One Therapist’s Journey Through The Insurance Jungle

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Insurance in private practice

There was I, standing in my first office space. I had decided to start my own private practice as a way to make a little extra cash in the evening after my day time job as a school social worker. My dream had come true. I was a real therapist now. I would get to work with clients on an individual basis and really get to help people with their problems. At this point in my career, the only way I thought I could get clients to come and see me at my new practice was to get on insurance panels. I wanted a lot of clients so, to me, that meant I should get on every insurance panel there was. I didn’t know of any other way, and so, I started my journey through the insurance panel jungle.

Choosing An Insurance Company

It didn’t take me long to figure out that this part of being a social worker wasn’t something they taught in grad school, although they should. I quickly learned that all insurance companies have a different process to go through to join their panel. Then, there is the terminology in the credentialing packets, which you need a different college degree to be able to fully understand. I filled out each packet and provided all my information and sent them to each company. This is when the waiting game started. In the mean time, I started getting calls from potential clients. I can still remember the first check I received from my first client. She was willing to pay me out of pocket. It was amazing to think she was paying me for something I enjoyed doing. It was incredible.

After about a month from not hearing back from any of the insurance panels I applied for, I began calling them. This is when I started to learn the virtue called “patience”. There were times I spent 45 minutes on hold only to be told that my application was in process and that it could take up to 180 business days to be completed. I learned twice that my paperwork was lost with one insurance company, so I needed to fill the paperwork out again.

At this point, I started envisioning what the credentialing department of insurance companies looked like. I imaged that this department was run by sloths who were forced to trudge through molasses to get my paperwork from one person to the next. I started to believe that leaving people on hold was a purposeful tactic. That it was to see who could last the longest. Would I give up before they would answer my call? It was all a well-thought-out conspiracy. This is what happens after spending hours on hold. Your mind goes to survival mode, an alternate state.

Getting Onto Insurance Panels

After all the paperwork and follow-up emails and phone calls, I ended up only being paneled with two companies. I applied to five. But, due to paperwork getting lost in the mail and insurance panels claiming that my area was already saturated with therapists taking their insurance, I only ended up on two panels. This, however, was actually ok. Because, these two panels ended up dominating a lot of my time trying to get reimbursed.

Learning how to fill out claims, requesting authorizations, and not run out of covered sessions cost me several thousands of dollars my first year in practice. I didn’t know what I was doing and had to stumble my way through it. Every time I would call the insurance company to ask why I wasn’t getting paid, I would get a different answer or get sent to a different department.

Also, I found out that my contracts prevented me from being able to charge my full fee to clients that were covered by their insurance. I was being reimbursed by only 50% of what my session fee was. I also could charge clients for sessions they didn’t show for. After looking at the time I spent with clients, doing paperwork, and sitting on the phone, I wasn’t making much money at all. I was hardly paying my bills each month, let alone being able to pay myself a salary. That year, I brought home a total of $2,000. I had to make a change.

Moving Away From Insurance

It became obvious that this insurance option was not a good one for me at the time. I knew I needed to come off of them. The thought of it made me sick to my stomach. I was afraid I would lose my clients, that nobody would come to me. However, I took the leap off insurance panels. And I did end up losing some of my clients. Although, I was able to keep some of them by giving a sliding scale. I found that other therapist and doctors were hesitant to refer to me, since they knew I didn’t take insurance. Despite all of this, I believed in myself and my practice. I knew what my worth was and started getting clients that paid my full fee.

So, I found that the solution to my mischievous situation would be to explain to new clients why I don’t take insurance. I explain how my time is spent with clients and not fighting for reimbursements. Then, I explain that they may be able to apply for reimbursement themselves with an invoice for our session, if they have Out-Of-Network benefits. I also explain that I want to keep sessions confidential and that many of my clients find this beneficial, especially with the population I work with. I specialize in working with LGBTQ clientele and many don’t want to risk being known to anyone outside my office that they are seeing me.

Out Of The Insurance Jungle

Since I have been off insurance panels, I have been able to grow my practice. I currently have three clinicians working under me. Because of this, I have the ability to focus on tailoring treatment to each individual client now and I am not worried about filling my schedule to the max. I have found that I have more time to spend with my family and to do activities I enjoy. My mental health is better now that I am not fighting for every cent I am owed. I have more time to dedicate to causes that I feel are important, such as ‘I Am That Girl’, where I help to encourage young girls to empower one another. Also, I have been able to reinvest in myself and my business with more time to attend trainings. I will be a certified hypnotist by the end of June.

It sounds strange, but the freedom I have now not being on panels is amazing. I charge what I am worth and provide the best therapy I possibly can to every single client. Now, I am able to implement what I always thought therapy was supposed to be – client centered, tailored treatment – and help create change for each and every one of my clients. I am no longer lost in the insurance jungle.


Melissa DaSilva, LICSW is a licensed therapist in private practice located in Providence, RI. She is the owner/president of her group practice East Coast Mental Wellness ( has been a therapist for over 10 years, is an advocate for LGBT rights and public speaker. You can also find out more about Melissa on: Facebook and Twitter .

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