Why did I go Out of Pocket?
- Grace Huntley, LMHC
- Mar 25
- 2 min read
When I first started my private practice I had a lot of ideals about accessibility. I wanted to be one of the providers who were working to make mental health care more affordable, because I honestly believe it's a necessary human right.
However, over the course of three plus years, where cost of living rose without seeing any corresponding rate increases and where I was continually confronted with issues including:
Changes in client insurance: Due to switching jobs, going on your partner's insurance, or a workplace transition
Back pay charges for clients/the clinician: Retroactive charges occurring when claims weren't processed right or because client's didn't fully understand their coverage or because the insurance company doesn't agree with the need for treatment. For providers, these are called clawbacks and can result in the loss of thousands of dollars for treatment up to 24 months from the date it was issued
Limitations on treatment/Care: Due to pre-set specifications depending on diagnosis code or because of location requirements that transcend necessary licensure for a given state
Privacy issues: Diagnoses and progress notes becoming a part of the client's record. This can be requested by insurance companies to validate a claim, check policy eligibility, or justify higher premiums.
Ethical issues: Utilizing insurance necessitates a diagnosis code. Since our medical system is a treatment model more than a proactive model, therapy is only covered when it is reducing symptoms, not when it's helping clients live better
Parity issues: Despite multiple parity legislations dating back for over twenty years, reimbursement rates continue to considerably lag behind physical healthcare reimbursement for similar services
Decreases in rates: Reimbursement rates, rather than being increased for cost of living, being decreased, resulting in the loss of hundreds in income a month
Capacity limitations: Being reimbursed less means needing to take on more clients
I became disillusioned with a system that places the burden of accessibility on the individual provider. Truthfully, without systemic changes, mental health care won't be getting more accessible.
Finally, I decided to make the transition to out of network in an effort to make the work feel sustainable and to ensure I could continue to show up fully for the client's on my caseload. This choice not only makes it possible for me to stay in the game as a therapist, but also means that I can keep my caseload to manageable numbers and ensure I don't extend past my capacity for care.
Ultimately, working as a therapist is a challenging career that requires a targeted undergraduate degree, a graduate degree, 3,000+ years of post-graduation work under supervision, a licensure exam and subsequent licensure and continuing education per state. I realized, that the same way I advocate for my clients to be compensated what they're worth, I needed to step up and do that for myself.
All of this being said, I am not the therapist for everyone. That is due to my specializations, my personal background, and my strengths; no therapist should be a perfect fit for everyone. If you're looking for more affordable options, some resources are below.
Low-Fee Therapy Options + Resources
Lotus Therapy Fund (supporting access to therapy for individuals of Asian descent)
Hamilton-Madison House (accepts Medicaid)