Payment

 

Information & Benefits

Insurance companies require a diagnostic code for reimbursement, which is a routine part of health and mental health care. Once you have been given a mental health diagnosis, it becomes a part of your permanent health record. While insurance companies and medical information boards (MIBs) are legally required to use your information ethically, they have the ability to deny coverage of mental health care if they do not deem the diagnostic code appropriate for treatment at that time. Any diagnoses given may also influence your future rates of health or life insurance. When paying privately, your insurance company never needs to be notified and no diagnoses become a part of your health record.

Sometimes therapy can be used as a tool to improve your quality of life before it becomes a crisis. In the case of using your insurance benefits, a managed care panel will be involved in making decisions about your treatment. This panel may deny coverage if you are not given a diagnosis immediately. Additionally, many insurance policies have a cap on the number of sessions you are allowed to attend. They may also place limits on the kind of treatment you receive, for example limiting your therapeutic services to certain interventions or not allowing other members of your family or support system to join you in therapy, if needed. If your needs change while in therapy, a private pay therapist has the freedom to explore new issues without any changes to diagnostic codes or any limitations on treatment modalities. When paying privately, you get to dictate the parameters of your own treatment.

Research has shown that the therapeutic relationship is as important, if not more, than the specific treatment modality used. Having a good relationship with your therapist can be a key element in positive change. Insurance can help decrease the cost in the short-term; however, in addition to the immediate sense of connection and improved sense of well-being you may experience when you find the right therapist, the long-term effects may include healthcare savings over your entire lifetime as your mental health and physical health can improve with effective therapy. Also paying out-of-pocket allows you to choose a therapist that is most convenient to you geographically.

Insurance companies require frequent updates on your status in therapy. At any point they may deny coverage based on the status of your progress. In addition, when significant life changes occur, health insurance coverage often changes as well. Paying privately allows you to stay with the same therapist, with whom you have already built a trusting relationship, despite any changes in healthcare coverage. This keeps your treatment momentum going and allows you to stay with the same therapist without a break in treatment while you may be navigating a difficult time.

Many insurance companies have a cap of how many sessions you’re allowed to use. Once you reach this cap you may need to switch therapists (which delays progress and can be emotionally upsetting) or have to file for extensions (which as noted above, requires further diagnoses). A private pay therapist, on the other hand, will continue to be available to you regardless of the number of sessions you have attended.