Insurance or Private Pay in Mental Health Counseling: Which is Best For You?
When considering therapy options, many clients decide whether to see a provider within their insurance network or a clinician not covered by insurance. This is an important decision and often a difficult one for many clients. There are pros and cons either way, but here are some of the considerations to keep in mind:
The initial concern for many is that going out of network is more expensive. Undoubtedly, it can cost more for private pay therapists, which may be prohibitive. That said, many clinicians will provide clients with a statement they can submit to insurance companies in hopes of reimbursement for some portion of the expense. The reimbursement options and amounts differ for every insurance provider and every policy, but it is worth exploring as one way to help save on the cost of going out of network.
Another essential consideration is recognizing that insurance companies have the right to access your medical record when going through insurance for therapy. Insurance companies require extensive paperwork from clinicians who work with insurance. They are privy to diagnoses, assessments, and treatment plans. They control the method of documentation needed by therapists and can require a review of mental health records. Thus, mental health information gleaned during counseling can stay with your record with the insurance company, which has the potential to impact your ability to acquire disability or life insurance down the road. Additionally, federal bureau’s affiliated with insurance companies could also have access to medical information that comes with that.
Why Considering Private Pay Could Be Favorable:
A strong reason to consider going out of network is that many of the most qualified clinicians choose not to enroll as insurance providers. These clinicians are often highly experienced and well-qualified and do not rely on insurance companies to drive clients their way. Because insurance reimbursement rates are low for mental health clinicians, it is favorable for them not to become providers.
Typically, most clinicians with the highest expertise are private pay clinicians.
Because such extensive paperwork is involved for therapists who are in-network providers, many hire additional staff to manage the paperwork, creating more expense despite the lower rate covered by insurance. This is another motivator for many clinicians to maintain a private pay practice. Because there is less of a burden on private pay therapists to handle all the paperwork required for insurance, they have more time to focus on high-quality care for their clients.
There are limited treatment options for providers within networks.
Private pay clients have more control over the therapy and can collaborate with the therapist to control the frequency of the sessions and collaborate on treatment goals. When going to an in-network provider, the insurance company dictates the frequency, length, and, to some extent, treatment goals. They often limit the frequency and length of sessions and do not allow flexibility with the treatment goals.
Whether you decide to find an in-network provider or a private pay provider, it is extremely important to find a therapist who is well-qualified and a good fit for you. The right therapist can ultimately help you in fewer sessions if you are comfortable with them, and they provide expertise and high-quality sessions. This alone can save you valuable time and money.
