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Direct pay versus third party pay

When starting up Headwaters Wellness and Counseling, the question of “To Empanel or Not To Empanel” with insurance companies weighed heavy.

On the one hand, becoming empaneled would ease the initial financial burden for clients, who would not have to up front the cost of counseling. This was a compelling factor, because when we are struggling emotionally, it’s a relief to not have to factor in finances. Unfortunately, this benefit can be short-term, especially once clients get the EOP that says they have not met their deductible and must pay for service in full.

The other hand of empaneling is that to do so would require a not-so-subtle shift of attention from counseling to the business of counseling.

Empaneling with third-party payees subjects licensed professional counselors to receiving wildly different compensations for the same service. Ethically, a counselor must abide by standards to provide the same best service possible for each client, but insurers get to choose how much to compensate this service. These rates vary wildly. A counselor cannot counsel less for the client whose company pays 50-75% of what other insurers pay.

Having a direct pay counseling practice allows for more focused attention to clients. Direct pay can keep client numbers down, which can enhance the quality of care provided. Headwaters has chosen a direct pay fee structure to help its focus remain on counseling, and not business.

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