In the nearly eight years since we opened our doors in a small office with just the two of us, working part time while still working full time, we have seen a dramatic shift in how health insurance handles mental health benefits. It used to be that if you had an insurance company you knew they covered your mental health care as well. All you had to do was call and they could tell you, with certainty, who they covered as a provider for you.

It was simple.

And now it is not. 

Now your insurance company may have ten or fifty different plans. Each of them may have a different coverage for mental health care. Some of them may be “carved out” to a third party, which in turn has multiple levels of contracts with different providers. Some of those third-party companies have now merged, changing the contracts even more.

It is, in a word, a muddy mess.

You may be told we are a covered office, but the person on the phone with you from your insurance company may be looking at a list from last week. The company may have changed the formulary for coverage yesterday. You are told you must pay your co-pay. You are not informed you still have a huge deductible that you owe, and they will not pay for your care until you pay that. You come in thinking that we only need to be paid a small amount, and we discover that there is a much bigger amount owed. Or, worse, that they were wrong, and when we called they we wrong, and you are not covered at all.

This month alone we have had twenty different claims denied that were “confirmed” for coverage when we called for verification. We now must notify twenty families that we are going to have to enforce the contract with them that states that of the insurance company does not accept responsibility for the fees that client is responsible for the entire bill.

Trust me when I say none of us likes those moments. We are in this business to help people. We don’t want to tell you ten visits later that you have no coverage. But we have no control over any of it. Some companies take six months to reply to billing. We can’t speed them up- we are at their mercy as much as you are.

But we are stuck. We must pay our bills and pay the staff that greet you and the therapists that work closely with you. We must be able to cover our costs and to be able to keep our doors open.

We are absolutely 100% committed to continue to provide you with the best possible clinical care. To have staff available to you as you have become accustom. However, we can’t do that if we continue to not be paid by insurance companies. We simply can’t. We have all earned master’s degrees, kept our training current, and we have our own families for whom we are the providers. We simply can’t afford to provide services while hoping fees will be reimbursed. Then that shifts the burdened to you, our clients to cover the costs. Due to the insurance companies, not willing to fulfill their contract with us. It is no different than your dentist, your doctor, or even your massage therapist. They all require payment prior to services being rendered.

As a result, and after wrestling with our budget, our consciences, and in recognition that we are providing a valuable service and that we are professionals providing them for you, we are changing our policy regarding accepting insurance.

We will no longer bill most insurance companies. We will be happy to provide a superbill for our client’s monthly that you may submit to your insurance provider for reimbursement directly to you.

We will expect payment of our full fees at the time of service.

A superbill is a specialized receipt or invoice that contains specific information. Insurance companies require this information to consider requests for reimbursement or requests that your charges be counted toward your yearly deductible or co-insurance amounts. Please note that ultimately it will be your insurance company’s decision to reimburse our fees or not. Please check with your insurance company to see what your reimbursement rate might be.

We truly wish we did not have to come to this decision – it was not easy – but we simply do not have any other choice at this point.

We thank you for your continuing trust in the value of our services.

Sincerely,Sherry Shockey-Pope, LMFT & Jill Johnson-Young, LCSW

San Bernardino County Community Resources

Riverside County Community Resources