Finding the right therapist is a crucial step on your mental health journey. But navigating the world of insurance can add an extra layer of complexity. While insurance can make therapy more affordable, there are situations where paying out of pocket might be a better fit.
It is not uncommon for new clients to share with me that they have received multiple pages of referrals for therapists in network only to contact 50-100 therapists without being able to hear a response back or to only find that the therapist is full or no longer accepting that particular insurance. Insurance companies often rely on its members to report when there is a flaw on those referral pages, which just adds to the frustration of finding a provider.
Insurance companies often may have limitations on the type of therapy they cover, the number of sessions they will authorize, and limit your choices to in-network therapists. This can restrict you from finding a specialist who perfectly aligns with your needs and prevent therapists from providing the care they believe is best for their clients.
Self-pay opens the door to a wider pool of therapists, potentially including those with specific areas of expertise or experience.
Therapists who don't take insurance are still qualified professionals who can provide excellent care, however that care will look different when insurance companies are not over seeing care. Self-pay opens the door to a wider pool of therapists, potentially including those with specific areas of expertise or experience.
There are several potential advantages to paying for therapy out of pocket, rather than using your insurance:
Private Pay Increase Choice in Therapists
Insurance companies typically have a network of in-network providers that you can see. While this network may include many qualified therapists, you might find a better fit with someone who doesn't take insurance. Out-of-pocket therapy allows you to choose from a wider range of therapists.
Taking Control of Your Care
Insurance plans may dictate the number of sessions or treatment approaches covered. Self-pay allows you and your therapist to tailor the treatment plan to your specific needs and goals, without insurance restrictions session numbers or treatment approaches.
Private Pay allows for Greater Confidentiality
When you use insurance, the insurance company has a right to see your treatment records, including your diagnosis, treatment plan, and notes. Insurance companies require a diagnosis to justify coverage for therapy to ensure it meets their requirements for medical necessity. A diagnosis can sometimes be helpful in getting the most appropriate treatment.
Insurance companies don't have access to your treatment records if you pay out of pocket. Self-pay therapy offers greater privacy and confidentiality. If you're concerned about having a mental health diagnosis on your permanent medical record, self-pay therapy may be an option. Self-pay therapists are not required to share treatment records with anyone, giving you more control over your mental health data.
Streamlined Billing
Trying to understand your insurance policy to determine deductibles and copays can be confusing and it is up to the member to learn and understand the intricacies of your policy. If there are denials, changes in the amount that a member owes, or retroactive denials, that can leave a client with a large unexpecting bill, Â 2 months to 18 months later. Â
Pre-approvals can take anywhere from 72 hours to 60 days, which can be a hassle and can act as a barrier to entering into treatment.
Self-pay therapy offers simplicity and streamlines the process. You'll typically pay a set fee directly to your therapist, avoiding the complexities of insurance.
Considering the Cost
While self-pay offers advantages, it's important to be realistic about the cost. Therapy can be expensive without insurance coverage, so it's important to weigh the benefits against the cost.
Some therapists offer sliding scale fees which means they adjust their fees based on your income.
Additionally, if you are not concerned about medical privacy, you might be able to get partial reimbursement from your insurance company, even for out-of-network providers. Your therapist will provide you with a receipt to submit to your insurance company for possible partial reimbursement.
Making an Informed Decision
Ultimately, the choice between self-pay and insurance-based therapy depends on your individual circumstances. Talk to your insurance provider to understand your out-of-network coverage. Consider your budget and research therapists who specialize in your concerns.
Remember, the most important factor is finding a therapist you feel comfortable with, who can support you on your path to mental wellness. Self-pay therapy can empower you to take control of your care and prioritize your mental health on your own terms.
If you are interested in scheduling a consultation to learn more about your options you can schedule a free 15 minute consultation.
If you are struggling to find a therapist that meets your needs in network, you may have learned that more clinicians are leaving insurance panels. If you are looking for more information as to why, please read more on this blog: BottonÂ