- Financially Better for Clients. This maybe counterintuitive, but paying out of pocket for many healthcare services has been shown to actually be the same or less expensive. The average number of sessions I see clients in a year is 21. Here’s the math: 21 Sessions x $159/session = $3339. That’s a big chunk of money. But…whatever is not reimbursable to you by insurance is often tax deductible. Most healthcare expenses can also be paid directly with an HSA or FSA. Additionally, more and more families are choosing high deductible, lower fee plans. Pay $5000 deductible and then insurance kicks in. That’s after you’ve paid your $833/month.
- Less Complication. It takes longer to verify insurance, verify their plan covers my services and ensure they can be seen It is a fact that every document or form that needs to be sent to insurance is an opportunity for them to avoid financial responsibility. I’ve had dozens of situations where my office manager would send in a form and the insurance company would first claim they never got it. We’d resend it. Then they claimed it was not completed correctly. Resend after corrections. Then they would claim it was incomplete. This game can last up to a year (I’m still getting payments from insurance claims filed over a year ago).
- Clinical Decisions are Not Driven By Insurance. I’ve had way too many instances where an insurance company told me or the family that the client ‘no longer met criteria for services.’ What? How the heck would they know that? It’s based on the number of sessions they allot, the diagnosis I gave and how much money has been spent. At no time does insurance actually review my notes, talk to the client or family or inquire about the clinical status. No thanks – I don’t want insurance professionals making decisions for my clients. And just in case you were thinking it, I’m not a right-wing, libertarian nut job. This is actually my progressive, liberal side coming out advocating for my clients against huge companies whose sole business model is to take in as much money as possible and avoid contractual obligations.
- Flexibity. No insurance company has ever liked hearing that I’m on-call for clients and use texting, video chat, etc. to continue treatment and support between sessions. They also are not fans of me working with parents in a consulting manner. They don’t want to hear that I provide insider knowledge of treatment programs. None of this fits within their narrow definition of what a counselor should do. I do what is necessary to create stability and promote a healthier life.
- Protection. Until there are safeguards that protect clients from being blacklisted for a preexisting condition (ACA is currently under attack from the Trump administration for this) I’d prefer not be forced by insurance companies to diagnose a client. For me to get payment, I have to provide client’s name, diagnosis code, CPT code (what service I provided), my license information, and my NPI (national identifier for healthcare professionals). If I fail to provide any of that, the claim with be denied. In my opinion, there is no reason why a company needs evidence that a client has a diagnosible condition. I totally understand requiring all the other information but diagnosis is unnecessary. At times, a diagnosis is important for the client or family to hear and understand.
I’ve been working on a project that just is not working. There are so many reasons, some of which are my fault, many of which are out of my control. But let’s move on. I need to pivot. It’s time to do something differently. Pivoting with this means to end that project, change the people involved, 10x my behavior with obsessive focus or something entirely different. There are probably a hundred other possibilities of ways to pivot out of the current trajectory. I am emotionally and financially in the middle of it so I can’t see all the options. I also don’t have an outside mentor or family member or consultant to provide that outsider perspective.
Everyone has stuff they get stuck in. Sometimes it’s really important to suck it up, dial-up your grit and just get through it. We are often pretty whiny and complain about how hard stuff is.
But when is it the right time to quit? When is it time to pivot? This is what I’ve been looking for since so many clients I work with (eg. parents, college kids, entrepreneurs) really struggle with this. I struggle with this.
Here are some observations. There are other times in life when pivoting is important, essential or just part of the game. People pivot playing basketball looking to pass or avoid defense. People pivot when mountain biking – an unexpected downed-tree or squirrel in the way dramatically changes things. People pivot when driving – I’m thinking of all the shredded truck tires I used to dodge when driving on I-40 around Raleigh-Durham. No time to think, just move or risk the car, bike or losing the ball.
What’s the take-home? In those instances, pivoting is reactive, requiring instinct rather than careful planning.
Pivoting in larger life issues maybe requires long-range thinking like how will this impact my family, finances, etc. I think it also requires an outside perspective (new information into the system). Pivot is moving in a different direction based off this new information (…or perspective or paradigm or assumption).
But, research is here to challenge the assumption we need to think through all big pivots.
Researchers, studying choices and life satisfaction found that people were often more satisfied and happier if they committed to making a big decision based on a coin flip.
Yes, a coin flip. A coin flip for quiting a job, ending a relationship, getting married, having kids, etc. Heads….or…..tails.
What? How the…? A coin flip takes the thinking, second-guessing, planning, sleepless nights and hands all of it over to chance. It becomes externalized, kind of like believing that God controls mudslides, getting a promotion, and whether a kid gets into Harvard. It’s no longer mine (internalized) and within my control. It’s up to something or someone else (coin or God).
So, if you need to make a hard decision, flip a coin.
If you need to pivot out of a messy situation or something complicated, get outside information from a counselor, consultant or super smart family friend.
Tomorrow – I’m finally meeting with someone to give me perspective on my pivot. Better late than never.