What is Mental Health Really Worth? (And Why I Don't Accept Insurance)

The number one question I am asked by both patients, as well as trainees and students, is: "do you accept insurance?" The simple answer is: No. But it lends itself to further explanation, as I fully acknowledge the limitations that this places on my practice (though shockingly not as much as you may think, as most of my patients are still reimbursed by their insurance companies).

"Know that just because I do not accept insurance upfront does not mean that you yourself will not receive money from your insurance company."

Before I give you my reasons for not accepting insurance in my psychiatric practice, I want to reframe the question to: what is mental wellness really worth to you?

You've likely spent the same amount of money (if not more) on any one of the following:

• Professional photography
• Binge spending spree at Target (just me?)
• Brazilian Blow Out
• Holiday groceries bill
• Amazon Kindle reader
• iPhone X (definitely more than my standard fee)
• Inventory for your MLM business
• Protein powder, vitamins, and/or supplements
• Home gym equipment
• Toys for your kids
• Video games for your kids
• Amazon spending spree
• Weekend out with your husband
• Kombucha, protein bars or other deluxe groceries

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And let's not forget about the other "medical" services that you easily spend cash on:

• Tanning, facials, and massages
• Botox and/or Lip injectables
• Microblading or permanent tattooed makeup
• Waxing or laser hair removal
• Breast augmentation
• Cool sculpting or laser liposuction
• Creams, lotions and treatments for stretch marks or cellulite

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Let me ask you something. Are all of these above mentioned products, goods or services more important than your mental health? Maybe it is and that's okay. I also know that none of the "things" will change your internal state. If you truly want to feel "good enough," then it starts with a mindset shift and an improvement in your emotional health. I'll go as far as to say that your emotional well-being is the backbone for all of your health (read my definition of holistic health here.)

Of course, I am making the assumption that you waste hundreds of dollars monthly on frivolous expenses that are not really serving you. But you may actually not spend money on any of these things. You may say that you live by a strict budget and truly "can't afford" to spend money on your mental health. 

Believe me, I used to believe the same thing. When I first sought mental health services for my postpartum depression after my daughter was born (read my story in my book Let Your Heart Out here), we were living in D.C. on my minimal resident salary and definitely had no extra money in our budget. In fact, I was swimming in debt and student loans. I also knew that I couldn't go on living the way I was living and if it meant I was going to spend $1,000 (it wasn't that much, don't worry), I knew that I had to do it because that's what I needed at that time in my life. 

It's incredibly challenging for us women and moms to make time for ourselves, to spend money on ourselves, or to "be selfish." You'd drop $1,000 on your child without batting an eyelash, but if it's the same amount on yourself, you hesitate. I want to challenge that thinking though, because that is a fundamental problem. 

"It is only when we can invest in and prioritize ourselves that true mental wellness, as well as, overall family wellness will happen."

I know that when you tell me or yourself, "I can't afford it," what you're really saying is: "I'm not worth it" and "This isn't a priority." I can argue with you otherwise, that you ARE worth it and that emotional well-being is the foundation for all of your health and well-being, but I know that you have to come to this conclusion on your own. When you're ready, I'll be waiting. 

Now, so I don't leave you hanging, let me tell you briefly why I've chosen to not accept insurance right now (and this may change in the future, who knows, but this is where I stand today):

1. Time

The number one reason that I do not accept insurance is time. As a solo practitioner, I do not have the resources to spend hours on the phone each day waiting on hold, then having to negotiate and argue with five different people in an insurance company, all for the care of one patient. I would rather use that time to spend with you.

If I were to accept insurance, I would have nowhere near the same amount of time with my patients. And that is not consistent with how I want to practice medicine. I entered the field of medicine to help people and relieve suffering and I cannot do either of those things if I'm only spending 15 mins (or less) with my patients due to the other 45 mins of an hour spent on the phone with insurance companies. 

2. Confidentiality

This is not talked about enough, but if I were to accept insurance, you as the patient relinquish confidentiality rights over your medical records. Technically, insurance companies have within their power the right to request further medical records, notes, prescriptions, etc from me as the provider. 

I am privileged to receive immensely intimate information from my patients. I go to great lengths to protect the privacy and security of that information. To disclose this information to an insurance company is unethical and out of alignment with how I want to practice psychiatry.

3. Misdiagnosis

This is also not spoken of a lot, but most insurance companies only reimburse for certain diagnoses in mental health. Those are generally depression, anxiety, schizophrenia, and bipolar disorders. This is often the reason many patients are misdiagnosed with catch-all "depression" "anxiety" or "bipolar" when in fact, they may actually have a primary eating disorder, trauma disorder, or somatic syndrome.

I find offering clarity to my patients brings calm. When I can provide a clear diagnosis for my patients, then we can have a clear, straightforward path to healing and wellness (which is what we all want, right?). When I am limited by an insurance company to diagnose a patient with "depression" when in fact they actually have trauma, this creates a host of confusion and with confusion, breeds anxiety both in me and my patients. I do not want to practice psychiatry with confusion. It's just bad medicine.

4. Money

Let me be real with you. I did not become a doctor for the money. If I was truly in it for the money, I would've chosen a much less strenuous path, like business, hospital administration, or YouTube sensation. But I was called to be a doctor. And I love my career.

That said, insurance companies are trapped in the stone ages when it comes to reimbursement for psychiatric services. The fee rates are all over the map, with no standardization and many significant limitations. The fact that I cannot even tell you what I am paid by an insurance company (legit, I don't know!) speaks to the inconsistency of the bureaucracies.

 My reasons for not accepting insurance are few, yet significant. For these reasons, I cannot practice medicine the way I determine to be most ethical and beneficial. Thus, I do not accept insurance.

I fully acknowledge that mental health treatment is an investment. It's an investment in your time, in your money, in your resources. I do not take that lightly. I know that your time, resources, and money are valuable to you, and I will never take advantage of that. 

That said, it is an investment. And I will ask you to make this investment, because I truly believe that with emotional health, you truly can "have it all," whatever that means to you. Now, let me ask: what is mental health really worth to you?