The benefits of paying out of pocket for mental health therapy
Paying for therapy can be stressful and sometimes that keeps us from seeking help. Sometimes you have insurance, but they don’t cover mental health. Other times your deductible is so high that you are paying out of pocket anyway. Many therapists and clients are choosing to forgo dealing with insurance when seeking mental health therapy.
Many private practice therapists do not accept insurances which may seem odd but there are many benefits to clients when therapists choose to do this.
Sometimes your mental health concerns are not drastic enough to warrant a formal mental health diagnosis. If this is the case your insurance could deny coverage. This could leave you with large, unexpected bills once your provider realizes their claims have been denied. Although there are situations in which therapy is necessary and helpful, you may get denied coverage based on your diagnosis or lack of diagnosis.
Some insurance plans simply do not cover mental health, have a high co-pay, or a large deductible. We have all been in the position where we would like to get some help but feel stuck because we don’t know who we can see or what our insurance will cover. Sometimes the amount of time and energy understanding details of your coverage is more of a hassle than actually getting the service. And there is nothing worse than doing all that work to only be denied coverage because of a small detail.
Some diagnoses are just not covered by insurance. Many common life stressors are not covered. Unfortunately, some of the most common reasons people start therapy are not covered by their insurance (divorce, relationship concerns, life transitions, environmental stressors, work struggles, etc.). These events alone are not enough for insurance to cover services. This means unless our stressors have caused a diagnosable mental health illness it is not likely going to be covered. Although we all know how impactful those events can be and we know therapy is a helpful option, insurance doesn’t always see it that way. This creates a barrier because people wait until they are drastically suffering before getting help. Unfortunately it often happens that the help would have been more beneficial immediately when symptoms were not debilitating.
Specific types of therapy like Couples therapy and most group therapy is not generally covered by insurance. Unfortunately if group or couples therapy is the best fit, it might not always be accessible through insurance.
With private pay your insurance company or place of employment will never know any of your mental health concerns or diagnoses. This is an added sense of security. You never risk Jim from HR knowing that you are seeing a therapist or what your diagnosis is. With private pay you'll know 100% that no one else outside you and your therapist will ever know your mental health concerns.
Insurance company policies drastically impact the ways in which I as a therapist approach your treatment. There are more restrictions and boundaries when using an insurance to cover services. Those restrictions and boundaries are not always in the best interest of the client. There are often limits of how many times I can see you in a time frame and how long your appointments can be. Even though your therapists is the expert and should be making decisions about your treatment plan. Additionally, therapists have to spend a lot more time on your paperwork, submitting claims, and talking with insurance providers. When using private pay therapists use that time for planning for your sessions, gaining more education about your concerns, and generally focusing on the best treatment for clients. If you are paying for services out of pocket, you have more control and freedom regarding your treatment. The treatment plan is made between your therapist and you. Not your therapist, you, and Bob from insurance who gets decision making power without any expertise.
Clients tend to be more active in therapy when they have some personal investment into it. We all value money and when we spend it we want to feel it was worth it. In therapy having investments leads to more drive on the clients end to meet goals and make the most out of it.
Finally, your out of pocket therapist is getting a fair wadge when you pay out of pocket or use out of network benefits. Big insurance companies get away with paying therapists low rates. Therapists typically have an undergrad and graduate degree. We are required to complete continuing education and most of us go above and beyond those requirements to help our clients. Maintaining a therapy license comes with a high costs. Beyond that, the low payments from insurance creates a mentality of quantity over quality for some practices. This is unhelpful for clients as they are not getting the best service and creates an unhealthy workplace for therapists. Consider a private pay therapist seeing 15 clients a week that all have concerns within their specialty. During non client hours that therapists spends time reading specialized materials, or maintaining a healthy work life balance. Now consider how different your experience would be with a therapist seeing 35 clients a week because it’s agency policy. Those clients with vastly different concerns, ranging from PTSD to children struggling with ADHD. On top of all that they have to spend time making sure that insurance is happy with the treatment goals and worried that insurance could “claw back” payments at any time. Therapists are in a losing battle when this happens because insurance companies always have the upper hand. I have been both of these therapists and I can tell you confidently, YOU WANT THE SPECIALIZED PRIVATE PRACTICE THERAPIST.
Ultimately the decision to start mental health therapy is always a good one. If you have the option to go private pay it decreases the hoops to jump through.
