Updated: Jun 7
If you don’t know how health insurance or big box medical platforms work, hold onto your hat for this bumpy ride.
Big box platforms that accept insurance cut deals with insurance companies to only charge X amount/insurance companies make a deal that they’ll only pay X amount. Providers on those platforms receive a small percentage, the big money stays with the insurance company, second largest pile with the platform, and a very small pile spread amongst the providers helping both earn money. Perhaps an even more interesting behind-the-scenes deal is that major insurers are often investors in or owners of these platforms, doubling their money.
Translation: these companies get together and decide who pays what for healthcare, without you, the consumer at the negotiating table. You get to sit back and hope that the right deals get struck that allows you to be able to continue using your preferred platform/provider/therapist, etc. If they don’t, what do you do?
You may move over to another therapist or psychiatrist, true. That leaves you starting at square one. These deals also leave therapists and other providers looking…well, we look like money hungry weirdos at best. We look like we’re fine with your insurer bailing on both you and us and your treatment; we look like we’re fine with you being forced to either abandon treatment or choose to pay a huge cash fee to continue to see us through the platform you originally connected to us on.
Those things aren’t true. Our hands are tied by non-competition clauses pushed on us by major health insurers and their chosen platforms. We’re told we can’t provide you with our email addresses, private practice phone numbers, or social media accounts. We’re told that we can’t tell you that if your insurance stops being accepted by a particular platform, that you can find us on a different one or come through our private practice, which may save you loads of money and prevent you from having to start all over with another therapist.
If we were to do any of that, we would violate our contracts with these platforms. Why would we mind that? We struggle with that because they have millions of dollars at their disposal to sit at that negotiating table and make sure they get the best rate, while those of us not with those platforms are left fending for ourselves. They also have millions of dollars to spend on advertising and making it so that anytime someone types in “counselor” to their search engine, they’re the first options that show up. The rest of us are lost in the noise and not able to connect with our niche groups.
The ethical predicament this places counselors in is one that concerns continuity of care. Continuity of care means a few things in the healthcare industry, but here it simply means the ability to receive cohesive, sensical, organized, and streamlined care.
When you show up for your first appointment, you begin building your relationship with the therapist you chose. This relationship is the biggest predictor of good outcomes in counseling. You tell the therapist all about yourself, your goals, and that therapist creates a plan with you to get you from point A to point B.
If you’re 6 months into your treatment and suddenly your insurer decides that you can’t get counseling via the platform you signed up on, your therapist’s hands are tied. They violate the contract if they tell you what other options there are for continuing your treatment with them. Meanwhile, if a decision is in the best interest of a client, a clinician should be able to cite ethical and continuity of care reasons for offering you other options, but if the platform finds out about this, it rarely ends well.
There are some serious issues with this kind of non-competition agreement. These corporate rules prevent employers from hiring great talent, they keep people pinned into jobs where they’re unable to do the work they’re passionate about, and they limit competition in the market. At present, the FTC is working on drafting a rule to disallow these sorts of non-competition clauses that interfere with your ability to get the best service across any industry – not just healthcare.
I urge you to consider reading up on this proposal by the Federal Trade Commission here and to leave public commentary urging the FTC to take action to limit these sorts of noncompete agreements and especially when it comes to your healthcare, both for employees of hospitals/insurance companies/healthcare platforms and for independent contractors who work in those settings.