3 Benefits of Working with a Private Pay Therapist
3 Benefits of Working with a Private Pay Therapist
September 28, 2022
Stefanie M. Lawson, MSW LCSW
The Mindfulness Space Psychotherapy Services, PLLC
While utilizing health insurance carries several benefits, such as, protecting you from unexpected high medical costs and making mental health therapy and psychotropic medications more affordable and accessible, seeing a private pay therapist who is out of network with health insurance companies can also have its own benefits.
Working with a Private Pay/Out of Network Therapist Allows you to have More Autonomy Over the Course of your Treatment
Insurance companies’s level of monetary control has created a power dynamic in healthcare where these companies often dictate decisions that have a significant impact on your personal health. Insurance companies can control factors like the duration of your treatment and how many sessions they are willing to pay for. In some circumstances, they may only choose to reimburse if your therapist utilizes certain evidenced based approaches that may be researched to be effective, but are not necessarily the only or most appropriate treatments for you. For example, many
insurance companies love when therapists utilize Cognitive Behavioral Therapy or CBT because of its short term application and benefits. CBT is a wonderful evidenced based treatment in many situations, but not always appropriate under every circumstance. Also, in many cases, clients often seek therapy for certain situational or life changes that may be stressful, but don’t always meet the criteria for a formal diagnosis. Insurance companies do not pay in these situations if they determine that treatment does not meet “medical necessity.”
Working with an Out of Network Therapist Safeguards your Privacy
Therapists know that insurance companies often ask for a lot of sensitive health related information about you through processes called utilization reviews or clinical reviews. This sensitive information can include your mental health and medical diagnoses, medications, and even progress notes to determine if they deem your treatment to be medically necessary and whether or not the insurance company wishes to continue paying for your mental health treatment. Additionally, insurance companies always require your therapist to assign a mental health diagnosis for reimbursement purposes and this diagnostic information now becomes part of your medical record. Unfortunately, because of the stigma towards mental health in our society, you may have many valid reasons as to why you wish for this information to remain private.
You May Have Out of Network Benefits that Can be Applied to your Treatment
If privacy is not a concern for you, in many cases you may be able to take advantage of your insurance’s out of network mental health benefits. Private pay therapists are able to provide you with a document called a “Superbill” which is an itemized list of services that includes basic demographic information, dates of services, diagnostic codes and billing codes which you can “self-file” with your insurance company for reimbursement. Some therapist also work with 3rd party companies who can help you to verify and bill your insurance’s out of network benefits on your behalf.
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