Therapy Basics: Pros and Cons of Insurances and Private Pay Therapy
Welcome back to our Therapy Basics blog series! If you haven’t read our blogs about Things to Consider Before Starting Therapy and How to Find a Therapist, check those out as well. We’re exploring several topics related to therapy, including those mentioned above and what to expect from therapy as well as our vision of what makes good therapy. If you want the new blog posts sent to your inbox, sign up for our newsletter here.
Seeking out therapy is a beautiful way to take care of yourself and there are many therapists out there eager to help! Similar to other healthy choices, finding a therapist can be challenging as we run into what therapists are available in our area, whether or not to utilize your insurance or private practice and what it all means to you and your mental wellness. I am going to review some of the pros and cons to utilizing both your insurance and paying privately for mental health treatment. What exactly is the big difference?!
Pros of Insurance
Insurance is super helpful for taking care of our bodies and can be helpful for our mental health as well. Utilizing insurance offers a cheaper way to find treatment for mental health concerns, which is a deciding factor for some. Insurance offers a chance to find a deductible or co-pay that we can use to limit those “out of pocket” expenses. We also have the opportunity to find a therapist by looking up who is covered by calling our insurance or checking out their website or app. Convenient!
Cons of Insurance
However, we also run into some challenges when we decide to utilize insurance for mental health needs. Did you know that insurance requires a therapist to provide a diagnosis after their first session with you? That means that the therapist has to immediately report a diagnosis to the insurance so that the insurance can determine future coverage like the number of visits allowed, the techniques and style of therapy that can be used, length of session, or if coverage will continue for the sessions at all-and this is all put on your permanent medical record. Yes, your permanent medical record! This permanent medical record can impact you down the road as far as pre-existing conditions when looking for new health insurance, life insurance or disability insurance.
Your insurance company now has access to your therapy records which can feel like an invasion of your privacy. If you want to utilize your insurance for mental health treatment, you also have to consider if the provider you have chosen is going to forever continue working with your insurance or change what insurance providers they work with. This can happen at any time! What if you need a specialist? Sometimes finding the right provider for you is challenging when you are limited to finding someone your insurance covers, especially when we are looking into specialties like anxiety, couples and family or postpartum depression.
Pros of Private Pay
If you don’t want to work with their insurance or don't have mental health coverage, a lot of opportunities are now available! When you research private practices in your area, you may find that the opportunity to find the best fit for you has increased. In private practice, you are able to find the specialist you need or want and the freedom to choose who you think is the best fit for you and your needs. Another benefit to utilizing private practice providers is that you have far more privacy; private practice therapists are not required to report a diagnosis which means this information is not shared with anyone you don’t want it shared with and will not impact your future coverage options regarding health insurance, life insurance, or disability insurance.
Why else would you not want an assigned diagnosis after your first session with a therapist? There is far more information for your therapist to take in! A private practice therapist has the flexibility to really learn about you and your needs before assigning a diagnosis and is then able to determine the best treatment plan for you without the limitations of numbered sessions, frequency and length or sessions, approved interventions, or reporting information to an insurance company. When you are researching private practice providers, you are able to dive deep into the specialties of each provider and really find someone that is going to be able to supply you with the best care for your current needs without concern of coverage.
Cons of Private Pay
Private practice provides far more freedom with your mental health treatment but that also comes with the “out of pocket” expense that some people use insurance to avoid. Although your private practice provider is able to supply a superbill that you can give to your insurance company, there is no guarantee that the insurance company will reimburse any or all of that cost.
You will need to understand your personal budget for therapy, as therapy often lasts 3-6 months. You can ask a potential therapist for their average number of sessions and about what you can expect so that you know how much to save or set aside. Therapy is typically a short term treatment in the scheme of things, so even with a shockingly high dollar amount for 3-6 months of therapy, you can keep in mind that you’ll be done at a certain point and can return your budget to normal. You’ll need to put careful thought into determining how much you can manage to spend and for how long, and then be honest about how that amount affects your treatment choices.
The amount of information behind utilizing insurance for mental health treatment or seeking private practice providers is incredible and significant when it comes to making what you feel is the best decision for you. Use this material when you look for the right therapist for you and feel confident that you have the information you need to make an informed decision. Take care of yourself and good luck!