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Why consider self-paying for therapy, as opposed to using insurance? Here are 6 reasons:

1. You value finding a therapist who is the right match for you:

Oftentimes in-network providers who accept your insurance may not be available in your area (or don’t offer in-person sessions, for example), have a long waitlist, don’t specialize in the area of concern you have, or may simply not be the best overall fit for you. Choosing to self pay for therapy allows you the control to choose the therapist that is the best fit for you.

For decades research has shown that the most important predictor of positive outcomes in therapy is the quality of the therapist-client relationship (not the therapist’s education, credentials, training certifications, or the treatment modality/techniques used). In terms of therapeutic progress, it is well worth the investment to find the right therapist you can have safe, honest, and open communication with.  This person may not be on your insurance panel.

2. You value specialized and quality mental health care:

Therapists who do not accept insurance oftentimes are able to have smaller caseloads, allowing them the time, energy, and flexibility to provide each client with specialized care. They are able to spend more of their time on direct client care as opposed to spending hours on the phone fighting with insurance companies over denied claims, and completing hours of paperwork. This can translate into timely responses to client messages, more time for the therapist to spend on their continuing education, and decreased instances of therapist burnout (all of which benefit you as the client!).

Self-paying clients often have more control over their actual treatment as well. They can collaborate with the therapist to set goals, determine the frequency of sessions that best works for them, and explore different therapeutic approaches without insurance constraints.

3. You value keeping your personal information and work in therapy completely private:

If you use insurance to pay for therapy your therapist is required to provide personal information about your treatment to your insurance company in order to get paid.  This includes labeling you with a mental health diagnosis (that may stay permanently on your health record), and access to treatment plans and progress notes.

Your insurance company will have access to this information and you could be denied other types of insurance in the future (such as life insurance, disability insurance, or private health insurance) or raise your current health insurance rates because of this information. This could also impact your ability to obtain employment in certain professional fields where your health records are reviewed.

4. Your main goals for therapy include personal growth or self-exploration:

Many people who seek therapy are not experiencing major mental health problems, such as an Anxiety Disorder or Major Depression.  Many times people come to therapy for relational issues, to manage stress better, improve communication, work on boundary setting, or need support with making a large decision.  Some people also want to use therapy for self-exploration to gain a deeper understanding of themselves.  None of these things are mental health “problems”  that insurance will pay for.

If you try to use insurance to pay for therapy and you do not meet the criteria for a mental health illness, your therapist is confronted with an ethical dilemma. They would need to diagnose you with an illness that is more severe just so your insurance will pay for services.  This is misleading and leaves you with a more serious diagnosis on your record than you actually have.

5. Increased stability in the event of long-term or ongoing therapy:

If you use insurance to pay for therapy you risk the chance that your therapist could leave your insurance network at any time, resulting in you needing to find a new therapist who accepts your insurance.  Therapists leave insurance networks all the time and this can disrupt continuity of care, and be emotionally difficult on the client who may already have a great relationship with that therapist. Utilizing a private pay therapist could potentially provide more stability and fewer disruptions in therapy for a client who would like to stick with that same therapist long-term.

6. You have a high deductible insurance plan (as so many of us do!):

Having insurance does not mean you will necessarily always get to enjoy the benefits of insurance paying for services.  I’ll use a concrete example: Let’s say you’re a relatively healthy person who doesn’t go to the doctor much, and your insurance plan is high deductible with a deductible of 3K (that’s for IN-NETWORK services!).  That means if you went to therapy and saw someone who “accepted” your insurance, you’d have to spend 3K out of pocket before insurance would even consider partially paying for the next appointment.

In this example, if you went to therapy bi-weekly for 6 months you’d still only be about halfway to hitting your deductible.  Meaning you’d be paying out of pocket for therapy anyway whether you used insurance or not.  In this scenario, you might decide it’s better for you to forgo using insurance and enjoy all of the other benefits and freedoms of seeing a therapist out of network, as I’ve listed above.

FAQ: I’m concerned about having the budget to pay out of pocket for weekly therapy sessions. What are my options?

I understand paying out of pocket for therapy is an investment in your mental health and am certainly empathetic to budgeting concerns. I’m happy to discuss adjusting the frequency of sessions to better meet your financial needs:

For example, you could choose to meet bi-weekly as opposed to weekly if finances for weekly sessions are a concern. Many of my clients opt for bi-weekly sessions for this reason, and we can still make great progress with consistent bi-weekly sessions. Some clients choose to start with weekly sessions and then drop down to bi-weekly after a period of time, which is also a good compromise. As therapy progresses, monthly sessions may be appropriate for established clients who have met most of their treatment goals and are looking to “maintain” progress.

Why I choose not to participate with insurance companies:

The reality is that when a therapist chooses to go in-network with an insurance company they enter into a contract with that company. That means there are aspects of therapy that your therapist has to abide by in order to meet their contractual requirements.  It doesn’t feel right to me that an insurance company (who by the way is not a mental health provider and has never met you) has so much control over your treatment.

When I decided to become a therapist, helping people by providing high-quality mental health care was my number one goal.  Participating with insurance companies creates many ethical dilemmas for me and impacts my ability to provide the quality care that my clients deserve.  Personally speaking, I’ve determined that I can provide better care to my clients by not accepting insurance in my practice.

Good Faith Estimate Notice:

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises