The Modern Health Care Team is trained to match you with the best possible provider based on your unique preferences and their deep understanding of our provider network. While we try our best to accommodate the requests of all Modern Health members, we want to ensure we are transparent as to why we may be unable to match based on insurance.
We pride ourselves on our diverse network. Our priority is to ensure we can bring you providers who serve all identities and care topics and as such we do not limit our network based on insurance affiliation.
Insurer Network Constraints
We would love to have the same network diversity and providers that both accept insurance and have availability. Unfortunately, to-date we have been constrained by both the limited number of providers who accept insurance and by the limitations of those providers who do.
There are a few common reasons therapists say they do not accept insurance:
- Insurer Policies: Many providers have shared concerns regarding insurer policies, indicating that the policies do not promote their clients’ optimal well-being.
- Reimbursement Rates: On average, insurers only reimburse providers for 25% to 50% of what they typically charge (i.e. market rate). Note: There are multiple factors insurers consider when determining rates and one such factor is the density of providers in a given location. As a result, providers in metropolitan areas (e.g. New York, San Francisco) are disproportionately impacted.
- Administrative Overhead: A significant administrative burden is placed on the provider requiring use of unintuitive systems and rules, which ultimately reduce the clinical hours they have available for clients.
For therapists who accept insurance, there are a couple of additional factors that create constraints when matching by insurance:
- Insurer Network Diversity: A provider may provide coverage through your insurance, but may not be a good fit based on their specialties and your care needs.
- Limited Provider Availability: Providers who accept insurance often limit the number of clients they are willing to accept through insurance. For example, a therapist may choose to fill a few slots with clients using insurance, and the remainder of their practice is reserved for those paying out-of-pocket.
Please note, we sit outside of insurance so we recommend contacting your insurance plan directly if you would like to explore other options through your health plan.