Private Pay Pros

Flexibility in Choosing a Provider (Including One Who Specializes in Your Problems)

A key benefit of private pay services is that you get to choose your counselor. This might seem basic, but studies show that having a strong relationship with your counselor and feeling safe and understood greatly boosts your chances of success in therapy. Feeling confident in your choice of clinician can lead to better outcomes, tailored to your needs.

No Parameters on the Length or Type of Therapy

Private pay affords you the opportunity to engage in as much or as little therapy as you’d like to pursue, allowing for a flexible and personalized approach. This flexibility isn’t dictated by anyone else but is instead determined solely by you and your clinician through a collaborative and supportive process.

Services Can Be ‘As Needed’ and Not “Medically Necessary”

Insurance requires therapy to be "medically necessary" for coverage. As a private pay client, you and your therapist don't need to share information with insurance to prove therapy is needed. It's your choice to decide when to attend sessions. If you're feeling good but want to check in, that's perfectly fine and doesn't require justification.

Insurance Pro

Lower Out of Pocket Costs (After Meeting Deductible)

Most insurance plans require you to meet your deductible before they cover services. When you pay for counseling, that amount counts towards your deductible. However, if you’re only getting counseling, it might cost you a lot upfront before receiving any reimbursement. Occasionally, some insurance plans fully cover mental health services without requiring you to meet the deductible first.

Insurance Cons

Your Mental Health Records Can be Audited by Insurance

Insurance companies can randomly conduct audits with your clinician in order to justify paying for your coverage. Those medical records may contain what you shared in therapy as evidence to why you qualify for “medically necessary” services. Although both the clinician and auditor are bound by confidentiality, your mental health diagnosis, severity, and length of treatment might become a source of qualification for some government agency jobs. In short, when a third-party payer is involved, you have less privacy and protection. *Your clinician is not required to inform you when your files are being audited.

Less Flexibility in Choosing a Provider

Using only insurance restricts your options to clinicians who accept it. Insurance generally pays clinicians at a severely reduced rate. As a result, as a client, your choices become limited, which is a downside of using insurance. You may have less chance to find the perfect clinician who not only takes your insurance but also specializes in your specific issues. It makes the process more complicated.

Diagnosis is Required

Insurance requires a diagnosis, and it is illegal for a clinician to falsely assign a “medically necessary” diagnosis in order for client to obtain reimbursement by their insurance.

Mental health diagnoses differ from physical illnesses. For instance, infections are easily treated with antibiotics, while persistent feelings of being "off" or fatigued may leave patients confused. Doctors might order tests or provide vague advice. Therapy often aligns with feeling "off" without knowing why, making change difficult. Clinicians should help identify the issue, but this isn't always immediate, and "off" isn't a formal diagnosis. Clients may struggle through what could have been a healing process hindered by insurance requirements for a diagnosis to justify services.

Insurance Can Dictate Length or Type of Treatment

Your insurance provider can influence how long you see your clinician by controlling how much they reimburse you. If they don't believe you need ongoing services, they may not cover your visits.