When I finally finished my bachelor’s degree after 11 years of school and work (and enormous debt) I decided to get my Master’s in Social Work. I had been doing the work that many social workers do and it seemed an obvious choice. My heart was in it and I knew I had a muscle for the hard work. At dinner, a month after I got into the program, a friend asked why I wanted to be a social worker. I earnestly looked at him and said, “I want to help people”. It was a crowded restaurant and we were waiting for a table and that seemed to sum up my reasons perfectly. I kid you not, he laughed in my face. I am not naive and he is no longer a friend.
Our job as therapist/counselor/social worker is to serve those who ask for our help. We do it lovingly and to help people. Our business has a side that those we serve, often, know very little about and the curtain needs to be lifted. Insurance companies are going after the very people who want to help and serve. I will attempt a list of things that have happened in my small practice and in our larger group practice in the last five years:
- When I began as a therapist, a short ten years ago, we were paid to provide a 50-minute session. Now we must work for 53 minutes or we are paid for 45 minutes.
- Insurance companies are now requiring a review of notes for any “patient” they choose to make sure we did all the documentation correctly. If not, they are taking that money out of the bank accounts of the therapists. It is called “clawbacks” and they can go back as many years as they want.
- It took seven months to negotiate a higher fee with one company after we hadn’t had a raise in nine years. Another company promised a raise and then sent a contract with the same rate they had five years ago and refused to negotiate.
- When we bill claims we expect to be paid. It can take months now because private insurance companies argue about the type of service, state they are understaffed or make inconsistent errors that reduce payments that belong to us.
- Out-of-pocket expenses for clients have ballooned! They can’t afford it when they do have insurance.
- Administrative costs for billing have increased as we fight for every penny that belongs to us. Time for sending notes, doing notes, completing assessments and writing treatment plans are not covered by insurance.
- We used to argue for mental health parity, meaning we get paid the same fee schedule as doctors and nurses. We are so busy fighting for the money owed to us, we don’t have the bandwidth to fight for equity.
There is more, so much more. Here is an article from ProPublica on what is happening with our profession and insurance companies. This is the first in a series on this issue so look for more to come. I was interviewed multiple times and fact-checked repeatedly. Almost everything that is mentioned in the article has happened to me or someone in this group. As we help others; we fight to keep doing this work. When will the soul work we do each day be valued by companies so that I can finally feel like I am not being laughed at for “wanting to help people”!