Is it Better to be a Psychotherapist, Counselor, Psychologist -- or Work for Wal-Mart? : Insurance Absurdity, No Show Clients, and Lots of Student Loan Debt

Is it Better to be a Psychotherapist, Counselor, Psychologist — or Work for Wal-Mart? : Insurance Absurdity, No Show Clients, and Lots of Student Loan Debt

June 12, 2008 – 9:49 pm

A recent article in the Massachusetts medical publication, Proto, titled “Trouble in Triplicate” states that billing for medical services now accounts for close to one third as much as providing medical services! The problem, at its core, involves the complexity of administrative processes necessary to file with insurance companies that have un-standardized insurance plans, benefits, claim submission guidelines, and a tendency to make the process of submitting claims as arduous as possible. According to the article, Insurance companies have become absurd, now rejecting 15% claims the first time they are submitted, without cause!

For no reason whatsoever, Insurance Companies Reject 15% of all Claims the first time they are Submitted.

For mental health providers, the situation of filing for insurance reimbursement is even worse (when compared to physicians). For one, the rate that counselors and psychologists make is significantly lower than medical doctors, so there is less margin to contract the task of chasing insurance money out to an administrative staff (on that note, I was contacted just last week by a person cold calling, wanting to “help me” by taking over my billing. His fee was 7.9% of my counseling fee, plus a monthly “subscription fee” of $150 dollars).

So you Decide to Accept Insurance, and then! …

Still, counselors are clamoring to get on insurance panels. Why? Because many clients are unwilling to pay out-of-pocket for counseling therapy services. They pay their high insurance premiums every month and therefore consider counseling to be a service that “should be free” to them. That’s fine of course, except that in some place, such as Boston, Massachusetts (where I live and practice), the majority of Insurance panels are CLOSED. Be a new therapist and try to get on any of the major panels: Blue Cross / Blue Shield – CLOSED. Harvard Pilgrim – CLOSED. Tufts – CLOSED.

Do you Know what the “Average” Counselor is doing?

These circumstances have contributed to a situation where the average person with a Masters degree in counseling is, well, not a counselor! In a discussion with Dwight Bain, owner of LifeWorksGroup in Orlando, FL, he explained that the average person with a masers degree in counseling is “Working as a secretary in an insurance office” (paraphrased quotation).

Do Psychology Majors have Mental Problems?

For those counseling graduates (Graduate Level) who do go into the business of providing therapy, most make only 30,000 a year, without retirement or benefits. This is with a graduate degree! The situation is so bad that Forbes Magazine recently published an article that declared Psychology to be the absolute worst subject to major in, in college—the job prospects and potential income is that poor. Forbes stated, “persons studying Psychology must have mental problems” (paraphrased quotation).

Is it Better to Work at Wal-Mart?

The picture for graduate counseling students, and practicing therapists, gets even worse when you compare working as a counselor to the alternative of working for Wal-Mart. A person working for Wal-Mart straight out of college, after 5 years, will be making about 45,000 plus health care and retirement. With a Masters degree the Wal-Mart employee has the potential to break 100,000 dollars a year, and after 10 years their health insurance is covered for life. Meanwhile the counselor, just out of school is a hundred thousand dollars in debt, still unlicensed, with no clients and no job prospects.

“I can not change others, I can only change myself.”

What is the take home point here? That the system needs to change? If you are a counseling student, or a new therapist, you know the idiom, “I can not change others, I can only change myself.” Consider strongly the trials and struggles you will face as a therapist, talk to other therapists and learn from their experiences. Don’t just assume that everything will work out (Logotherapy would call that “specialness”), that somehow you will be the person who lands the great job, or has the thriving counseling practice.

It is possible to be a successful counselor, but your will need to be good at counseling, managing a business, marketing, organized, willing to struggle for a number of years, and mentally strong and healthy. Good Luck!

P.S. I wrote this while getting stiffed by two clients in a row (first sessions).