Before we dig into the reasons that we don’t accept insurance...
...at The Matrix Repatterning Therapy Center of Minnesota let's list a few phrases and ideas that we will expand upon and then tie together. They are: "Usual and Customary" services, Understanding an Insurance Adjusters Real Job, How Much it Costs to File and Attempt to Collect Insurance Payments, and, How That Effects the Time and Attention You get From the Doctor and What That Costs.
Those phrases and ideas listed above which I’ve experienced as a practitioner for over 31 years are the concepts I had to pull together as I made my decision years ago to not accept insurance as payment for my (our) services.
"I was trained as a clinician to make the best possible decisions that I could for each client."
Most importantly, I was trained as a clinician to make the best possible decisions that I could for each client. During the first part of my career, accepting insurance as payment for services, I found that increasingly, the insurance adjuster, or even a representative paper reviewer somewhere in the world was deciding how much and what type of care my clients should get when they never met the client, never examined the client and usually had no medical training whatsoever.
Cost containment is an important concept. Playing doctor when you are not one should be illegal, and it is, except when insurance companies dictate care.
Given that, I found that I could not do my best work as a clinician for clients that needed my best. It is frustrating as a clinician. I wanted to do better.
“Usual and Customary”
One of the concepts that insurance companies use to decide whether they will pay for care or how much they will pay for care is “Usual and Customary”. They are the judges of that and I will grant them their right to do it.
It is generally based on industry standards and averages of fees in a geographical area. If an adjuster or insurance company deems something “Not Usual and Customary” they will deny payment for the care. An insurance adjuster’s real job is as much to look for reasons to not pay a claim as it is to pay claims.
The intersection of Matrix Repatterning Therapy here is that it is a type of care where the Clinician spends an hour with you on each visit (Not Usual), doing a type of therapy that is unique (Not Customary), and can easily be judged by an insurance adjuster as “Not Usual and Customary”.
Very few clinicians get to spend an hour with you on each visit and I’ve heard the concerns from many clients over the years about how little time they get with their doctors and how much that little time costs.
So far, you may say, “So what. Just submit the claim and find out”. I wish it were that simple. You see, to have the time to file insurance you need a full-time staff. The staff greatly contributes to overhead. The filing of insurance takes more of the Doctors' time. Then, a significant increase in paperwork requests show up at the office by the insurance company looking for more documentation of care which the doctor needs time for.
"To have the time to file insurance you need a full-time staff."
Now, the Doctor has a significant increase in required paperwork. And he or she now has just had a large increase in overhead while at the same time, they are waiting for insurance reimbursements that may or may not come. Can you see what is coming next?
Next, the doctor is forced to have fewer patient hours because he or she needs time to follow up on the insurance billing and paperwork requests. The doctor then needs to raise rates to make up for the time he or she is not earning. Then, because so much of the billed services are being arbitrarily paid by the insurance companies, the doctor needs to raise his or her rates more and see more people in that same hour.
And, since Matrix Repatterning Therapy, done by only 26 practitioners (as of 2023) in the U.S., can be judged as “Not Usual and Customary”, the client is left with a higher bill than if no insurance is accepted and those people without insurance or have minimal insurance will now have to pay a much higher rate. That is how the system works. I’m not judging it. I’m explaining it.
Many years ago, I decided that I wanted to provide services that could help people in the way I wanted to help them. I said “no more” to being pigeonholed into providing services that demanded I give less to my clients than the best service I could give.
That’s our commitment at the Matrix Repatterning Therapy Center of Minnesota.
We understand that does not work for everybody, but the other system doesn’t either. We feel, that for the appropriate clients, Matrix Repatterning Therapy is the best service we can provide, and we can’t do that in the context of how our insurance reimbursement system works at this time.