After more than 25 years of working within a managed care paradigm, I have spent the past year transitioning into a Private Pay Practice. 

In my early years as a private practitioner, I can remember scrambling to apply to any and every insurance panel out there. For several years, as more and more of my colleagues discontinued accepting insurance of any kind as payment, I continued to struggle internally, my mantra remaining “People pay a lot of money for their health insurance and I feel a sense of responsibility to see they are able to use it”, while at the same time becoming increasingly more ambivalent and mistrustful, particularly of the big HMOS! I became increasingly more suspect, especially for the “privacy” of my clients. 

Within this last year, I was made aware of the perils of managed care. A client I had known for many years as a responsible person evidently had applied for long term care insurance and was shocked to find out her premiums quoted her were four times higher than other people she knew who had recently been accepted. After some investigating, the problem was, indeed, a depression diagnosis with two years of psychotherapy and she was seen as a “higher risk” as a result!

My new mantra has become “eliminating third party payment allows me to work more freely and collaboratively with my clients”.