On Why Not to Use Insurance for Therapy & Our Social Justice Values
Kindman & Co. is not in-network with any insurance companies and does not directly bill through insurance. While this can seem, at first, in opposition to our mission to provide social justice-informed psychotherapy, we’d like to clarify how this decision instead intends to uphold our values.
the medical model
Insurance companies operate based on the medical model, which means that they approach mental health care like physical health care. In physical health care, doctors identify issues in individuals and treat them according to current medical standards. Insurance companies then determine if the treatment was necessary—if the patient needed to be treated, and pays for the care. If treatment is determined medically elective, meaning it didn’t need to happen from the insurance company’s perspective, insurance can decline to pay.
Additionally, the standard, Western medical model treats problems, not prevention. Insurance covers people who have become ill or parts that have broken—you seek medical care when something is wrong. We believe in reaching for therapeutic support both when you’re navigating a crisis as well as when you’re wanting to prevent a crisis from happening. Maybe things are actually going fairly well, but you’re interested in your own self and relationship-growth to learn how to maintain what’s working and find ways to feel even more purpose, connection, and joy. Unfortunately, by current insurance standards, anything not deemed a “necessity” doesn’t get covered.
“Our standards for mental health care are broader and more inclusive than those of insurance companies, and we want to keep it that way.”
medical necessity
When translated to mental health, this system means that therapists must also prove “medical necessity” for any services they provide. To do this, clients must be diagnosed with mental health disorders from the DSM (think depression, bipolar disorder, etc.), and that these disorders must be shown to cause daily “significant impairments in functioning” for their treatment to be reimbursed. Put more simply: as therapists, we have to document that our clients are in medically-significant, pathological distress for insurance to pay for their services.
But we don’t see your distress as pathological. Needing support in times of pain, stress, or loss isn’t a problem located entirely inside you. One of our goals is to de-pathologize the medical model and shift away from conceiving of human distress as an individual, medical problem. Distress can be caused by all kinds of things—relationships, situations, oppression—and is deserving of care regardless of its intensity, duration, frequency, or origin.
There are also situations in which distress appears in ways not recognized by the DSM. For example, by insurance standards, some kinds of therapy are almost always categorized as “elective”—like couples therapy. At Kindman & Co. we work with lots of couples. We commonly see relationship conflict as the primary source of distress, anxiety, and depression for our clients, and that these are perfectly normal and valid reactions to feeling disconnected. We believe all forms of mental health care are necessary. Our standards for mental health care are broader and more inclusive than those of insurance companies, and we want to keep it that way.
the problem with diagnosis
You may wonder why it matters if we diagnose—if it’s just for insurance anyway. From our perspective, diagnosis can be both positive and negative, depending on the client. Some clients might find their diagnosis affirming, or it might help them understand their experience or feel less alone. Others might find that the stigma associated with their diagnosis is limiting or oppressive, or may feel that it impacts their relationship with their therapist.
The overarching problem with diagnosis is in its possible permanence and longevity. Any diagnosis submitted to an insurance company becomes a part of your official medical record. While this may not impact you at the time of therapy, it can have future consequences related to qualifying for other health insurance or life insurance. Once a diagnosis is submitted, it cannot be retracted, and there is no surety around its future impact.
“The collaborative therapeutic work that we do with our clients is not bound by timelines, diagnoses, or pathology.”
concerns for your privacy & confidentiality
The work you do in is therapy is yours, and what happens is between you and your therapist. We feel strongly about this. We keep records of our sessions to uphold professional standards, but these records are confidential and are only shared with your permission or in situations related to safety and risk (and even then, as minimally as we can). Insurance companies do not have the same standards. Once therapy is being paid for by insurance, not only does a diagnosis goes on-record, but full-access to your mental health record-including progress notes about your sessions-may be required to be accessible in the case of an audit. They often can be required to be available to other insurance companies in the future, too.
your agency & our holistic treatment approach
Because we are not in-network with insurance, the collaborative therapeutic work that we do with our clients is not bound by timelines, diagnoses, or pathology. We recognize individual needs, paths, and growth in our practice, and work together with our clients to support them in whatever way is best suited for them at the time. We’re able to be adaptable, flexible, and creative.
At Kindman & Co., no big insurance companies will dictate what your therapy looks like or how essential it is for you. All decisions about the style, frequency, and goals of therapy are decided between you and your therapist exclusively.
social justice commitment
While we recognize the limitations of the medical model, we also acknowledge that to uphold our practice’s social justice commitment, we have to address inequity in the accessibility of therapy—especially in populations who have historically been oppressed by society and excluded from psychotherapy. To this end, we reserve 20% of each of our therapists’ caseloads for sliding scale spots, where the session fees are based on client income. We also provide a variety of group therapy offerings, which are both more affordable and more accessible.
support in using insurance to supplement therapy costs
Ultimately, it is your choice whether to involve your insurance company in your mental health services. If this is the route you’d like to pursue, we are more than willing to support you. Upon request, we can happily provide our clients with Superbills to submit to their insurance companies for out-of-network services (though we cannot guarantee the approval of claims or the rates and timelines of reimbursement). We will also do our best to answer any questions and offer guidance to support you in considering your options. Some useful things to ask your insurance company ahead of time:
· Do I have mental health or behavioral health out-of-network benefits for outpatient settings?
· What is my deductible? Has it been met?
· How many mental health sessions does my plan cover annually?
· How do I obtain reimbursement for an out-of-network mental health provider?
· What will the coverage amount be per session? How much can I expect to be reimbursed?
· How long does it usually take to receive reimbursement once I’ve submitted my claim?
· Is a referral required by my primary care physician?
· Does my insurance plan cover sessions provided via telehealth?
“We’re always thinking creatively about new ways to increase accessibility…”
To Our Clients
Our choice to remain out-of-network with insurance companies is not one that we make lightly. We value our connections with our clients and our colleagues in healthcare. We believe in therapy. And to help create healthier communities by nourishing intimate relationships and healing trauma, we feel we’ve got to stick to our values.
We’re always thinking creatively about new ways to increase accessibility and make therapy more affordable for anyone seeking services, so follow us on social media, or join our email list to stay informed!
If you have any questions about insurance, accessibility, or the cost of our services, please reach out to our intake coordinator at hello@kindman.co or by phone at 213.793.8223