When I opened my private psychiatry practice, I made a decision to accept private-pay only. This means I accept payment by cash, Venmo or PayPal. More importantly, it means I do not accept or bill insurance. I do not participate in the payment or reimbursement process with insurance companies. This is an important boundary for me as an ethical obligation to my clients and a self-care obligation to myself.​​​

​

1. Insurance requires a mental health diagnosis. This does not work for me because I believe diagnoses are flawed, subjective representations of pathological tendencies too easy applied willy-nilly. I recognize the utility and unfortunate importance of categorization & labeling; I also choose to work outside the system when possible. I see my clients as whole, resilient, capable people facing behavioral and emotional roadblocks to fulfillment. I do not see them as diseases needing cures.

​

2. Diagnoses can easily become a central or integral part of someone’s identity. It is easy to “become” OCD or ADHD once the label is announced, to come to see it as part of one’s core self. I treat people, not diseases, labels or categories.

​

3. Insurance companies require clinicians to reveal diagnoses, symptoms, behaviors, and treatment plans. I’m unwilling to reveal confidential, potentially damaging information if hacked, to the insurance company to justify my clients’ needs for emotional support. Avoiding interactions with insurance companies protects the confidentiality of my clients.

​

4. Further, insurance companies limit the amount paid for treatment and the number of sessions available to a client. I am not willing to be paid an amount for my professional service that leaves me feeling resentful and devalued. That’s a boundary of mine I must uphold. More pointedly, I’m not willing to have my clients’ treatment cut off or limited by an insurance company. That decision is between my clients and me.

​

5. A major component of my practice is relationship and couples counseling. Most insurance policies do not cover couples counseling/marriage counseling. Therapists who bill insurance for couples counseling are often doing it under the guise of one client’s diagnosis with the other partner present as support. This does not fit with my ethical standards.

​

6. Finally, working with insurance companies demands an incredible amount of time and patience to fulfill paperwork demands, pursue reimbursements, re-authorizations for treatment, etc. This is time I could actually be working with clients face to face, which I find invigorating and enjoyable. It is also time I can be taking care of myself so I am at my best when I’m with clients, present and energetic.