Why My Private Counseling Practice Does Not Take Health Insurance

Update 1/11/22: Two months after I wrote this post, the COVID-19 pandemic began. Since many people in Virginia experienced financial hardship and could not afford direct pay services, but had Anthem health insurance, I applied for my private practice to become a provider. Many months later, that application was approved. However, for those who wish to protect their privacy, I continue to offer the self-pay option.

Do no harm.

People’s health care records accompany them for life. Given that substance use is stigmatized and criminalized, I urge anyone with a substance use concern or an addiction issue to self-pay if they can so no third parties – including health insurance companies – are notified.

In private practice as a direct-pay, independent counselor, I keep clinical notes that can only be accessed with a client’s release or if the records are subpoenaed for use in legal matters. I write notes to meet professional and ethical standards but they carefully include minimal details. I do my best to help protect my clients’ human rights.

Doors can close with a diagnosis related to addiction of any kind. Opportunities – invitations to join in, scholarships, employment, promotions – can be denied because most do not understand – or refuse to acknowledge – that addiction is a very human, treatable condition.

(Since my health care record includes an alcohol use disorder diagnosis, even though I have been in remission for years, I assume I will not be allowed painkillers if I’m ever in an accident and taken to an E.R. Denial of medication to people with current and former issues with addiction is tragically sad and life-threateningly dangerous, but I’ve seen it too many times locally and it’s a noted nationwide phenomenon.)

I provide individualized, responsive, comprehensive services not covered by health insurance.

Substance use disorders, challenging behaviors, and the mental illnesses that may accompany them can be complex, on-going conditions that may not remit through medical care and individual and group counseling alone. Comprehensive assistance is needed. My fees for individual and group counseling sessions include case management services, within-24-hour replies to texts, phone calls, and emails, contingency management awards, and custom-created, individualized readings, materials, and activities. These services are not reimbursed by health insurance companies.

I offer evidence-based care.

Health insurance companies specify what treatments will be reimbursed and can deny coverage for research-backed treatment. I keep abreast of the latest research on treatment for addiction. Today, right now, I can offer the very best care suggested by research that I am qualified to provide. (Medical care is the first line of treatment for addiction and may be sufficient. I am not a medical care provider.)

Clients and I are free to co-create individualized, evidence-based treatment plans designed specially for them to include the components and pacing that fit their specific needs.

I am here to help.

If I were to take reimbursement for services from health insurance companies, I would be obligated, under contract, to charge agreed-upon fees. I would commit a billing violation if I offered a sliding scale or discounted fees for low-income or no-income individuals. I have a small practice and can only offer a limited number of scholarships. I am honored and gratified that they are filled. I respect contracts and do not enter ones that compromise my ability to be of service to those in need.

Time is finite and precious.

I am 61 years old. I respect the protective intent of the vast amounts of information required to provide services covered by health insurance. I am passionate about clients and this work. I choose to spend my remaining time on the planet serving clients, not completing forms.

If the way I offer counseling services is a fit for you, please contact me. I would welcome the opportunity to work with you.

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.