Psychotherapists, Counselors, Medicaid, Money, & You

Psychotherapists, Counselors, Medicaid, Money, & You

Therapists and $$$$

Many therapists (maybe ESPECIALLY Psychologists) will not take Medicaid. Mostly they say that the administrators of Medicaid are a pain in the rear, that a lot of clients on Medicaid can be very complicated, and last, but never least, Medicaid does not pay enough for those troubles.

OK, I get it. I think it is usually about the pay, but that is only my guess, or intuition, after having spoken to many of these practitioners.

What Therapists Make

Let’s just name the money thing. As a licensed Psychologist, the top-paying insurance companies pay me around $133.00 for a one hour session. Medicaid pays me $87.12. (Licensed Counselors make somewhat less, but I do not know the exact number.) I almost NEVER do one hour sessions, as my clients can confirm. I always go longer, often much longer. Call me silly in that regard, but it is how I work. I think of it as getting paid per session, not hour. Hardly any therapists look at it that way, and I get that.

Some other insurance companies pay somewhere in the middle. None of them pay under $100 except “A Certain Popular Insurance”, which all practitioners gripe about, bar none. THAT insurance company will NOT even pay for a one hour session—only 45 minutes. By the way, they got kicked out of the Medicaid business as of 1.1.19—apparently even Medicaid (Centennial Care) did not like working with them.

Therapists Who Do Not Take Insurance

As many of you know, many therapists out there do not take insurance at all. Many charge $125 to $200 an hour, and some do sliding scale (but usually only for a few clients at a time.) I belong to a lot of social media groups for therapists and coaches, and they usually argue “My time is worth more than that—I refuse to work for what insurance or Medicaid pay me.” Pretty straightforward.

Of course, that means their clientele is willing, and more critically, ABLE to pay that kind of money for weekly sessions. Good for them.

$700 a Month: Therapy or France?

I called a Psychologist here in Santa Fe, with a great reputation, and the fee was about $175.00 an hour, and they took no insurance. Were I to go weekly, that amounts to $700.00 a month.

My thoughts? “I could buy two nice cars for that, or pay my mortgage, or go to France every month for that kind of money.” I ended up NOT doing any of those things, but I also ended up not seeing that person. Sorry, not paying that kind of money, personally. I can actually afford it, and there is no way I am going to pay a therapist that. But that’s just me.

Where Do The Other People go?

So if as a therapist you are doing cash on the barrelhead, you are dealing with only a certain segment of this society—those who have that kind of cash, and are willing to spend it. There are evidently a lot of people around who fall into that category, as evidenced by the ongoing traffic I see into my colleagues’ offices, who I KNOW do not take insurance. But it also means that if you do NOT have that kind of money, or have kids, expenses, educational loans, and other life exigencies that may even CAUSE you to seek therapy, you are NOT going to be able to see those therapists.

I try to have no judgment about that, but again, at a personal level, I am not going to choose in that direction.

FINDING a Therapist That Takes Insurance (Good Luck)

The other complication is that therapists who DO take insurance, and Medicaid, and Medicare, get filled up really fast, because of all the ones that do not. So even if you have insurance (and maybe especially if you have “A Certain Popular Insurance”), you might have a hard time finding somebody who has openings. That’s just the way it is.

Note to New Therapists

A lot of graduate students I know say “I am not going to take insurance. There are other therapists out there who do not, and they are doing great.”

I really, really recommend that you re-think that one. The new-ish therapists that do not take insurance usually have extraordinary skills (with all due respect to you), or work with VERY specialized populations or clinical issues. I see a lot of new therapists who think they can pull that off, and flop miserably. It’s really hard. It’s hard to find clients who will pay you a hundred bucks when you are fresh out of graduate school, with maybe five or ten or fifteen clients behind you.

It is not always easy to get on insurance panels, but if you persist, and if you are maybe willing to work in the next town, you can figure this out, over time. And even then, you don’t get loads of clients right away. It takes time, but you kind of get a steady flow. Clients find you, you tell your friends that you have openings. Things work out.

Yes, maybe later in your career you can get more selective. LOTS of practitioners decide they do not want to work with this insurance company or that one. Many stop taking Medicaid, because they feel they are working for $25, $30, $40 an hour less, and they’re just tired of it.

My Position.

I feel honored to be in this line of work. I used to have “A Certain Popular Insurance”, and now have Medicare. Nobody wanted to take either one. It kind of sucked, but I know the experience of not being able to find a therapist for a reasonable amount of money, or who will accept my insurance.

Probably half or more of my private clients in New Mexico are on Medicaid. They are the coolest clients. Whatever the narrative is out there that “Medicaid clients can be complicated” has not been true for me or my practice. Yes, I make $46 less than I would with a Presbyterian or New Mexico Health Connections client. Yes, I work over an hour (my choice.) Yes, that is a big difference.

But still—it is not somebody’s fault that they have whatever insurance they have. They have needs too. Who is supposed to see them? I cannot find a better answer yet than “Well, I will….” We all make our decisions about this stuff. Maybe I will change my mind in the future.

I am also licensed in Hawai’i, and will be working with clients in telemental health, and even on the ground sometimes. I m getting paneled with everybody I can, including Medicaid, Medicare, and the insurance companies all the Hawai’ian therapists hate. We’ll see how that goes.

Anyway, I wanted to bring some transparency to this discussion. All of this information is probably available somewhere online, but I have never seen anybody talk about what I just talked about, and I thought you might find it interesting…

My contact information is the following:

jamesmicknolan@gmail.com

drjamesmichaelnolan.com

505.699.7616 (I text better than I phone)

546 Harkle Road, Suite B

New Mexico Psychologist License #1382

New Mexico Licensed Professional Counselor #0183411

New Mexico Licensed Alcohol and Drug Abuse Counselor #0183421

Hawai’i Psychologist License #1653