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Shrinks Are Liars

Posted Oct 23 2008 11:10am

Sadly I've been wasting a lot of time during the day surfing the internet. When I'm not seeing clients I'll sometimes peruse the websites of other shrinks, some of whom advertise on ShrinkTalk. Most of them are more impressive than my generic business page but since I photograph horribly and don't know anything about web design I need to be content to let my kind demeanor and all-powerful therapeutic skills speak for themselves.

In New York City many therapists do not accept insurance and this is sometimes addressed on a therapist's site. There are generally three reasons why a provider would opt to run a "self-pay" practice:

1) Insurance companies will often delay or even withhold payment for services rendered
2) The provider doesn't want to have to fill out copious paperwork
3) The provider believes that his/her service is worth more than the insurance company will pay

Dr. John is a big fan of reason # 2. "I'm not sitting around filling out treatment plans just to get paid. Especially at night after I've seen all my clients. That's Miller Time!" Dr.Steve, who charges well over $250 per session and will occasionally do "good Samaritan work" at $225, clearly supports position # 3, as many insurance plans pay as low as $60 per session. "Why would I see four clients and wait four months to get paid for it when I can see one and get my money on the spot?" Steve says.


I have no problem with shrinks making a good living. Many of them are quite good at what they do and deserve to be compensated fairly. Many studies have suggested that therapy is just as effective as medication for Major Depressive Disorder, so one could argue that a service of that sort is on par with that delivered by a medical doctor who generally makes much more money.

What I do have a problem with, however, is shrinks giving bogus reasons as to why they don't accept insurance. Dr.Allison tells her clients that only by paying for the service can complete commitment to the treatment be demonstrated. This is in spite of the fact that co-payments can be as high as $50 per session which is much more than many people can even afford. And yet they pay it because they value what they are getting in return. In other words Allison's spin that money translates to commitment is a lame justification on her part to not admit to reasons 1-3 above.

One website I noted reported this as a justification for not working within managed care:

"We find their requirements for disclosure of confidential information unacceptable."

I call bullshit on this one too. The shrinks who wrote this are disguising their own real reasons (see 1-3 above) as a magnanimous gesture to protect clients' privacy. The reality is that insurance companies have one goal: make money. So if you're using your mental health insurance benefits, take note: your company has little to no interest in knowing the details of your life unless it impacts them financially. In seven or so years of dealing with a small number of companies I've never been required to disclose anything about my clients other than a diagnosis and how much time I need to get them feeling better. All these companies care about is making money and insisting that mental health professionals fill out endless forms and periodically talk on the phone to justify treatment methods as a way to not have to pay out.

I'm no better than Dr. John and only slightly better than Dr. Steve. I don't want to spend my Miller Time (what I call "Pinot Time") filling out treatment plans only to have to wait to get my rent money. I'm not nearly as money-driven as Steve but I appreciate the fact that his business is thriving and he doesn't want to do four times the work for the same amount of money. So right now I only accept one managed care plan. It was required of me to join a group practice when I first graduated and I haven't bothered to take myself off of it. I hate calling them to get an authorization to provide treatment, their billing forms suck and if a client goes into crisis and needs to be seen more frequently I sometimes have to justify it over the phone to some "expert" who is really a hired gun to find reasons to not allow more sessions.

That being said, I make a small percentage of my income from them and, more importantly, I'd hate to ask the clients who use that insurance to start paying out of their own pockets. Even if they agree (which I wouldn't say is all that likely) they might be resentful at the extra money for services, and some of them probably can't afford to, which would mean that I'm pulling out the therapeutic rug from under them. Not cool. Thus I will stay with the managed care plan for now and deal with the bureaucracy. I suppose I could hire an office manager to deal with all of the paperwork. But seriously, who in their right mind would work for me?

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