Shrinks Are Liars

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 PsychologyToday.com 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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16 Responses to “Shrinks Are Liars”

  1. Katie says:

    I would totally work for you. I doubt the commute from Wisconsin would be worth it though 🙂

  2. Rob, I was always aware that shrinks (and plenty of other doctors) do this but it seems extremely unethical, and almost worthy of revoking one’s license.
    Can a therapist really say that seeing a client for lunch is more harmful than claiming that they need to spend more money in order to get better?

  3. Azrael says:

    I’ve been in the community mental health/chemical dependency field for over 9 years now, working as an insurance specialist for two differen agencies. I can relate to what you wrote about, but I don’t feel sorry for you. Why? Because you only have to spend a fraction of your time filing out endless forms or sitting on a phone trying to get authorizations for a patients treatment, where as I have to spend my entire day doing so.
    I’ve never been a fan of managed care or benefit limits when it comes to MH/CD services because dependance and/or mental issues can’t always be rectified in 20 sessions.
    I can understand why therapists decide not to accept insurances due to all of the headaches and paperwork involved…not to mention the time and effort you have to put into in order to follow-up with insurance companies if they haven’t paid in X amount of time (but I guess the one benefit I do have, because this is indeed part of my job, it gives me time to peruse the world wide web and read blogs such as yours).
    Another downfall of accepting insurances is: in order to even bill that insurance company, you have to accept their reibmursement as “payment in full” (in addition to any copays). Now being that we’re a public agency, we’re able to offset the insurance’s Usual and Customary Rate with state and federal funding so we can continue to operate (thanks to all who pay taxes!), but pivate providers don’t have his option, and then they’re left with “eating” the cost of their services.
    Finally, being in the field for as long as I have, I can’t tell you the number of hoops we’ve have had to jump through in order to be paid…or the numerous, totally outragous and sometimes offensive excuses as to why an insurance company denied a claim for a patient.

  4. [Lumberg]Dr. Rob….yeah…I’m gonna have to disagree with you on this one.[/Lumberg]
    RE: Confidentiality
    I know peer to peer review is not only a PITA, but it is a delicate walk in between getting your pts more sessions covered vs. protecting their privacy.
    Oh, and just because we are in the helping profession doesn’t mean we shouldn’t be able to charge fair market value. Some people think that we should discount our services out of the goodness of our collective hearts, but I still have to pay the same bank for my mortgage as the plumber, policeman, or teacher.
    ps. Cash only practice in my future….I can’t stand the hoops that insurance companies make providers and pts jump through.
    ps. 7 years already…were you in NYC for 9/11?

  5. April says:

    Do shrinks with higher student loan bills charge more?

  6. Fifi says:

    I’D WORK FOR YOU!!!! And I’d have to fly in from Seattle! Of course, you could always move to the Pacific Northwest. This is a great place for those of us who want to avoid the sun!

  7. Dr. Rob says:

    I don’t know anyone who charged higher fees based on student loans. That being said, when push comes to shove this is our livelihood and I could envision someone needing to base his or her price on needed income. Other businesses do it all the time.

  8. Amber says:

    Oh Rob, you know I’d work for you.

  9. Laural says:

    Of course, the flip side of this is that most insurance companies don’t even cover mental health.

  10. Maris says:

    “Dr. Allison tells her clients that only by paying for the service can complete commitment to the treatment be demonstrated.”
    Yeah, and I’ve got a bridge I can sell her…
    What a collossal load of b.s. Commitment is a two-way street, btw. She can show some, herself, by deigning to work with people’s plans, as much as she can.

  11. Rhett says:

    A quick comment from someone on the other side of the couch…I started seeing a therapist this year due to this site (thanks Rob) and for me, it’s imperative for a therapist to accept insurance. The primary reason being is my medical insurance is part of my compensation which I work my ass off for. If I have to pay out of pocket for something I’ve already worked for, I’m not going to do it. Co-pays excluded of course, and even then lots of people would bitch about that.
    Thanks to all therapists out there who take the time to do the paperwork and deal with insurance. I’m sure it’s a headache, but your clients go through a lot of BS just to keep that insurance themselves. We’re in this together I suppose.

  12. Dr. Rob says:

    Rhett brings up an interesting point, as there are plenty of great therapists who take all major insurance plans. This is obviously great news for people who need to stay in network. As I’ve said time and time again, it’s not a “get what you pay for” game with mental health. Don’t assume because someone doesn’t take insurance and costs a boatload of money that he or she is any better than someone who takes insurance.

  13. jackmo says:

    haha follow up post of how Alison took you owning her please Rob :p
    It’s funny – and true – how people are more willing to accept someone being honest and saying they won’t do it because of money rather then lying and making up a bogus reason.7

  14. PJ says:

    I guess I never would have been your client even if we did live in the same city, Dr. Rob. It never would have occurred to me to consider a psychologist outside my plan. Are you able to help me significantly more than any of the therapists I could see for reduced or no cost?
    And Dr. Allison’s spin seems dangerously close to “the more money you give me, the more you empower me to heal you”

  15. PJ says:

    Really, it baffels me as to how you get clients. The two groups of people I can see going to a therapist who isn’t covered by their insurance plan are (a) people without insurance, and (b) desperate people who have tried traditional therapies and are ready to pony up the extra coin for things their insurance companies won’t cover.
    I’ve been a member of column a and column b at one time or another, but that doesn’t seem to be what’s going on in your practice, so I’m stumped.

  16. Seviah says:

    I’m grateful for the sliding scale.