THE SYSTEMIC ISSUE WITH THERAPIST REIMBURSEMENT

Mar 7

Headlines cite concern for the mental health epidemic in our country as well as the increasing demand for mental health treatment. Many complain of waitlists or closed caseloads for therapists. But something no one is talking about is the systemic issue with therapist reimbursement.

The pandemic was hard on our profession. We worked hard and navigated the change of services to Telehealth platforms. We are tired, and yet, despite the demand for clients, still broke.

Here is why…

COMPENSATION FROM INSURERS LAGS WAY BEHIND RATE OF INFLATION

Compensation for a mental health provider in private practice working with insurance is dictated by the insurance company’s contracted rate. Meaning, most of our work is actually paid at a “discounted” price. For example, the going cash rate listed for a 50-minute session of therapy typically ranges from $150-185. A social worker’s reimbursement rate for this session tops out at $126. Furthermore, this rate varies among insurers (some pay much lower) and hasn’t changed much in my two decades of being in practice (and by much, I mean a matter of a dollar or two at most over the span of many years). Also, payment by insurers is not always prompt, leaving therapists waiting months for payment.

In contrast, the current rate of inflation for the 12 months ending January 2023 is 6.4%. Meaning, if there has been no increase in rates, a therapist has lost 6% of their hourly rate. Now multiply that by several years! Further, consider that in the past year alone, operating expenses such as rent, platform fees for electronic medical records, internet, and licensing fees have increased.

Since compensation is gridlocked by insurers, the only way for a therapist to make more money is to decline participating in insurance panels or to increase their volume of clients. At some point, neither option feels good, and the latter becomes incompatible with life balance. Few therapists go into the profession to get rich. The incentive is to help people. Therapists do want this help to be reachable for clients, thus, we contract with insurance. But due to low reimbursement rates and volume of clients, we experience compassion fatigue and burnout. As a profession, we understand the importance of self-care, however, given compensation rates, the balance of self-care and contributing to our household can feel tricky.

As a therapist in private practice accepting insurance, the increase in demands and expenses far exceed compensation rate. No wonder there is a therapist shortage!

HOW TO VALUE THE TIRED AND BROKE THERAPIST

Clients/Patients

Respect your therapist’s time

Cancel within the guidelines to allow your therapist to reschedule that slot.
Respect the late cancel fee (just to compare, your physician also charges a late fee, but sees 4 clients an hour vs. the 1 per hour a therapist can see).
Honor 50-minute session (give your therapist a few minutes to pee and take a breather between sessions).
Pay bills in a timely fashion.

Therapists:

Advocate!

Nudge the professional organizations to which you belong (APA, NASW) to lobby on our behalf for fair reimbursement rates.
Contact private health insurers you are contracted with to ask for an increase and/or consider moving towards cash payment rates only. **draft letter below

Bottom line, we say we value mental health and accessing support, but do we value the mental health providers? Compensation would say no. I would love to know your thoughts.

**Dear Provider Relations Specialist,
I’m writing on behalf of myself, ___________________, NPI (12345678910), and my practice, _________________, Group NPI (10987654321). This letter is a request for an increase in reimbursement rates for the routine outpatient mental health services that I provide and have provided to (Aetna, Evernorth/Cigna, UHC) clients for _____ years.
Due to the nature of the world since 2020, mental health providers like myself require an increase in wages. We operate in a climate where inflation is at 6.4%. I’m feeling these price increases at the grocery store, gas station, and on our monthly bills (rent, EMR/Telehealth platform fees, internet costs, licensing fees). To afford these changes in routine spending, I’m requesting this increase in reimbursement.
Additionally, because of the dramatic increase in demand for mental health services and the added stresses involved in treatment since 2020, I request an increase in pay as an essential and integral worker serving ______(Aetna, Evernorth, etc.) clients.
For the aforementioned reasons, I am requesting reimbursement increases for the following CPT codes.
CPT Code Requests
90834: New Rate:
90837: New Rate:
90791: New Rate:
90847: New Rate:
90846: New Rate:
I have enjoyed serving (Aetna, Evernorth, etc.) clients and hope to do so in the future. In order to ensure I do not change the proportion of clients away from (Aetna, Evernorth, etc.), I ask for a fair but competitive increase in pricing to keep up with my other insurance contracts.
Thank you for spending your time and energy in consideration of this pay increase request. I hope to continue to serve (Aetna, Cigna) clients for years to come.
(“How To Ask for A Raise (Negotiate Your Rate) in 2023 for Mental Health ...”)

Thank you again,
Provider / Practice Name
Practice Address
Practice Billing NPI