WASATCH LEARNING & WELLNESS

Navigating our health insurance system can be difficult, frustrating, and disheartening. Finding, accessing, and getting reimbursement for mental health services is often even more challenging. Yet many providers, including Wasatch Learning & Wellness (WLW), have chosen not to work with any insurance companies. Though this is a conscious and deliberate decision for our company and the psychologists who work with us, we also understand that it may feel especially challenging when trying to access the highest level of expert support and care for you or your family member. This article hopes to explain some of the reasons why psychologists who work with WLW (and many others) have made this choice.

Individualized Care
The psychologists who work with WLW deeply value the ability to provide assessments and recommendations tailored to an individual’s needs. Our testing is guided by the questions that you, your child, and their treatment providers want answered. We customize each testing battery to best answer these questions and to provide the most comprehensive understanding of your child’s current strengths and weaknesses that is possible. This ability to offer personalized, evidence-based assessments is a key value for us, and it is one we would have to compromise by working with insurance.

Unfortunately, treatment and assessment plans are often dictated by insurance companies. They place restrictions on the number of hours we can spend with an individual, the types of testing we can use, what diagnoses we can search for, and more. Part of this stems from insurance working from a “medical model,” which operates from the assumption that an illness or deficit must be present to receive care. Regardless of the extensive research on preventative medicine or the vast gulf between what is considered “functioning” and what is truly healthy, you must be diagnosed with a disorder to receive reimbursement from your insurance company. This means that if you do not meet criteria for a psychological disorder, you cannot receive reimbursement by most insurance companies. Even then, some diagnoses are not considered debilitating or ill “enough” to reach the reimbursement threshold. Insurance companies focus on “medical necessity” and will often only reimburse what meets their individual criteria. For example, insurance companies rarely see the diagnosis of learning disorders and their impacts as a “medical” issue and, therefore, refuse to cover the testing required to diagnose any learning disorder. However, many of us know what an enormous impact learning disorders can have in life – if left untreated, they can impact a child or adolescent’s educational attainment, reduce their self-esteem as they fall behind their peers, create or perpetuate mood disorders, and much more. Identifying these (and many other diagnoses) is often the first step to developing an awareness and understanding of their impact and seeking treatment to reduce the symptoms and their impact on the individual and their family.

As a part of providing individualized care, we spend significant time meeting with you and your child, collecting and reviewing past historical data and records; scoring and interpreting assessment measures; and writing a detailed, personalized report. We also peer review each and every report before releasing the final written document, and then work with you, your child, and their treatment team to understand the implications of the report findings and the evidence-based recommendations. This can be a long, complex process, but is often a useful and rewarding one. It is what we love to do! However, insurance companies do not reimburse for all of this time, and trying to work with insurance companies typically adds hours of additional paperwork and phone calls to this process and, in truth, reimbursements are often minimal and do not cover our time and services.

Privacy and Confidentiality
Many of us, when we work with insurance companies and have providers sending information about us back-and-forth, have no idea just how much detail these companies require. We expect that our information is private and confidential, as our mental health providers and doctors often reassure us. Unfortunately, your privacy and confidentiality are much more limited when you work with insurance. The vast majority of insurance companies hire non-mental health staff to review your documentation when you make a claim. They can audit your providers at any time, demanding to see every note or every piece of your psychological and medical history. This means that your providers (who take insurance, not PSI) may be required to share every nuance of your child’s history; and, to maintain compliance, the providers have to allow that access. In addition, insurance requires ALL diagnoses and other personal information to make your claim (without guaranteeing any kind of reimbursement). We want more privacy for you and your family, not less.

It is important to understand the implications of these standards. Staff at insurance companies (again, often not trained mental health providers) can review all the documents related to your care – treatment plans, care notes, full assessment reports, and more. Companies state that they are typically auditing this info to search for fraud, to see if you’re overusing your insurance benefits, or review if there are “other” treatments or interventions that could still, hypothetically, meet your needs while saving them money. This is also how many companies determine the medical necessity to qualify you for reimbursement. That means whatever you or your providers share with your insurance company may also impact your coverage. Again, most insurance companies require diagnoses for any reimbursement, which then go in your permanent medical records. Even if you recover from certain diagnoses or no longer meet clinical criteria in the future, those diagnoses will remain as a part of your history forever. And, in the United States, insurance companies may later ding you for “pre-existing conditions” due to these previous diagnoses – whether you still experience the symptoms or not (there is no guarantee that the pre-existing protections that are in place now will remain in place over time). That may mean you or your child cannot get coverage or may end up paying much higher rates in the future. Sharing these diagnoses and details may not only impact your insurance coverage, but can have farther reaching implications that providers cannot control. For example, some diagnoses may impact your ability to get additional insurance coverage, qualify for life insurance, work in employment that requires any security clearances, purchase a gun, and more. We believe that you should be in control of your mental health/medical information, not your insurance company, and we do not want to be responsible for submitting information to your insurance company that you may not want in your or your child’s medical record.

We Focus on Quality
While we want to believe that insurance companies are designed to provide us the support we need when we are sick, struggling, or striving toward better health, they are, in the end, for-profit businesses. We cannot provide you with excellent services (or even spend as much time with your child as we want) if we practice under the insurance model. With low reimbursement rates, many providers have to take on more and more clients so they can make ends meet, pay their operating costs, and continue purchasing the expensive testing materials used in these psychological assessments. But more clients means less individualized attention; less time to write our detailed, thoughtful reports; and more time spent grappling with reimbursement issues. We maintain a small, dedicated staff who are focused on

the heart of our operation – working with you to provide the best assessment services possible. The burden of insurance requirements would shift this focus from the heart of our operation, which is not acceptable to us.

Complexity of Care
Wasatch Learning & Wellness and the psychologists who work with the company are focused on you, your child, and your family. We want to meet your needs; not insurance companies’ needs. To become an in-network provider, each insurance company has its own standards and rules to meet; these also vary drastically from state-to-state. Given that we work with people from all over the United States (and the world), this would require us to work with hundreds if not thousands of different healthcare plans, companies, and their offshoots. These individual differences typically end up requiring more time and financial resources to be dedicated. This, in turn, drives up our operating costs and reduces our effectiveness.

Taking a Stance
Our reasons to avoid contracting with insurance are also societal. As providers cope with this difficulty across the country, costs for mental health care continue to grow and providers are driven away from the parts of the jobs they love. For this reason and the reasons given above, we have chosen not to work with any insurance companies as contracted providers in an effort to take a stance and encourage the system to change over time. This change is very gradual and often painful, but we feel it is important not to collaborate with a system designed to profit from reducing or denying the care recommended by our patients’ treatment providers. Rather, we want to give each and every person the kind of individualized, focused, and caring mental health treatment they need and deserve.

These are only a few of the reasons we do not work with insurance companies at this point in time. We certainly do not feel that this kind of personalized psychological assessment and care should be restricted to the wealthy. Yet all of these reasons (and more) drive us to remain independent; it is more important to us that you or your child receive the best possible care, directed by experts in their fields, and receives an assessment in-line with these recommendations to better understand, support, and tailor your future treatment work.