Admittingly, this is a long informational page about insurance. We want to take the time to inform our clients. We want to be honest and transparent. Please read this page fully. We will cover:
- How to use your insurance
- Sliding Scale
As therapists, we are frequently asked about insurance from potential and current clients. Understandably so, people want to save money on mental health services. Believe us, we get it.
At one point, we accepted insurance. Now we have decided, at least for now, to avoid taking insurance until there is a meaningful change in the insurance system. This decision has not come lightly. One reason is insurance has been denying multiple claims for the honest hard work that we have provided for our clients. They “clawback” (it’s an actual term) multiple payments for services dated as far as 3 years ago! It doesn’t matter if our service is empirically-based and meet the highest state board standards. Clawbacks can happen even when it’s an insurance company administrative error. It is like your boss taking your paycheck back after all your hard work. It is unfair. Sad to say, but it’s challenging to pay a fair wage and retain great therapists under these circumstances. These situations are prevalent in the mental health field, and that is why many wonderful therapists do not accept insurance anymore. This is the reason many folks have a hard time finding excellent (and available) therapists within their insurance network. Details are highlighted in this Bloomberg article.
Another important reason we are stepping away from insurance is privacy. We want our clients to feel as comfortable as possible coming to us. When people use company-sponsored insurance and/or EAP benefits, often times their employer can know what they are using it for.
In 2014, the CEO of AOL got into a firestorm because of a “distressed baby” comment he made. The CEO was discussing reasons for cutting benefits in a conference call with employees, and he singled out two women because they had been using the company insurance extensively to treat their children’s medical conditions, thus driving up benefits cost of the company.
It’s widespread that employers know about our healthcare usage. The company benefits administrators send regular reports on benefits usage to employers. In theory, these reports do not include individual’s identifiable information. If that’s the case, then…
How did the AOL boss know about personal medical conditions of his employees and their families? Many of these employers are self-insured. Being self-insured means that rather than paying an insurance company to pay medical, dental and vision claims, the company pay the claims ourselves, using a third-party administrator to process the claims on our behalf. It means the companies are the insurance company and they have the rights to your health information.
How many employers know employees’ medical conditions? Uncertain. The AOL is just one company that got leaked.
Can small start-up and mom-and-pop shop that are not self-insured know about your health conditions? Yes. See below.
Is this legal? Yes. Employers are legally allowed to monitor something called “health insurance utilization.” That means an employer can see the number of claims being charged against its health insurance plan. Insurance companies can share both aggregate charges for the entire workforce as well as claims per employee and family members.
HIPAA (Health Insurance Portability and Accountability Act of 1996 ) does not forbid employers from requesting relevant medical information that may be necessary to medical leaves, administration of a benefits plan, or reasonable accommodation. Release of such data requires employee authorization, and often times employees may have inadvertently given the authorization to their employers when they sign up for the benefits.
Think of it is like your parents paying for your cell phone bill. Your parents don’t necessarily know the content of the conversation, but they have ways to knows what number you were calling or texting and what time you called/texted. Your employer may not know what you talked about in the therapy session, but they can obtain other information about your treatment. Whoever pays the bills has the information. From our understanding, it is possible for employers to use healthcare utilization information against an employee for cost-cutting measure.
This is why we have decided to avoid attaching any mental health treatment with employer-sponsored programs. Employers who spend money on benefits know how much they are spending and on what. They have the right to see every cent in and out. Many of our clients told us this grossly violates their privacy. They don’t want to risk what employers do with that information.
Therapy isn’t brain surgery, an it doesn’t cost tens and hundred thousands of dollars so many clients opt to private pay. Often they chose to do self-pay because they want to maintain their privacy and they don’t jeopardize their employment standing. They don’t want their employers knowing they are seeking mental health services and/or how often. Some self-employed choose to private pay to keep their insurance premium from increasing in the future.
How To Use Your Insurance
Some folks need to use insurance for treatment. Awesome! We do not want cost to deter you from seeking treatment. We also do not want to deter you from using your insurance. We just want to educate so our clients get the full picture. Currently we are private pay. We are working on helping clients submit paperwork so there’s less headache. Stay tuned.
Sliding Scale/Free Therapy
We also want to make therapy accessible. That’s why we take extra effort to provide the best sliding-scale and free therapy Palo Alto has to offer.
We don’t receive special funding or grants from outside sources. This service is made possible by the session fees from our paying clients— we allocate a portion of our earnings to fund our sliding scale therapy service. We are grateful to our clients for their ongoing support.
Check out our Sliding Scale Therapy page.
Check out our Free Therapy page.
If you have questions about payment or insurance issues, we would be happy to discuss them with you privately. Call us today to learn more.