This Sad Reality About Insurance In The United States Is The Reason So Many Therapists Won't Accept Insurance

Farah Zerehi is a licensed marriage and family therapist who recently went viral for explaining why a lot of therapists don't accept insurance with a little storytime about her experience:

In her TikTok, which has been viewed over 12 million times, Farah explains how she applied to be in-network with an insurance company in January 2022. The insurance company told her it would be 30–45 business days before she would get a response from them.

After 45 days went by with no response, Farah checked on the status of her application. She was told the timeline was "extended," and when she asked for a reason, they told her they weren't obligated to give her that information. She was told to call back in 60 days to check on the status then. And this time, with no response after 60 days, she called once again, only for them to inform her this time around that they needed an additional 30 days on their end.

Then, for the next several months, Farah was told the same thing — to wait 30 more days. She even ended up hiring a professional to help her speed along the process, but it didn't help. Finally, after nine months — and after Farah threatened to report the insurance company to the state — the company sent over the approved contract within days, and Farah immediately signed it.

After signing, she followed up with the insurance company to make sure she was good to go, but they told her to wait another 30–45 business days for them to execute the contract.

Finally, after a full year, the contract got executed, so she could start accepting insurance...

CBS

...however, after she saw her first client with insurance, the insurer denied the claim. Farah has had to go through numerous hoops (and is now waiting 30–45 more business days) while not knowing whether she is actually going to get paid. You can watch her Part 2, which details everything, below:

BuzzFeed spoke to Farah, who owns the Hive Therapy Collective, a budding group practice that is rooted in values around social justice, increasing access to care for mental health, client-centered practices, and also work-life balance for staff.

Farah made her TikToks to show just how egregious the process of getting paid by insurance can be.

"I was reflecting on the last year and how I was so frustrated about the opaque nature of the whole process, and realized for myself firsthand why so many therapists avoid insurance reimbursement for services. I also see comments all the time about how therapists charge too much or don’t accept insurance, and how therapists should do more to make it accessible to have mental healthcare. I don’t disagree with those statements to some extent, but we therapists catch a lot of the blame around accessibility, and the conversation about how we meet the roadblocks I’ve named here are rarely highlighted," she said.

Over the last year, she estimates, she has spent 60–70 hours on the phone with this insurance company. "I have been given incredibly confusing and conflicting information, and had deadlines they set to begin with extended with no warning and no reason provided. That time is all unpaid. It's so wild to reflect on that," she said.

Farah feels that everything professionals have to deal with when being paid out by insurance companies is overwhelming, difficult, and confusing. "I do understand that there are a lot of moving parts, and I want to be clear, I don’t currently have a better idea in mind that I can write down and present to the world. But this all just feels a little bit too much like insurance companies don’t want to pay for mental healthcare, and like our government isn’t paying attention," she said.

"There are currently very few benefits to accepting insurance as a therapist — the biggest being the fact that it makes care more accessible to the public — but I want people to see the realities behind it too. For every clinical hour I see a client with health insurance being their source of payment, I spend at least two hours on the back end dealing with it, totally unpaid," she explained, emphasizing that she has to submit a claim for every single session or service provided.

All Farah wants is more conversations around care for mental health, accessibility, and ways that big systems (like insurance companies) make it harder to provide accessible care. "Let's not forget that what we are talking about here is the difference between someone being able to afford getting the mental healthcare they need and…well, not being able to."

With that in mind, Farah shared with us a few "call to action" items for insurance companies, the US government, and practitioners like herself:

FOR INSURANCE COMPANIES:

1. Pay clinicians more, what they are worth.

2. Don’t gate-keep therapy from folks whose conditions don’t meet your approved list of diagnoses.

3. Make the process to get on insurance panels (groups of healthcare providers that an insurance company will pay for services given to their customers) shorter, easier, and clearer.

4. Make the process to follow your guidelines for documentation clearer and easier.

5. Don’t claw back money from clinicians unless something illegal or unethical happened. (A "clawback" is when an insurance company, even months after claims have been paid out, requests records to review for medical necessity and literally go into your bank account and take the money back. You can read more about the clawback contractual provision here.)

6. Make the process to talk to representatives easier.

7. Let therapists talk to their colleagues about how much money they are making so they can negotiate better, because they aren’t legally allowed to share what their contract pays out.

FOR THE GOVERNMENT:

1. Step in and regulate application timelines.

2. Regulate what insurance companies can do to deny claims and claw back money.

3. Set policies that make mental health a clear and core part of healthcare.

4. Step in and regulate tech companies that are engaging in opaque and unethical business practices in the mental health field.

5. Consider student loan or tax benefits for therapists who are paneled and actively seeing clients with insurance payments.

FOR THERAPISTS:

1. Get comfortable sharing information with your colleagues. Obviously, don’t violate your contracts or do anything unethical or illegal, but teach one another.

2. Be open to consultation about getting paneled and billing.

3. Keep having these conversations with your colleagues AND your elected representatives.

Farah also wrote an article that highlights everything you need to know about therapy — you can read it here.