No, I Don’t Take Insurance—Here’s Why

As a Psychologist who specializes in psychological testing, every day, people ask me whether I take insurance. Some are just checking, not really expecting me to accept it. Others are hoping to use their insurance, so they move on in attempts to seek out in-network providers (that often don’t exist). Then there’s a group that, upon learning I don’t take insurance, becomes very angry. Once, someone even told me, “You’re what’s wrong with the healthcare system in America. You’re why we’re in a mental health crisis.” While I understand the frustration of not being able to use insurance, it still hurts to hear such things. It’s not about greed, nor is it my intention to limit access to care. In fact, I would love to take insurance—I did for nine years. But ultimately, it became an unsustainable business practice, and the fault lies with the insurance companies.

A recent ProPublica article discussed why it’s so hard to find a therapist who accepts insurance. The points made in the article hit close to home—insurance companies dictating care, delayed or non-existent payments, and low reimbursement rates. But when it comes to psychological testing, the barriers are even more significant, and that’s what I want to address here.

The Administrative Burden of Insurance for Testing

Most insurance plans require pre-authorization for testing. This process is often lengthy and, in the end, the insurance company might decide that you, the policyholder, don’t need testing. This decision is made by someone who has never met you and doesn’t understand why testing is crucial to your treatment. It doesn’t matter that you and your Psychologist have determined that testing is the best course of action—insurance has the final say, and they may decide not to cover it, even if it’s listed as a benefit in your policy.

Sometimes, insurance companies grant pre-authorization and assure that they’ll cover the testing. But after the testing is completed, they may change their minds and refuse to pay. This leaves your Psychologist unpaid, meaning either you get stuck with the bill, or the Psychologist ends up working for free. No one wants to work for free—imagine if your employer decided not to pay you for several days of work. It’s not a situation anyone would accept.

Even worse, insurance companies sometimes pay the Psychologist and then, a year later, demand the money back. This is called a clawback, and it has happened to me. Sometimes, it’s a significant amount—thousands of dollars. Imagine your employer taking back several months’ worth of pay a year after you earned it, with no recourse available. Sudden, large financial losses have forced some mental health practices to close their doors, as they simply can’t afford to absorb such significant hits, leading to financial distress for Psychologists and their families, as well as the community who has lost access to a mental health practice.

Limited Coverage for Psychological Testing

Another issue is that insurance often doesn’t cover the psychological testing services clients need. For example, many insurance plans don’t cover ADHD and autism testing for adults. Sometimes they don’t even cover ADHD and autism testing for people over age 12! As someone who specializes in neurodiversity-affirming care, these tests are a significant part of my work. Even if I accepted insurance, many clients wouldn’t get their testing covered because insurance companies have decided these services aren’t medically necessary for adults. Shouldn’t medical necessity be determined by you and your Psychologist? Unfortunately, not when insurance is involved.

The Problem with Reimbursement Rates

Insurance companies also don’t reimburse Psychologists at fair rates for testing. The payment Psychologists receive is called the “negotiated rate,” but there’s nothing negotiable about it. Each insurance company sets this rate, which is often about 75% less than what I charge. From that reduced fee, I still have to cover the cost of tests, rent, employee salaries, and other business expenses. After doing the math, I realized that with current insurance rates, I’d be making about $4.00 per hour—and that’s before taxes. No one can live on $4 per hour, and I don’t think anyone would argue that it’s reasonable.

Insurance companies pay higher rates for therapy per hour than they do for testing, even though therapy has fewer associated expenses. Unless insurance starts reimbursing more for testing, it’s simply not sustainable.

The Reality for Small Practices

There are still some places where you can use your insurance for psychological testing with an in-network Psychologist. However, these are usually large clinics or hospital systems that can absorb the financial loss. Testing is a loss for them, but they offer it to provide access to care for those who need to use their insurance. Small private practices like mine can’t afford to operate at a loss. I wouldn’t be able to keep my business running or support my family if I were constantly operating at a loss.

Conclusion: Why I Don’t Take Insurance

These are just a few reasons why insurance is problematic for testing Psychologists. It creates an administrative burden and forces us to live in fear of losing income. It’s not that we’re greedy or don’t want to help people. Quite the opposite—we entered this field to help. For those of us who don’t take insurance for testing, it genuinely hurts that we’re limiting access to care for people who rely on insurance for their mental health needs. But it’s not fair to ask us to do what no one else would—work for less than minimum wage, work for free at times, and live in constant fear of having our earnings taken away. It’s not sustainable for our businesses, and it’s not sustainable for our families.

So the next time a Psychologist tells you they don’t take insurance, be angry, but direct that anger at the right people. It’s not the Psychologist’s fault for trying to keep their business afloat and support their family. It’s the insurance companies that you pay every month—those who promised to pay for your care, but aren’t holding up their end of the deal.

Where Can I Find Psychological Testing Near Me?

If you are looking for psychological testing, I’m happy to help. I specialize in ADHD testing, autism testing, and mental health testing for adults and children. Testing is available in Nashville, TN or virtually to people in most states.

Contact me today and let’s talk about testing!

Author: Heather Joppich, PhD

Dr. Joppich is a Licensed Psychologist and owner of Zephyr Care Mental Health. She specializes in neurodiversity-affirming assessments for autism, ADHD, and mental health concerns.