More Nevada clinicians go cash-only, limiting accessibility to therapy, counseling

More licensed therapists and counselors in Southern Nevada are leaving private insurance networks and accepting cash-only payments, mental health leaders say.
Published: Oct. 10, 2022 at 8:49 PM PDT
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LAS VEGAS, Nev. (FOX5) - Nine out of 10 adults believe there is a mental health crisis in the US, according to a recent poll. Still, on World Mental Health Day, there is a concern in Las Vegas that people who need help are not able to get it.

That is because more licensed therapists and counselors in Southern Nevada are leaving private insurance networks and going cash-only, according to Dr. Sheldon A. Jacobs, a local mental health leader who sits on the National Alliance on Mental Illness, or NAMI, Board of Directors.

That leading expert said it has created an environment where more locals are having trouble finding any in-network licensed therapist.

“For a lot of individuals that are practitioners, a lot of them, they don’t want the headache!” said Jacobs.

Jacobs was the first Nevadan to be elected to the board. Now, he is sounding the alarm on a problem he says many Nevada therapists are dealing with; ones like Las Vegas-based Stefanie Flores, who told FOX5 in a Tweet, “I’m a private practice therapist who has chosen not to accept insurance because of the nightmares they put therapists through.”

Licensed counselor Courtney Dandy-Fralick has a similar experience. She said that the delay in getting reimbursed by insurance in many cases has made it extremely difficult for her to keep her therapy business, The Healthy Foundations Center, afloat.

“We went for-- I wanna say we went for maybe nine months without getting paid for any services we had done,” said Dandy-Fralick.

Jacobs said long wait times to get reimbursed is a situation that is happening all too often for clinicians.

“Especially these private insurances, how can you be more efficient when it comes to reimbursing practitioners for their services?” said Jacobs. He is now working to put focus on this issue.

He said some insurance companies are paying providers at low rates as well.

“Some insurances tend to pay at a much lower rate than what somebody could get in the cash-pay sector,” said Jacobs.

Dandy-Fralick said even initially getting on an insurance network is a lengthy, complicated process.

“I don’t believe we have a shortage. I believe that when you become licensed as a therapist, you can only take cash until you get enrolled in insurance, and if the process to enroll in insurance is too cumbersome for people, they will just stay as cash-based therapists,” said Dandy-Fralick.

The mental health experts both said this is hugely consequential.

“More clinicians are also leaving Medicaid,” said Jacobs.

They said the issue is affecting access to services for populations with the highest needs.

“Mental health becomes a case of the haves and the have-nots,” said Dandy-Fralick.

Jacobs added, “There’s less to choose from through their insurance.”

Las Vegan Matt Keeler agrees. When he sought therapy recently, he said there wasn’t much to choose from.

So when he went to seek a cash-pay therapist, he said he had sticker shock, and decided against doing therapy at all.

“The first thing that sticks out though is the price, and um... it’s literally like a gut punch,” said Keeler. “It’s like, you think like you’re proud of yourself, for like, wanting to get help and like reaching out and thinking, ‘Hey I’m doing something.’ But then when you see it’s like $250 to 300 a month, it’s like, ‘Wow.’”

He continued, “That in and of itself is like a car payment.”

The question is also whether state and local regulators are aware of these issues with red tape for therapists.

FOX5 will continue investigating this.