Should I Stay or Should I Go?
Weighing the Pros and Cons of Accepting Insurance
Judi Garland, Psy.D.
The Professional Development Committee ran the workshop, “Should I Stay or Should I Go?,” which was a panel discussion in January 2020 regarding the pros and cons of continuing to accept insurance, the mechanics of leaving panels, and how to remain accessible to clients who rely on using their insurance. The speakers on the panel were: Julie Anderson, Amy Matias, and Guy Croteau and was moderated by Oona Metz.
Julie has been in private practice in Brookline for twenty-three years and accepts Medicare, Blue Cross Blue Shield and out of network insurances. Amy is in private practice in Cambridge and very recently went off insurance panels. Guy has been in private practice since 2014. Initially, he accepted Blue Cross, Tufts, and Cigna and in 2018, withdrew from the insurance panels and is now an out of network provider.
Participants went around the room to discuss whether or not they accept insurance and reasons for attending the workshop. We learned some participants were hoping to get off insurance and others were debating it. Many had recently gotten off panels. The panelists each spoke for about fifteen minutes about what went into their decision.
Julie reported that when she began her practice, she went on insurance panels to “do the right thing” stating she wanted to serve people who otherwise couldn’t afford therapy. She said that when she made the decision to go off insurance panels, she feared referrals would dry up, as she worked with young people. Julie continued with Medicare and Blue Cross PPO policies, stating she transitioned to leaving most insurance companies very gradually and the transition stirred up issues of “love, loyalty, and caring.”
Amy reported that she was on one insurance panel and deliberated for several years about the decision to leave. Amy reported that she prepared for the transition for about a year and a half. She shared that most clients had a “Good for you!” reaction and several were willing to change insurance plans to continue working together. Amy shared her importance of being accessible to clients, yet was working many hours and began to feel exhaustion with the combination of work and raising a family. Also, she stated feelings of tiredness from talking to insurance companies and worrying about clawbacks. Amy shared great relief from seeing fewer clients and not having to deal with insurance companies. She found she had more time to work on her website and be more present with her family. Part of her process involved continuing to bill with people she was working with and have new people pay up front while giving them receipts to submit to insurance.
Guy reported that he became a therapist as his second career, and as a therapist, Guy earned half of what he made in his prior career. He had accepted several insurances, but was advised to only accept private pay. After four years of accepting insurance, he left the panels feeling devalued because of the poor pay he was receiving. To his surprise, Guy found that he earned the same amount of money with seven private pay clients than he did seeing twenty five to thirty clients per week who were paying with insurance. Guy stated it was a positive change for him in a very brief period of time. He simply needed to notify his insurance companies ninety days in advance followed by sending letters to all his clients. Guy shared that most of his clients had PPOs and “didn’t blink an eye” about the change, however he did lose one client, a decision he viewed as an act of self-care. Guy used a sliding scale and found the full fee clients compensated for ones only able to afford lower fees. Furthermore, in his sessions, he discovered going off insurance panels led to important conversations about the value of treatment.
Oona offered advice for those who wish to go off insurance to say that they ARE out of network providers rather than they don’t take insurance. She added that it is very difficult to determine how much various PPO insurances will reimburse clients ahead of time. However, Oona added a note of optimism, stating that in both good economic times and in downturns, clients still seek therapy.
Following the panel discussion, there was a question and answer segment where participants inquired about balancing self care by leaving insurance panels and taking care of clients by being financially accessible. Other questions involved the “how to’s” of leaving insurance panels, whether balance billing is an option, the use of sliding scales and how to bill insurance panels in order for patients with PPO’s to be reimbursed for part or all of their out of pocket therapy fees. Other questions involved how and when to tell clients about the decision to leave insurance panels. Amy suggested sending clients an email explaining how the billing process and reimbursement works and to give patients a script to inquire with their insurance companies about how much they will be reimbursed for their out of pocket therapy expenses.
A final topic of discussion was how much notice to give clients before leaving insurance panels. In the range of opinions, some said as short a period of time as possible to avoid debate and limit discussions about this issue while others thought allowing more time is advisable to allow the client ample time to prepare financially, change insurance to a PPO if possible and to discuss the impact of this change during their therapy sessions.
This workshop did not present a conclusion to the question “Should I Stay or Should I Go?,” but it very effectively elucidated factors to consider when making the decision. Moreover, the workshop offered specific advice about how to speak to clients about the decision to leave panels, the mechanics of leaving panels, and how to remain financially accessible to clients who are not able to pay the full fee for therapy.