Private Pay vs. Insurance: How to Decide

The biggest question many clients ask their therapists… “do you accept insurance?” As a new client, it is important to know your payment options and what it could mean for you. Maybe you are undecided or insurance isn’t accepted and you are left stuck wondering if therapy is worth the investment. I am here to tell you… YES! Think of it as investing in yourself and your care. It is worth it!! Here is a breakdown of the differences between paying private pay and using insurance:

Insurance:

• Insurance requires a diagnosis from the first visit to justify medical necessity for sessions. Some clients may not know this and would prefer to not have a diagnosis label, some clients do not have a preference.

• Session notes are visible to more eyes. While therapists maintain confidentiality with their session notes, insurance companies have easier access to these notes for audits. Therapists are required to submit session notes, diagnoses, and session documents for continuous insurance coverage.

• Insurance plans help save money, but plans vary which can lead to inconsistent session costs for the client.

• Insurance can have a say in session length and treatment frequency.

Private/Out-of-Pocket Pay:

• Therapists have more autonomy in diagnosing and focus more on personal growth, goals, and processing life stressors instead of immediately assigning a diagnosis label.

• Session notes are strictly for clinician eyes only and remains within the practice. The only time notes and diagnoses are shared is in the event of a record request or subpoena. This ensures client confidentiality.

• Out of pocket pay clients have a set standard rate. Depending on the clinician, a sliding scale rate could be offered to make it more financially feasible. Depending on insurance, a superbill could be provided for reimbursement; however, some insurance policies as listed above might apply then.

• Clinicians will work with clients to establish a set treatment plan and frequency, without insurance barriers.

Regardless of choosing to use insurance or out of pocket pay, the service remains the same. Sessions last from 50-60 minutes, care is client centered and focused, confidentiality still applies, and the overall focus is emotional and mental well being. If you’re trying to decide which option is right for you, schedule a consult call today and we can talk about your counseling goals and financial options! My goal is to make care accessible, and not be hindered by financial barriers.