Discovering Freedom: Out-of-Network Online Therapy Options in Seattle
As a therapist working throughout western Washington for the last 13 years, I’ve worked in a variety of settings. During graduate school, I practiced at our onsite Couple and Family Therapy Center at Pacific Lutheran University as well as being an intern at Multi-Care Behavioral Health. The PLU CFTC is a great resource for the community, they offer services on a sliding scale basis which gives the students hands on training and supervision. My offsite internship worked mostly with Medicaid clients who tended to be lower socio-economic status and highly impacted. Upon graduating, I worked for a Community Mental Health Center in Everett for three years. Community mental health centers typically focus on Medicaid and Medicare clients and many of them experience poverty, significant trauma, severe mental illness, disability, and substance abuse. I then started as an independent contractor at a group practice where I was paneled with multiple insurance companies and worked there for four years. In 2020, I went out on my own, becoming a completely individual practitioner in private practice. As of January 2024, I no longer contract with any insurance companies and am considered an out of network provider.
Image from Unsplash
State of Mental Health Care
It's helpful to understand the a few things about the state of mental healthcare before we move further in this conversation. People struggle to find therapists who have openings, and many providers don’t even call people back. People struggle to afford appointments with therapists, psychiatrists, and other doctors. Recognizing such challenges, big, rich, powerful companies have gotten into the game and exploit people by offering low cost, accessible services while boosting their profits by selling client private health information.
More therapists, counselors, and social workers are leaving the profession than coming into it. It’s hard work and burnout is very real. Therapists, counselors, and social workers are the lowest paid master’s degree out there. When a provider is contracted with insurance companies, the provider gets clients referred to them from the company and get paid at a fixed rate. This rate does not keep up with inflation and some companies have even decreased their reimbursement rates in the last few years. To bill insurance, your treatment must be ‘medically necessary’, and you must meet diagnostic criteria for a mental health disorder. The provider maintains ongoing documentation congruent with above mentioned diagnosis. The insurance company can review your medical record and, in some cases, perform a ‘claw-back’ if the documentation isn’t up to their standards. A claw-back means the reimbursement has to be paid back to the insurance company.
What’s an Out-of-network Provider vs. Private Pay?
Out of network means that I don’t have any contract agreements with any insurance companies. I’m not ‘in-network’ with any of them. If clients so choose, I offer to provide them what’s called a Superbill which has a billing code, diagnosis, and receipt of paid services. You can then choose to submit it to insurance for possible out of network reimbursement. Many people have out of network benefits and don’t even know they have them. Many people receive some portion of money in return. Private pay practitioners don’t offer superbills.
Benefits of Out of Network Care:
Many people don’t understand the benefits of seeing an out of network provider and the advantages that comes from someone who has the energy, time, and education to properly serve your needs as a client. This is by no means an exclusive list, but highlights some of the main benefits of out-of-network care.
Specialized Care:
If you have a specific health issue and look for a doctor, chances are you don’t just look for any doctor, you look for one who specializes in your issue and a person from whom you’ll receive good care. I specialize in the impacts of grief, infertility, pregnancy loss, medical trauma, health issues, and menopause.
Smaller caseload which means:
Less burnout, more focused care, more communication, more continuing education and session planning. (I’ve known providers to have ten sessions a day, that’s ten hours of therapy. That’s insane. My max is four.)
Fewer Surprises:
Ever gone to a provider and think your insurance is going to cover it, only to find months later you have a large outstanding balance? When working with an out of network provider, you know exactly what you’re going to pay and can budget appropriately.
Community Resource:
I’m now able to volunteer more, speak at community events, provide education to professional organizations and contribute to positive changes in the field.
Invest in Local Small Businesses (Often Woman-Owned):
Most private practice or group practice owners are small business owners within their communities. Since a vast majority of providers in mental health are women, when you find a private practice provider, many times you’re supporting a local woman owned business. Such small business owners are typically members of the community in which they work and give back in a variety of ways. Big companies focused on share price, profit margins, and exploiting workers don’t re-invest in your community.
Increased privacy:
When dealing with insurance, all of that information goes into your permanent medical record. They also have the access to your records as needed to justify paying for your care. With an out of network provider, you get choice if you want to share your information with your insurance company to receive some reimbursement or if you want to keep that private.
Treatment flexibility:
Experience treatment flexibility due to not having to conform to the ‘medical model’ and justify care according to insurance standards. You can receive tailored treatment that will best support you.
Episodic care:
I don’t expect you to be in therapy forever. I want you to get in, get better, and get back to your life. I also won’t kick you out of care because a third party says so. Treatment decisions are made collaboratively between me and you.
Internalized Self-Sacrifice
Most people that get into helping professions aren’t doing so to get rich. My career path is not uncommon to others in the field. Many providers work in extremely low paying jobs or settle for the consistency of insurance clients for the tradeoff of low reimbursement rates. This leaves many providers burnout, overstressed, and complacent in not providing quality care.
I share the following perspectives to challenge rhetoric targeted at providers simply wanting to make a living wage and as context as to the reasons why I decided to be out of network only. I’ve received criticism, often from other care providers shaming me for not taking insurance (despite a decade plus of working for low pay). Within helping professionals, a culture exists that prioritizes caring and helpfulness above all else, even at the expense of self-care. I often see this idea become internalized into self-sacrifice as a form of caring. I don’t think it’s a co-incidence that many people in helping professions are female and in this country, women are taught to be self-effacing and self-sacrificing. If we want more providers to enter the field, for existing ones to stay or professionals to have longevity in this career, providers must earn a living wage. It takes a lot more than empathy, care, and goodwill to run a sustainable, successful business. This is true for business that help people too.
Future Care
We all know the system needs to change for clients and practitioners. Mental health care (and arguably physical healthcare) is still not prioritized in this country. People need access to quality, affordable care and practitioners who have years of education and exposure to secondary trauma deserve a living wage. If we can utilize trainees, novice therapists, and incentivize early community service, I believe we could provide the community quality care while also taking care of our providers. If nothing changes, I believe more people will leave the field. It’s a privilege to be able to access out of network services. Ideally through education, conversation, and reform, clients and providers will be able to get what they need to thrive.
Image from Unsplash
Good luck on your therapy journey and please reach out if you have any questions about therapy in general, are looking for resources or guidance! Feel free to schedule a free consultation today and take advantage of my knowledge and experience.
Learn more about me here. Or check out my specialties: Infertility, pregnancy loss, medical trauma, health issues, menopause, anxiety, and grief. Or return back to the blog.