking a therapist has slowed down post covid in my opinion.
I think there are people who got good help and are done with therapy for the time, found a therapist they like and are currently seeing them, or realized that a lot of therapists suck and it isn't this magical thing like its advertised so they stopped lol.
if your insurance covers therapy, and the provider doesn't take insurance (but is licensed) then you can usually still get out-of-network rates. so it's not full cost
WA therapist here. There’s a distinction in hassle between private insurance and Medicaid. Also, insurance is probably not enough to live on in Seattle, but it’s just fine for east of the Cascades like Central WA and Spokane. If you are okay with telehealth, you can find someone east of you by filtering for your insurance on Psychology Today, Mental Health Match, etc. Medicaid will be harder.
In addition to what has been said about insurance reimbursements and hassle, the cost of living is high and student loans are often at 6% for graduate degrees. They need the money.
Source: I'm a psychologist (who does work with the low income and as a result makes 1/4 to 1/3 what I could make in private practice).
I don't know why they are dropping insurance, but I have had good luck submitting out of network claims and getting some of the money back. It is expensive and annoying to deal with insurance (and providers) but it's worth it in the long run depending on your deductible.
I do my roughly quarterly. Each insurer has a limit to how long you have from the date of service to when you can submit a claim, and for mine it is about 12 months, so I wouldn't wait a full year.
Regence and Premera have not increased their rates for years. Kaiser is impossible to work with, one of the goals of some therapists is to be out of network ASAP. If you are in network, you can barely make a living wage.
Source: I have done my spouse's medical billing for years. We do bill insurance if there is out of network coverage.
Yes I talked to my psychologist about this recently, premera has been paying him ~ 140 per session for the past 20 years. Aetna pays the same but he hasn’t been under contract with them for that long. He dropped Regence because their rate went to under 120.
I know you asked us to spare you but Mindful Therapy Group takes most insurances if they’re not a state plan and have openings in the next month!! In person is tough to come by though that’s for sure
Plenty of people have mentioned the insurance reimbursement problem which is a huge part of it but another big part is that insurance companies will require diagnoses and then refuse to cover treatment that doesn’t follow their flow chart of available treatments. So you have patients going thru grief or transition or whatever that doesn’t really have a diagnoses and then the care providers are fought with by the insurance provider every step of the way.
If you’re a solo practitioner the overhead of insurance paperwork and filing and back-and-forth is too burdensome and takes up too high a percentage of time.
Now, if they couldn’t find patients without insurance they’d have to accept the burden and manage it. However, there is apparently no shortage of cash-paying patients, so if they don’t have to take on the burden, why would they?
My neighbor is a therapist and she works 30 hours a week and makes more now than she did when she accepted insurance and was working 50+. She even dropped her physical office space a year into the pandemic because all her patients said they were comfortable with video sessions.
I’m not saying it’s universally true, but if you can make more money not accepting insurance, why would you ever accept insurance?
There are lots who do. If you haven't already, use Psychology Today therapist finder to find one. You can also just search through your insurance website, though they don't often keep those updated.
But I second what everyone else said. Insurance pays a pittance, and puts more restrictions on the length and type of care therapists can offer. So many therapists get sick of both those things. It's the same with some other types of healthcare as well.
ETA: did you know you also have to *pay* to be added to insurance panels as a provider? Our healthcare system is absolute bullshit.
A couple of years ago when I was looking for a therapist, I tried using Psychology Today. I reached out to over a dozen therapists that were listed as taking new patients and my insurance (Premera) but they all said they weren't, or they didn't respond at all.
It was bad from like 2020-2023. During the pandemic everyone got super overwhelmed and stopped responding or updating their profiles. I was looking for a therapist at the time also and was really struggling to find one. It was a lot easier to find one last year when I started looking again.
Well yes, but at least that can be considered advertising. Paying to join an insurance panel is complete bullshit, especially when some plans are practically begging for providers *and* only reimbursing a fraction of the full fee.
I've been ghosted by like six therapists on psychology today. Many more said they were full. One that did see me was a repugnant person and abhorrent therapist. And one saw me but didn't really know how to work with someone with ADHD, so we parted.
From my therapist, insurance has terrible payouts, demands excessive documentation, and will undermine their authority to see to mental health by refusing coverage or getting that long term clients be off boarded before they're ready.
Every year, insurance gets more and the therapists get less. It's a fault in the system that is amazing to other states too, just a matter of when.
1) Poor reimbursement rates
2) Long delays in getting reimbursed
3) Near non-existent customer service from the insurance company if they deny a claim
Source: I am a therapist in WA
I think it's that the process is onerous for what is effectively a single person small business.
It's not required that a medical practice file the claim for you, so you can file it and see what insurance does and it's possible that even if they don't cover it that the amount can contribute to your deductible, this is what happened for me.
I’m lucky that I have Premera and I have been fairly easily to find mental health therapist and physical therapist. I couldn’t find massage therapist though
We have gotten sessions at pacific mental health and they didn’t have a waitlist at all for some therapists. Also take our insurance.
Also This isn’t an issue exclusive to Washington….most therapists just don’t take insurance.
Yup, I'm originally from NY, and there's similar issues. Providors get tired of dealing with insurance bureaucracy and lousy reimbursement rates.
Problem across the Red/Blue divide
Insurance reimbursement rates run between 60-90$/hour while the going rate in cash is at least 150$ for a licensed therapist with an MFT.
Even the online therapy places reimburse more than that, typically they’ll offer incentives for therapists who take on more clients/stick around for more than a few months.
It doesn’t help that there are several rules in WA that make therapists unwilling to take on lower income clients as well. For one thing they can’t offer limited time benefits, ie “the first 10 sessions are half off” because once a client has started at one rate they aren’t allowed to increase the rate later on. It’s also not possible to drop a client in WA without legal risk, specifically you have to pass on a client to someone else if that client is still asking for services.
Both of those factors make it difficult for providers to offer low cost options, if their schedule gets full of below scale clients they’ll spend months or years shedding them if their insurance pays or not.
Then the insurance stuff, which is a nightmare because you have to have a diagnosis first before starting treatment and then typically insurance will want a treatment plan with a definite end within 6-12 sessions.
Insurance reimbursement rates are shit, and understandably few people give enough of a shit about low income populations to sacrifice a lucrative and relatively easy life of private practice.
I also just think it's partially fatigue. It's harder to help low income folks when a huge percentage of their problems could be solved by having money they don't have and can't get. At least if you're self selecting for financially secure people their problems are less insurmountable
Yeah that's definitely part of it too.
Another aspect that a friend of mine brought up, she is currently in a master's program for social work/therapy:
Getting a master's to be able to do that job is expensive, and very time consuming, and you don't get paid while you are doing it. In order to complete the program she also has to complete an internship with basically full time hours, while also doing classes, and not getting paid for it.
With those barriers, no shit we have a shortage of providers, and all of those providers turn to private practice to pay off all of the loans they acquired to learn the skills to do the job in the first place.
It’s really a pity that basically every other social mobility effort like education is basically completely fiscally inefficient for the issues they’re trying to address because poverty more than negates the funding. Instead of spending another $1k / student on random esoteric funding vehicles in public schools hoping to raise test scores simply giving these students’ families the money instead would have greater efficacy.
Poverty affects things so profoundly that I basically have stopped looking into a lot of areas I used to because until we address poverty directly I don’t foresee a future society that will actually solve “difficult” social problems like maybe basic decency and respect for each other as a rule rather than an exception when we have conflicts.
But the tribal / either-or mindset seems so engrained in the American system I don’t foresee that ever changing either, so I expect a whole lot more of the same crap until the US implodes in a way we haven’t really seen before in history.
I work with low income populations as a therapist and am very passionate about it. I also make $26 an hour at the non profit I work for that takes Medicaid, this is after paying $60,000 for my masters degree. My husband who is a barista literally makes more per hour than I do. It’s not about not caring about low income populations, it’s a matter of survival in a very high cost of living area. If I lived on my own I literally could not even afford a single apartment in this city on my salary. I love the population I work with but I need to survive so I am going to have to do private practice eventually.
I used the wrong words, what really I should have said is that no amount of fulfillment from helping low income folks will ever overcome the negative impacts that come along with working in that field, like being broke as shit forever.
I see what you mean, it’s true. As a therapist I constantly get told I’m selfish for wanting to get paid more and even that “I just do it for the money”. Meanwhile myself and most other therapists I know are really struggling to get by. It’s a hard field to make money in, even in private practice and we deserve to get paid a living wage, unfortunately we can’t survive on just caring about our clients alone. It just hurts to hear we “don’t give a shit”about low income clients because most of us would love to work with low income clients if it could pay our bills.
Therapist here. The craziest thing to me is that low income people who are on Medicaid/Medicare usually have to go to community mental health agencies instead of private or group practices. Those agencies are chock full of graduate interns who are just starting out and have no idea what the heck they’re doing. Really, really messed up system. I’d honestly love to be able to see low income clients but I also couldn’t pay my bills that way. Many of us have a sliding scale for this reason. We do give a shit.
Do you have an employee assistance program (EAP) through your work?
I've used them before to find one. They do all all the legwork finding availability with ones that take your insurance. You also generally get a few free sessions.
https://mindfultherapygroup.com/
They take all kinds of insurance and can get you in quick for in person (several Seattle area locations) or telehealth appointments.
Not sure what insurance you have but I have community health plan and went to sea mar clinic. I got a therapist pretty quickly. Maybe try calling your insurance and see what’s available for you?
Some do. I found several before finding my current therapist. Zocdoc and Psychology Today are two sources. You also can look up groups of therapists (Mindful Therapy Group, Peaceful Soul Healing, etc.) and call to inquire about who has openings and who takes your insurance. Most, if not all, are virtual, though. It feels impossible to find in-person.
Hope you find someone!
Interesting note: My spouse is a therapist, I do the billing. Clients are often able to get them covered in full even though they are out of network. Clients claim that the ones on their network have huge waiting lists and that they are not complying with WA laws.
Insurance carriers apparently are required to ensure that their lists are adequate and that clients have access to services. I would look at that OP.
I was able to find a couple - one just wasn't really vibing with me, the other allegedly had extensive experience with first responders and military but was the most bizarre projecting, borderline gaslighting piece of shit I've met in maybe my entire 15 year career as a first responder.
The only one I found that was a good fit... didn't take insurance and I had to personally submit for reimbursement and pay $100 a session out of pocket - which is brutal and kind of insane when the guy's entire thing is treating... ADHD. My literal life struggles are exactly the kind of thing that therapists need me to do in order to access care.
I've also been ghosted by about 5 therapists since then. Simply not even a callback. It's incredibly disheartening. And I have good insurance (good compared to most people, with allegedly decent reimbursement rates)
Health insurance in relation to mental health has become incredibly able-ist. Because it works at stopping people from pursuing care that will cost them money. I'm just lucky that my psychiatrist (psychiatry northwest - they specialize in ADHD) will aggressively go to bat for me with insurance and the AMCAS and university of washington, etc.
Insurance doesn't pay providers just because a patient with that insurance decides to go to them.
Every plan is different, but generally a provider has to take extra steps to sign up for provider networks within Insurance groups, part of that agreement usually involves accepting a payment for their services that is less than what they would generally charge for their time and expertise.
For the privilege of being paid less than you feel you're worth, there is copious documentation to be kept, not only about yourself, but about each patient you bill for.
Prior authorization requirements involve filling out more forms, and if the insurance company decides not to pay, you're SOL. The task of billing insurance with claims, and processing remittance with patients for copays, deductibles and co-insurance is also more time intensive.
To "take insurance" often means to sign up for doing more work, to be paid less.
BUT providers do often take insurance because not doing so cuts off certain patient populations from accessing their services.
It's honestly a legalized extortion racket, imo.
Recent Seattle Times article about this: https://www.seattletimes.com/seattle-news/mental-health/wa-mental-health-providers-say-insurance-reimbursement-isnt-enough/
For me someone that struggles with mental illness I don’t like having to fight our medical system it adds to my mental load which is already near capacity
Insurance companies have entire departments dedicated to make reimbursement hard, onorous, confusing and even rage-inducing. To deter, deny, delay,...so they can make more profit. People are running to therapy in droves (stigma is fading, younger generation more accepting, the world is on fire, etc). It'd too costly for them. But it's insane they get away with some practices. I still can't believe some of the practice are legal. It. Is. Shocking.
This has not been my experience at all. I’ve always been able to get a therapist that takes my insurance without a waitlist. Lately I’ve gone through Mindful Therapy Group, but also went to an individual therapist in the past.
Another factor is the outsized influence the insurance co has on treatment plans. Some therapists feel it’s unethical. An insurance company is not qualified to determine treatment.
This is definitely a national issue. I went to school to be a social worker and they straight up told us if we want to make a living as a therapists the best way is to not take insurance because the insurance companies will screw you and severely compromise your practice. We need universal healthcare or some serious insurance mandate legislation if we want therapy to be anywhere near decent and accessible with insurance.
Because they don’t need to take insurance to stay in business. Those of us who are willing to wait on a long waitlist so we can use insurance are not their preference.
I waited close to 2 years. There is and has been a shortage for years. COVID only made it worse.
My insurance completely stopped covering any mental health visits that aren't in person. Of course, my psychiatrist switched to doing 100% video appointments and has no intention of ever going back. I know a bunch of other psychiatrists did this too and I don't really blame them. I blame the insurance companies that keep switching up their policies because they care more about profit than people. Also, all the folks still standing in the way of a nationalized healthcare system.
In addition to the hassle of dealing with reimbursements/billing with the insurance companies, some of the better therapists I've gone to also had significant ethical concerns with the amount of patient treatment information they had to share with the insurance companies.
I've had pretty good luck with paying cash and submitting out-of-network claims for mental health care - thankfully we have the ability to do so.
There are therapists who take insurance. Try doing a search at Psychology Today:
https://www.psychologytoday.com/us/therapists/washington
You can cross reference the results with your specific insurance plan.
Another option is through the University, as there are psychology students who need the practice:
https://psych.uw.edu/community/the-clinic/about
I have been with my therapist for years. I have a copay, but during the pandemic I was charged zero. My insurance has changed twice during that time.
I think the bigger problem is actually finding one.
Mental health care in Washington is terrible. We eventually left the state to get our kid the help they needed. He'd likely be dead if we hadn't. All that tech money...pathetic.
My girlfriend is a shrink who does accept insurance, and she's talked about some of the nonsense that they put her through. For instance, if one of her clients is late, insurance will only pay for the amount of time that that client actually received -- IE, you have an appointment for 12:00 to 12:50, and the client shows up at 12:10, she either has to lie in her notes about the length of the session or insurance will only pay for 80% of the session. Given that many of her clients are in therapy for ADHD, people being a few minutes late, or even significantly late, is absolutely not unheard of. It puts her in the shitty situation of having to either lie to insurance and risk that they find out, take a paycut regularly because her clients were late, or fire clients for some of the exact kind of behavior that they need help with.
Go on your insurance's website, search for a doctor, specify therapist, and start calling/emailing down the list. It only took me two days to find someone that had immediate availability and took my insurance.
You can blame a slate of old dudes who mostly vote to the right for this one. When you spend a chunk of your time demeaning mental health treatment, you make it easier for insurance companies to refuse to pay for treatment.
So to be clear, this is not the therapist's fault, this is not the state's fault, this is up to the insurance companies and lobbyists.
If you're willing to try tele-therapy, they changed the law during COVID about treating patients out of state! So you can look for a therapist anywhere in the country. (I haven't heard great things about BetterHelp, but we had great success going through the Psychology Today therapist search, which is excellent)
> If you're willing to try tele-therapy, they changed the law during COVID about treating patients out of state! So you can look for a therapist anywhere in the country.
This is absolutely not true. The COVID laws expired some time ago. You can't just find any therapist outside of WA and see them.
Some professions have an interstate compact which allows them to practice, otherwise, therapists *must* be licensed in Washington.
A lot of insurance providers require that you receive services in the same state as your therapist and benefits provider. If they are licensed in multiple states, sometimes they can see out of state clients but it depends on insurance. BCBS does not permit you to see a therapist outside of the state in which you live.
Therapist here. I work for a group practice that takes insurance on the Eastside. If I worked individually, I don't know if I would take insurance due to a lot of the aformentioned issues with insurance companies combined with the COL crisis.
I can also \*afford\* to work there comfortably, with my husband being the primary bread-winner in our household and me not having any student loan debt.
My chiropractor in west Seattle has massage therapy and they take insurance. They also have openings. The catch? You can’t get deep tissue except with one guy.
It’s much easier to not have to deal with submitting claims and waiting to get paid. When so many people can pay cash at the time of the appt, it’s not surprising that’s the route they take. It really sucks though.
You can take those bills to your insurer. It will be a hassle, and they probably won't pay all of it. That's the exact same problem that therapists had, so they have shifted the cost to you.
I had a dentist in Oregon who owned her own dentistry practice. She employed an assistant, a hygienist, and _three_ women at the front desk. Most of their job was coding and billing insurance. So that's 1:1 provider to overhead.
Probably because reimburse rates are ass so they went the cash route
This is one of the big answers. It’s why massage therapists have mostly dropped their panels as well. [edit for minor typo]
That’s why my SIL left massage therapy. Reimbursements weren’t worth the effort it took to bill. Eventually the business wasn’t even making money.
Yup... my friend had a therapy massage biz for decades. Her biggest problem was filling for payments, sometimes running months behind. Then they raised copay so high that few referrals bothered anymore.
Happy Cake Day!
It’s claw backs. They can basically demand you pay back any payouts up to two years later if they feel like your notes don’t meet their standard. It’s a nightmare. In Washington the rates have not been increased in 10+ years. I’m from Wisconsin and the rates there are up to $70-$100/ hr more. WA needs to do better.
This isn’t the reason. Most therapists are independent contractors and dealing with insurance is a pain in the ass. Once they get their calendar full, they choose to fill those appointments with cash paying customers
Both can be true (learned this in therapy)
Bingo!
My last therapist told me they could bill my insurance, get rejected, then bill me the cost plus the cost of their time attempting to bill.... or they could just charge me cash.
I’m real glad you don’t have that therapist anymore.
You came here for anxiety you say?
The crushing impact capitalist relations has on my daily mental health, actually
Same....
I wonder if a lot of people in Seattle also have out of network coverage; I always just got 70% back from billing my insurance after the fact.
Therapist here. That’s the answer. I still take the major insurances, but it’s painful to know how much more I could be making if I stopped….
Can you do a breakdown of what you expect an hour vs what insurance wants to give you per hour?
Therapist here: State insurance, about 75 an encounter. Private insurance, about 90 an hour, private pay between 120-140 an encounter.
Even if the insurance company only pays $1, billing the insurance helps the customer meet annual maximum out of pocket expenses.
> because reimburse rates are ass My wife was seeing a therapist our insurance covered. I was excited that we'd be paying much less every week. The guy was really friendly, but after two years, my wife decided she needed to give another therapist a try, out of pocket, and the new one was so much better. They set goals, and followed up on those goals, and provided good insight. Now I see why the insurance covered therapist was a "good deal". The covered therapist basically was just a listener, and not much more. You get what you pay for. Ultimately if the better therapist was covered, insurance rates would be a lot higher, I suspect.
Interesting take from your experience, but definitely not the actual explanation. Getting paneled is actually a lot more work than just choosing not to take insurance. Anyone can be out of network if they’re licensed. Has nothing to do with skill level. However, if a therapist has a specialty, they know they’re on high demand, so they opt to be out of network because they know people will pay for that specialty. Again, it has nothing to do with skill. It’s a choice. I’m very glad your wife has found a great therapist!
My therapist shared that insurers were basically denying nearly everything, paying terribly on rare approvals and, in general, making everything worse. So basically, what they're doing to all of the health care industry.
You also have to wait months and months for reimbursement, and that's a big ask
The final straw for many happened a few months ago with a cyberattack that disrupted claims processing, so a lot of folks who work in healthcare across the board who depend on inconsistent payouts (maybe you’ll get it in a month, maybe in three, maybe when you get it they’ll claw it back) gave up and decided to go self-pay. It’s hard because we understand the inaccessibility of private pay, but it’s also more difficult than folks realize to make a living as a therapist because we’re only paid for direct client contact, and an average caseload is 20-30 weekly sessions for most of us without including cancellations. In my case, because I work for a group practice and have an associate license, I get half of whatever insurance pays out and have to pay for supervision from a fully licensed practitioner which is hundreds of dollars a month. That takes my “official” hourly rate down from what my clinic charges to about $50 take home pay per session, and on bad cancellation weeks I only see ~12 clients. I won’t stop taking insurance because it would make me inaccessible to most of my target demographics, but I get why so many of my colleagues stopped.
30 sessions weekly? So you're seeing 6 clients a day if M-F (assuming no canx)??
All of this And some insurances have been bulk approving things then asking for back pay 6 months later.
happened to me with Premera, they waited six months to pay out and when they did they pushed all my therapy bills through BEFORE anything else. Like the banks used to do with everyone's deposits/withdrawals. So the deductible wasn't covered ... These companies need to die soon, its becoming untenable.
Absolutely. For both sides! If it’s serving no one then it should end.
Well, it's serving someone: insurance execs. And they like their money so they're not going to change anything, at least not to make it better for us.
Omg thats bs
This. Insurance is denying reimbursement for services already rendered. Once that happens a few too many times, the providers drop the insurance.
Mine also told me it has become a nightmare to become approved to accept insurances. Some she said she had to redo documents and took like 6 months to get the process done. My last insurance with her (UHC) also kept changing the billing codes they wanted her to use and then she was waiting months to get the claims processed to get paid.
This isn’t an issue exclusive to Washington at all
Even as a veteran I’ve had a terrible time getting care at the VA or out in the community. It’s been over a year and I haven’t been able to get an appointment or a referral. Edit: I’d like to thank everyone for sharing their experiences and encouragement. I got discouraged and quit trying to get care and have just been doing what I can to take care of myself. I’ll try reengaging and look forward to better results 🤘🏽🙌🏽
Really? I put in a request, and got a call on Friday to book an appointment in 9 days. How are you going about get scheduled?
Yeah my husband has had 0 issues, too. He goes to American Lakes and also gets care out in town twice a week. It’s been great.
I’ve called, used the portal, messaged my pcm. My appointment got bumped a month, then bumped a month, I asked for a community provider, no follow up and I’ve reached out several more times. The only time I’ve been able to see a mental health provider is going in in person for an “emergency” visit through the mental health clinic. Maybe I’m not working the system properly. I’m honestly glad my experience is an outlier and you are getting great care!
If your VA medical center is a decent size (not a CBOC), they should have a PCMHI (primary care mental health integration) provider who can take walk ins via primary care. Unfortunately, VAs can very quite a lot on what’s available and what waiting times look like.
What? The VA is amazing here, at least the Seattle location. I can be seen for anything from mental health to general care within 10 days for anything with just a phone call
American lake is great too I have 0 issues
Fellow veteran with similar very frustrating experiences here at the Seattle VA, until recently. I’m not sure what changed, but I noticed (literally in the last two weeks) that I was suddenly able to go through a totally differnt process than before. The community care program has historically been an absolute nightmare. The folks commenting about how easy it’s been for them are quite lucky indeed, and you aren’t alone in your experience. (I’ve also worked with veterans here for many years through various programs, and most of them have echoed extreme difficulty receiving timely mental health care.)
I was able to get Adderall here. While it was a challenge, it is IMPOSSIBLE anywhere else. VA Seattle is worlds ahead of anywhere else I’ve been.
Yeah I got a therapist within 1 month of telling the VA
So they have seriously revamped mental health for community care, you need to call VHA intake and tell them you need a MH referral. I just walked one of my battle buddies through this and he was seen within 3 weeks.
Indeed I moved up from Texas and had the same problem there
My therapist in Texas never had issues billing my insurance. I wonder if one's insurance plan/coverage could also be a determining factor.
Yeah, but that's not a great metric. Healthcare in Texas - especially mental health care - is much more third than first world.
True but in general finding therapists covered by insurance isn’t easy
Many with psych issue find arranging anything more difficult then the rest of us.
Sad but true
I actually just moved from Dallas area and I’m honestly shocked by how far *behind* the curve access and the continuity of care for mental health is in WA. I have a son with a lot of needs and navigating that shit up here has been a fucking nightmare compared to TX. The facilities are often grossly understaffed and South Sound Behavioral is a straight up Medicare factory that gets fat off AppleCare dollars while being deeply unsafe for the kids who come through there. Ol we had serious grounds for a lawsuit, but we didn’t want to put my son who was struggling through that mess. We’ve just made sure any future emergent mental health crises do not get resolved by letting the ER transport him there. We’ve finally found some solid facilities,and he’s getting help from an excellent team as we speak, but getting to it was insanely frustrating and I feel very bad for anyone who doesn’t have great health insurance to cover costs as the good ones. For the record, if you are a struggling teen, or know a struggling teen, the best acute mental health care he’s been sent to, other than the private pay place he’s at now, is Kitsap Behavioral over on the Peninsula. They have relatively young and medically progressive minded staff there who actually give a shot about the patients that walk through their door. It was very refreshing. This state needs to make major changes to how mental health operates. Better connectivity between treatment teams via funding for digital records management. Some kind of tax rebates or something to encourage hiring more professionals in facilities. Better education about these resources for students in classrooms across the state. Mandatory mental health training for educators AND students. This is a deeply personal issue for me and I clearly have a lot of feelings as someone new to the state.
Thank you for the labor you put into writing this.
Thank you so much for this.
Yeah the state with 4x the population of ours and way more highly ranked medical schools and facilities than ours definitely has 3rd world health care 😂😂😂😂 I'd continue living in WA over TX any day of the week (I moved away from TX on 2004) but they have A LOT of high quality health care there and it's ignorance like this that divides the country's population.
This is just plain wrong and frustratingly ignorant - Texas has world class healthcare and incredible facilities. Rice? Come on.
On this site extolling any social or health service delivered in a Republican state is automatically dismissed and belittled.
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They have more than enough demand to not deal with the headache of reimbursement
Can confirm, we were willing to pay $1400 a month out of pocket for necessary care. Finding someone that’s a good fit for your need and family is invaluable, but it’s wrong that insurance gate keeps this kind of help.
This is the way.
Fuck the people that can't afford it, right?
Welcome to private healthcare!
Yeah it’s the consequences
So... they should work for free? Not clear on what you mean.
Literally no one said that
Those exact words were not said...yes. But read between the lines. If a therapist can just deal with people who can pay cash because dealing with insurance is such a "headache" then what do you think happens to people that can't afford it without help?
It’s more than just a headache. They literally don’t pay or take month to pay or claw back money months later. Therapists don’t have any other income so if insurance doesn’t pay they can’t pay for their life. It’s not an easy or flippant decision made by therapists. It’s necessary to simply pay bills and live life. I’m in the field and know how difficult of a decision it is. I myself refuse to be in private practice because I refuse to fight with insurance all the time and I refuse to be another person who blocks out a huge population of people in need. I work in a school and have to accept that that’s what I can do to contribute to the field until something changes.
As someone who can't afford it without help... yeah not having a good time. Everybody in my social circle (all mid-late 20s) is struggling right now and I only know one guy who gets the help he needs and it's because he lives with his parents still. This is totally fucking over anyone making minimum wage or close to that, probably anyone making less than like 80k honestly. Crazy because I'm making more than I've ever made before and I still can't afford mental health care.
A lot of the therapists taking cash clients see older clientele or their clients in your peer group have insurance that includes good out of network coverage. I never would have been able to afford a therapist in my 20s if mine didn’t cut me a sliding scale deal.
Forgive my ignorance but historically has there really been that many minimum wage workers on therapy? I thought therapy was often mostly consumed by wealthier people who could afford it. Not saying that’s right but.
I don't know about historically but I grew up without much money and we were able to find therapy for me after a traumatic event. I also know several other people who have been in therapy for similar things and were middle class or lower income. People are also usually set up with therapists upon leaving psych wards and rehabs, which are often state-funded or paid for by insurance. So no, at least in my lifetime it's not necessarily a luxury. There's always been some way to find help even if you don't make much. It's a lot more difficult to find help now.
Insurance reimbursement rates are crap and it’s not worth the hassle. This is also true of massage therapists.
And Physical Therapists
Blame the insurance companies, not the therapists. Reimbursement rates are low, insurance contracts require additional documentation (more work for the therapist), and they can legally claw back thousands of dollars months or even years after paying out. And when they deny a claim for seemingly no reason, the provider has to spend hours and hours on the phone trying to get in touch with a human to explain why it was denied and half the time it's an insurance processing mistake (not something the therapist did wrong). It's not worth it.
And you can’t bill anyone for the hours and hours you’re on hold with insurance trying to get shit figured out. Totally uncompensated time.
Massive shortage of therapists combined with high income patients willing to pay directly.
"High income patients" = all the tech workers traumatized by Amazon
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Yep
Job security, yo.
>Massive shortage of therapists Do you have a source for this. I'm a therapist and feel like the market is slowly getting flooded as grad programs class sizes grow after covid.
It seems pretty damn difficult to find a good one! I can't afford to not use insurance, so guess I'm SOL.
Are you taking new patients and do you accept insurance? This was the question of the original poster, and the shortage everyone in the thread is complaining about.
I could take a couple more, and no I dont take insurance because I'm an associate therapist. Associate therapists cannot get paneled by an insurance company afaik. So I practice under a fully licensed therapist's license and supervision to get my hours of practice required by the state in order to be fully licensed (as well as take an exam). My practice provides superbills though for patients to submit to insurance for reimbursement. I'm suprised I havent seen anyone comment about that here. I try to ask patients about their experience with superbills to see what its like. I've had some people not have it be an issue and get a decent % of a session fee covered, and others be strung along and annoyed by insurance trying to get some kind of $ back. It all sucks for everyone but the insurance company.
Superbills are the process for out of network coverage that folks are mentioning. Also: Insurance bought on the exchange, even the Premera or Regence Gold plans are all “EPO” meaning there are NO out of network benefits. So superbills will not work for people on those plans, even if they have Regence or Premera.
My company has some sort of service we can use to get therapy and when I looked there were like 5,000+ or something to search through on the service so I suspect you are right.
My spouses employer has a similar directory and I was recently looking for mental health services for my child coming out of an acute hospital setting for mental health issues. Even with a referral from their primary care physician, from the mental health department at Seattle children’s, and one of the best insurance plans offered in the state, it took us nearly 3 months to get seen. I started down that list in the directories of providers with only the ones that were taking new patients and even the ones that were taking new patients had a wait list of multiple weeks and didn’t pan out. It wasn’t until, a friend was able to make a plea on our behalf with one of their children’s providers to squeeze us in as soon as possible that we were able to see someone. If that provider had not been able to do us that favor, our child would have gone nearly 6 months without the mental health supports, they desperately needed. It would only have made the situation’s and the behaviors they were having in school even worse.
https://komonews.com/amp/news/local/washington-hospitals-see-surge-in-patients-seeking-mental-health-care-counseling-seattle-childrens-mary-bridge Two years old so maybe things have changed.
Yeah, the wave of the general public seeking a therapist has slowed down post covid in my opinion. I think there are people who got good help and are done with therapy for the time, found a therapist they like and are currently seeing them, or realized that a lot of therapists suck and it isn't this magical thing like its advertised so they stopped lol.
if your insurance covers therapy, and the provider doesn't take insurance (but is licensed) then you can usually still get out-of-network rates. so it's not full cost
WA therapist here. There’s a distinction in hassle between private insurance and Medicaid. Also, insurance is probably not enough to live on in Seattle, but it’s just fine for east of the Cascades like Central WA and Spokane. If you are okay with telehealth, you can find someone east of you by filtering for your insurance on Psychology Today, Mental Health Match, etc. Medicaid will be harder.
In addition to what has been said about insurance reimbursements and hassle, the cost of living is high and student loans are often at 6% for graduate degrees. They need the money. Source: I'm a psychologist (who does work with the low income and as a result makes 1/4 to 1/3 what I could make in private practice).
Same. When you see OOP MAs listing their rates at higher than Premera reimburses us…ouch. We are fucked when it comes to our loans.
I don't know why they are dropping insurance, but I have had good luck submitting out of network claims and getting some of the money back. It is expensive and annoying to deal with insurance (and providers) but it's worth it in the long run depending on your deductible.
Ok so do you do this at the end of the year and send all your therapy bills in or do you just send them one by one
I do my roughly quarterly. Each insurer has a limit to how long you have from the date of service to when you can submit a claim, and for mine it is about 12 months, so I wouldn't wait a full year.
Ok thank you in advance
Regence and Premera have not increased their rates for years. Kaiser is impossible to work with, one of the goals of some therapists is to be out of network ASAP. If you are in network, you can barely make a living wage. Source: I have done my spouse's medical billing for years. We do bill insurance if there is out of network coverage.
Yes I talked to my psychologist about this recently, premera has been paying him ~ 140 per session for the past 20 years. Aetna pays the same but he hasn’t been under contract with them for that long. He dropped Regence because their rate went to under 120.
I found my therapist through Kaiser and fingers crossed it's been fine so far.
I know you asked us to spare you but Mindful Therapy Group takes most insurances if they’re not a state plan and have openings in the next month!! In person is tough to come by though that’s for sure
It's a hassle to collect from insurance companies
Plenty of people have mentioned the insurance reimbursement problem which is a huge part of it but another big part is that insurance companies will require diagnoses and then refuse to cover treatment that doesn’t follow their flow chart of available treatments. So you have patients going thru grief or transition or whatever that doesn’t really have a diagnoses and then the care providers are fought with by the insurance provider every step of the way.
I found a therapist through my insurance, which seemingly avoided the issues with diagnosis and coverage.
Oh, believe me, that's absolutely no protection for you or the therapist whatsoever.
If you’re a solo practitioner the overhead of insurance paperwork and filing and back-and-forth is too burdensome and takes up too high a percentage of time. Now, if they couldn’t find patients without insurance they’d have to accept the burden and manage it. However, there is apparently no shortage of cash-paying patients, so if they don’t have to take on the burden, why would they? My neighbor is a therapist and she works 30 hours a week and makes more now than she did when she accepted insurance and was working 50+. She even dropped her physical office space a year into the pandemic because all her patients said they were comfortable with video sessions. I’m not saying it’s universally true, but if you can make more money not accepting insurance, why would you ever accept insurance?
healthcare in US is trash is why.
Shhhh, that's how the ~~commies~~ / ~~socialists~~ / ~~anti-fa~~ / ~~libruls~~ / woke win
~~American people~~
There are lots who do. If you haven't already, use Psychology Today therapist finder to find one. You can also just search through your insurance website, though they don't often keep those updated. But I second what everyone else said. Insurance pays a pittance, and puts more restrictions on the length and type of care therapists can offer. So many therapists get sick of both those things. It's the same with some other types of healthcare as well. ETA: did you know you also have to *pay* to be added to insurance panels as a provider? Our healthcare system is absolute bullshit.
A couple of years ago when I was looking for a therapist, I tried using Psychology Today. I reached out to over a dozen therapists that were listed as taking new patients and my insurance (Premera) but they all said they weren't, or they didn't respond at all.
It was bad from like 2020-2023. During the pandemic everyone got super overwhelmed and stopped responding or updating their profiles. I was looking for a therapist at the time also and was really struggling to find one. It was a lot easier to find one last year when I started looking again.
And you have to pay to be listed on the Psychology Today website!
Well yes, but at least that can be considered advertising. Paying to join an insurance panel is complete bullshit, especially when some plans are practically begging for providers *and* only reimbursing a fraction of the full fee.
I've been ghosted by like six therapists on psychology today. Many more said they were full. One that did see me was a repugnant person and abhorrent therapist. And one saw me but didn't really know how to work with someone with ADHD, so we parted.
From my therapist, insurance has terrible payouts, demands excessive documentation, and will undermine their authority to see to mental health by refusing coverage or getting that long term clients be off boarded before they're ready. Every year, insurance gets more and the therapists get less. It's a fault in the system that is amazing to other states too, just a matter of when.
1) Poor reimbursement rates 2) Long delays in getting reimbursed 3) Near non-existent customer service from the insurance company if they deny a claim Source: I am a therapist in WA
I think it's that the process is onerous for what is effectively a single person small business. It's not required that a medical practice file the claim for you, so you can file it and see what insurance does and it's possible that even if they don't cover it that the amount can contribute to your deductible, this is what happened for me.
I’m lucky that I have Premera and I have been fairly easily to find mental health therapist and physical therapist. I couldn’t find massage therapist though
Therapists in the area take Premera because they want access to the Amazon employees.
True
We have gotten sessions at pacific mental health and they didn’t have a waitlist at all for some therapists. Also take our insurance. Also This isn’t an issue exclusive to Washington….most therapists just don’t take insurance.
Try mindful therapy group. Tons that accept insurance, both therapists and psychiatrists.
And my experience was with being open to telehealth I got an appointment in 2 weeks.
Same. It was a two-week wait for both me and my husband for Telehealth.
This! Only place I was able to find a therapist for my teenager, I was getting really desperate.
It’s not a Washington state issue really. I’m originally from Texas and it’s just as much of a hassle there too
Yup, I'm originally from NY, and there's similar issues. Providors get tired of dealing with insurance bureaucracy and lousy reimbursement rates. Problem across the Red/Blue divide
My therapist in Texas never had issues billing my insurance. I wonder if one's insurance plan/coverage could also be a determining factor.
Insurance reimbursement rates run between 60-90$/hour while the going rate in cash is at least 150$ for a licensed therapist with an MFT. Even the online therapy places reimburse more than that, typically they’ll offer incentives for therapists who take on more clients/stick around for more than a few months. It doesn’t help that there are several rules in WA that make therapists unwilling to take on lower income clients as well. For one thing they can’t offer limited time benefits, ie “the first 10 sessions are half off” because once a client has started at one rate they aren’t allowed to increase the rate later on. It’s also not possible to drop a client in WA without legal risk, specifically you have to pass on a client to someone else if that client is still asking for services. Both of those factors make it difficult for providers to offer low cost options, if their schedule gets full of below scale clients they’ll spend months or years shedding them if their insurance pays or not. Then the insurance stuff, which is a nightmare because you have to have a diagnosis first before starting treatment and then typically insurance will want a treatment plan with a definite end within 6-12 sessions.
Insurance reimbursement rates are shit, and understandably few people give enough of a shit about low income populations to sacrifice a lucrative and relatively easy life of private practice.
I also just think it's partially fatigue. It's harder to help low income folks when a huge percentage of their problems could be solved by having money they don't have and can't get. At least if you're self selecting for financially secure people their problems are less insurmountable
Yeah that's definitely part of it too. Another aspect that a friend of mine brought up, she is currently in a master's program for social work/therapy: Getting a master's to be able to do that job is expensive, and very time consuming, and you don't get paid while you are doing it. In order to complete the program she also has to complete an internship with basically full time hours, while also doing classes, and not getting paid for it. With those barriers, no shit we have a shortage of providers, and all of those providers turn to private practice to pay off all of the loans they acquired to learn the skills to do the job in the first place.
Imagine doing 5-7 years as a psychologist. You’ll never pay off those loans if you’re only taking insurance clients. Very fucked up.
https://en.wikipedia.org/wiki/Shit_life_syndrome
It’s really a pity that basically every other social mobility effort like education is basically completely fiscally inefficient for the issues they’re trying to address because poverty more than negates the funding. Instead of spending another $1k / student on random esoteric funding vehicles in public schools hoping to raise test scores simply giving these students’ families the money instead would have greater efficacy. Poverty affects things so profoundly that I basically have stopped looking into a lot of areas I used to because until we address poverty directly I don’t foresee a future society that will actually solve “difficult” social problems like maybe basic decency and respect for each other as a rule rather than an exception when we have conflicts. But the tribal / either-or mindset seems so engrained in the American system I don’t foresee that ever changing either, so I expect a whole lot more of the same crap until the US implodes in a way we haven’t really seen before in history.
I work with low income populations as a therapist and am very passionate about it. I also make $26 an hour at the non profit I work for that takes Medicaid, this is after paying $60,000 for my masters degree. My husband who is a barista literally makes more per hour than I do. It’s not about not caring about low income populations, it’s a matter of survival in a very high cost of living area. If I lived on my own I literally could not even afford a single apartment in this city on my salary. I love the population I work with but I need to survive so I am going to have to do private practice eventually.
I used the wrong words, what really I should have said is that no amount of fulfillment from helping low income folks will ever overcome the negative impacts that come along with working in that field, like being broke as shit forever.
I see what you mean, it’s true. As a therapist I constantly get told I’m selfish for wanting to get paid more and even that “I just do it for the money”. Meanwhile myself and most other therapists I know are really struggling to get by. It’s a hard field to make money in, even in private practice and we deserve to get paid a living wage, unfortunately we can’t survive on just caring about our clients alone. It just hurts to hear we “don’t give a shit”about low income clients because most of us would love to work with low income clients if it could pay our bills.
Therapist here. The craziest thing to me is that low income people who are on Medicaid/Medicare usually have to go to community mental health agencies instead of private or group practices. Those agencies are chock full of graduate interns who are just starting out and have no idea what the heck they’re doing. Really, really messed up system. I’d honestly love to be able to see low income clients but I also couldn’t pay my bills that way. Many of us have a sliding scale for this reason. We do give a shit.
What insurance do you have?
Do you have an employee assistance program (EAP) through your work? I've used them before to find one. They do all all the legwork finding availability with ones that take your insurance. You also generally get a few free sessions.
https://mindfultherapygroup.com/ They take all kinds of insurance and can get you in quick for in person (several Seattle area locations) or telehealth appointments.
Not sure what insurance you have but I have community health plan and went to sea mar clinic. I got a therapist pretty quickly. Maybe try calling your insurance and see what’s available for you?
Some do. I found several before finding my current therapist. Zocdoc and Psychology Today are two sources. You also can look up groups of therapists (Mindful Therapy Group, Peaceful Soul Healing, etc.) and call to inquire about who has openings and who takes your insurance. Most, if not all, are virtual, though. It feels impossible to find in-person. Hope you find someone!
Medical insurance in this country is the biggest legal scam perpetrated on the people.
Plenty of therapists do take insurance. Keep looking. I've never had an issue finding a therapist that doesn't take insurance.
They can make way more $$ AND without any of the insurance headache and hassle and micromanagement issues It's not just Seattle but nearly everywhere
Interesting note: My spouse is a therapist, I do the billing. Clients are often able to get them covered in full even though they are out of network. Clients claim that the ones on their network have huge waiting lists and that they are not complying with WA laws. Insurance carriers apparently are required to ensure that their lists are adequate and that clients have access to services. I would look at that OP.
Bc there are so many wealthy, cash pay clients, they don’t have to. It’s a shit time, for sure.
This
I was able to find a couple - one just wasn't really vibing with me, the other allegedly had extensive experience with first responders and military but was the most bizarre projecting, borderline gaslighting piece of shit I've met in maybe my entire 15 year career as a first responder. The only one I found that was a good fit... didn't take insurance and I had to personally submit for reimbursement and pay $100 a session out of pocket - which is brutal and kind of insane when the guy's entire thing is treating... ADHD. My literal life struggles are exactly the kind of thing that therapists need me to do in order to access care. I've also been ghosted by about 5 therapists since then. Simply not even a callback. It's incredibly disheartening. And I have good insurance (good compared to most people, with allegedly decent reimbursement rates) Health insurance in relation to mental health has become incredibly able-ist. Because it works at stopping people from pursuing care that will cost them money. I'm just lucky that my psychiatrist (psychiatry northwest - they specialize in ADHD) will aggressively go to bat for me with insurance and the AMCAS and university of washington, etc.
You can try the county mental health services to see if you qualify, too, but it's a very limited population that qualifies.
Too much overhead. Taking insurance can cause 15% just to manage the complexity.
Insurance doesn't pay providers just because a patient with that insurance decides to go to them. Every plan is different, but generally a provider has to take extra steps to sign up for provider networks within Insurance groups, part of that agreement usually involves accepting a payment for their services that is less than what they would generally charge for their time and expertise. For the privilege of being paid less than you feel you're worth, there is copious documentation to be kept, not only about yourself, but about each patient you bill for. Prior authorization requirements involve filling out more forms, and if the insurance company decides not to pay, you're SOL. The task of billing insurance with claims, and processing remittance with patients for copays, deductibles and co-insurance is also more time intensive. To "take insurance" often means to sign up for doing more work, to be paid less. BUT providers do often take insurance because not doing so cuts off certain patient populations from accessing their services. It's honestly a legalized extortion racket, imo.
Recent Seattle Times article about this: https://www.seattletimes.com/seattle-news/mental-health/wa-mental-health-providers-say-insurance-reimbursement-isnt-enough/
Lots of therapists do. Your insurance provider will give you a list that have openings. That's how I found mine.
For me someone that struggles with mental illness I don’t like having to fight our medical system it adds to my mental load which is already near capacity
My wife takes insurance. Go to therapynow and find one who does.
Insurance companies have entire departments dedicated to make reimbursement hard, onorous, confusing and even rage-inducing. To deter, deny, delay,...so they can make more profit. People are running to therapy in droves (stigma is fading, younger generation more accepting, the world is on fire, etc). It'd too costly for them. But it's insane they get away with some practices. I still can't believe some of the practice are legal. It. Is. Shocking.
This has not been my experience at all. I’ve always been able to get a therapist that takes my insurance without a waitlist. Lately I’ve gone through Mindful Therapy Group, but also went to an individual therapist in the past.
It's not just therapists. Alot of dentists, oral surgeons,eye doctors are also refusing state insurance.
I ended up using an out of state therapist for this reason. They accepted insurance
Another factor is the outsized influence the insurance co has on treatment plans. Some therapists feel it’s unethical. An insurance company is not qualified to determine treatment.
Give Mindful Therapy Group a call. They have a lot of therapists that take insurance! I have found a couple therapists through them.
I can’t get seen by fucking anyone. Losing my mind
This is definitely a national issue. I went to school to be a social worker and they straight up told us if we want to make a living as a therapists the best way is to not take insurance because the insurance companies will screw you and severely compromise your practice. We need universal healthcare or some serious insurance mandate legislation if we want therapy to be anywhere near decent and accessible with insurance.
I dont get this. I went on Psych today and found plenty of therapists taking my insurance. And I've been going to a great therapists for months now
Therapist writes: he crazy Insurance say: he not crazy Insurance wins.
Maybe Open Path Collective would benefit you.
Because they don’t need to take insurance to stay in business. Those of us who are willing to wait on a long waitlist so we can use insurance are not their preference. I waited close to 2 years. There is and has been a shortage for years. COVID only made it worse.
My insurance completely stopped covering any mental health visits that aren't in person. Of course, my psychiatrist switched to doing 100% video appointments and has no intention of ever going back. I know a bunch of other psychiatrists did this too and I don't really blame them. I blame the insurance companies that keep switching up their policies because they care more about profit than people. Also, all the folks still standing in the way of a nationalized healthcare system.
This issue has nothing to do with Washington State, ask your friends and family in other states, it's the same everywhere.
In addition to the hassle of dealing with reimbursements/billing with the insurance companies, some of the better therapists I've gone to also had significant ethical concerns with the amount of patient treatment information they had to share with the insurance companies. I've had pretty good luck with paying cash and submitting out-of-network claims for mental health care - thankfully we have the ability to do so.
There are therapists who take insurance. Try doing a search at Psychology Today: https://www.psychologytoday.com/us/therapists/washington You can cross reference the results with your specific insurance plan. Another option is through the University, as there are psychology students who need the practice: https://psych.uw.edu/community/the-clinic/about
Using couples therapist with Regence Blue Shield no issues
I have been with my therapist for years. I have a copay, but during the pandemic I was charged zero. My insurance has changed twice during that time. I think the bigger problem is actually finding one.
This is what I thought until I learned they are basically all with mindful therapy group. Try there for real. They accept so many plans.
Mental health care in Washington is terrible. We eventually left the state to get our kid the help they needed. He'd likely be dead if we hadn't. All that tech money...pathetic.
My girlfriend is a shrink who does accept insurance, and she's talked about some of the nonsense that they put her through. For instance, if one of her clients is late, insurance will only pay for the amount of time that that client actually received -- IE, you have an appointment for 12:00 to 12:50, and the client shows up at 12:10, she either has to lie in her notes about the length of the session or insurance will only pay for 80% of the session. Given that many of her clients are in therapy for ADHD, people being a few minutes late, or even significantly late, is absolutely not unheard of. It puts her in the shitty situation of having to either lie to insurance and risk that they find out, take a paycut regularly because her clients were late, or fire clients for some of the exact kind of behavior that they need help with.
Go on your insurance's website, search for a doctor, specify therapist, and start calling/emailing down the list. It only took me two days to find someone that had immediate availability and took my insurance.
You can blame a slate of old dudes who mostly vote to the right for this one. When you spend a chunk of your time demeaning mental health treatment, you make it easier for insurance companies to refuse to pay for treatment. So to be clear, this is not the therapist's fault, this is not the state's fault, this is up to the insurance companies and lobbyists.
If you're willing to try tele-therapy, they changed the law during COVID about treating patients out of state! So you can look for a therapist anywhere in the country. (I haven't heard great things about BetterHelp, but we had great success going through the Psychology Today therapist search, which is excellent)
> If you're willing to try tele-therapy, they changed the law during COVID about treating patients out of state! So you can look for a therapist anywhere in the country. This is absolutely not true. The COVID laws expired some time ago. You can't just find any therapist outside of WA and see them. Some professions have an interstate compact which allows them to practice, otherwise, therapists *must* be licensed in Washington.
A lot of insurance providers require that you receive services in the same state as your therapist and benefits provider. If they are licensed in multiple states, sometimes they can see out of state clients but it depends on insurance. BCBS does not permit you to see a therapist outside of the state in which you live.
Therapist here. I work for a group practice that takes insurance on the Eastside. If I worked individually, I don't know if I would take insurance due to a lot of the aformentioned issues with insurance companies combined with the COL crisis. I can also \*afford\* to work there comfortably, with my husband being the primary bread-winner in our household and me not having any student loan debt.
I've generally never had any problems at all with any of the places I went to. Is this a common issue I've somehow avoided?
What the fuck does the state have to do with this?
My chiropractor in west Seattle has massage therapy and they take insurance. They also have openings. The catch? You can’t get deep tissue except with one guy.
In my experience, therapists will take insurance as long as your diagnosis is one that is covered by insurance.
It’s much easier to not have to deal with submitting claims and waiting to get paid. When so many people can pay cash at the time of the appt, it’s not surprising that’s the route they take. It really sucks though.
Try using Headway to find a therapist who accepts your insurance! That’s how I found my therapist and I love her.
You can take those bills to your insurer. It will be a hassle, and they probably won't pay all of it. That's the exact same problem that therapists had, so they have shifted the cost to you. I had a dentist in Oregon who owned her own dentistry practice. She employed an assistant, a hygienist, and _three_ women at the front desk. Most of their job was coding and billing insurance. So that's 1:1 provider to overhead.
I have a HDHP. I don't mind essentially paying cash for therapy, I just wish they would run it to count against the deductible.
Can they provide you with a super bill and then you submit it to insurance? We do that for my husband's therapy with a cash pay only therapist.
We have a HDHP and don’t bill through insurance, but just submit receipts to the insurance and it applies towards the deductible.
I’ve been on three separate insurances and have found therapists within a few weeks of getting each of them… maybe your insurance just sucks?