Those who need therapy often have to pay out of pocket or go without care, even if they have health insurance. Hundreds of mental health providers told us they fled networks because insurers made their jobs impossible and their lives miserable.
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
It’s fascinating reading your side of this, everything you said tracks with getting paid by insurance carriers as well. I’m a revenue analyst for an insurance agency. There are no established rules or SOPs they follow. They each make up their own thing. For each established rule one carrier follows, there’s another one who does something completely different. Some of their websites are really good and helpful while others are the oldest looking sites I’ve seen in years. We have a team of people who are assigned carriers, and only work with those carriers, so we can keep track of how each one operates and pays us. It’s a mess. I couldn’t imagine trying to navigate all these carriers by myself in order to get paid, on top of managing a practice.
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
It’s fascinating reading your side of this, everything you said tracks with getting paid by insurance carriers as well. I’m a revenue analyst for an insurance agency. There are no established rules or SOPs they follow. They each make up their own thing. For each established rule one carrier follows, there’s another one who does something completely different. Some of their websites are really good and helpful while others are the oldest looking sites I’ve seen in years. We have a team of people who are assigned carriers, and only work with those carriers, so we can keep track of how each one operates and pays us. It’s a mess. I couldn’t imagine trying to navigate all these carriers by myself in order to get paid, on top of managing a practice.