The Messy Truth About Insurance-Based Therapy

In order to provide the highest quality therapy service, I no longer accept insurance at my practice.  I spent many years billing insurance in community mental health, group practice, and private practice settings.  I appreciated the ease of access this gave to clients and worked hard to make this work for my clients and myself.  However, as I grew as a therapist and my focus evolved, I reached a point where the insurance model was no longer a good fit for my work.


Brennan C. Mallonee, LMHC • Individual Therapy in Cambridge, MA

Insurance follows a medical model for mental health.  What this means is that in order to pay for mental health services, insurance companies require a diagnosis that they recognize as meeting “medical necessity” guidelines.  This model emphasizes mental illness and tracking symptoms with interventions designed only to decrease specific symptoms.  This creates a mentality where we see ourselves as “sick” if we require therapy.  

I wholeheartedly disagree with that model.  I believe that we learn and grow in relationship with each other and in community.  At the same time as many of our other outlets for interpersonal growth and support have shrunk, counseling provides a warm, nonjudgmental space where we can become fully alive and learn to embrace ourselves in all of our messy, unique beauty.  

What the medical model calls “symptoms” are really expressions of pain and distress, and they do not mean we are sick - they mean we are seeking health, wellness, and a way to live more peacefully in a challenging world.  When I worked with insurance companies, I had to justify a medical diagnosis (Major Depressive Disorder, PTSD, etc) in order to work with a client.  That requirement boxed both of us in and prevented the full scope of vibrant, creative work that is possible in therapy.


A related issue is the sometimes seemingly arbitrary limits that insurance companies place on treatment for different diagnoses.  Sometimes insurance will pay for a 45 minute session, sometimes a 60 minute session.  Sometimes they allow unlimited sessions, sometimes they require regular requests for more sessions.  Occasionally insurance companies require therapists to decrease frequency of sessions with a particular client or end therapy altogether.  These decisions are made by a doctor at the insurance company who has never met you and has nothing to go on but a list of symptoms and a company mandate to reduce costs.  Your therapy should never be cut short due to a bureaucrat’s decision. 


Brennan C. Mallonee, LMHC • Individual Therapy in Cambridge, MA

Providing a diagnosis to your insurance means that diagnosis becomes a matter of record.  Once it leaves my office via a billing submission, I can no longer guarantee the security of that information.  Some insurance plans require regular updates from the therapist in order to continue paying for treatment, which puts even more of your personal information into the hands of bureaucrats.  Insurance companies are legally able to audit therapists, meaning that at any time, they may request access to my private clinical notes, deeply compromising your privacy.  Additionally, having been given a mental health diagnosis can pose difficulties for people seeking life insurance, security clearance, or a job in the financial sector.  Your privacy is my priority.


Insurance reimbursement rates for mental health services are extremely low in Massachusetts and many companies’ rates have gone down since I began practicing.  This pushes therapists to see more clients per week in order to make ends meet and cover all the expenses of keeping a business running.  Add in all the paperwork required for insurance, complicated billing procedures, and many hours on the phone with insurance companies following up on unpaid claims and you have a recipe for therapist burnout.  A burned out therapist is a therapist who can’t dedicate herself 100% to working with you because she is exhausted, stressed, or even getting physically ill from overwork.  

No longer accepting insurance allows me to be healthier and in turn to be fully present with you.  Time I previously had to spend on paperwork, billing, and over scheduling is now invested in training, consultation, and growing my skills as a therapist - a payoff that goes directly to each and every client I see.  I encourage my clients to practice good self-care and limit-setting, bravely creating lives that are healthy, in balance, and fulfilling.  In shifting my practice away from insurance, I have allowed myself to do the same.  

Brennan C. Mallonee, LMHC • Individual Therapy in Cambridge, MA