Self-Pay vs. Insurance

You’ve made the decision to start therapy. You interview several therapists and decide that you want to move forward with one. Everything aligns. The therapist is warm, inviting, and specializes in treating what’s bothering you. The therapist has immediate openings for new clients.

There’s just one problem.

This therapist does not take insurance.

So what do you do?

When I was a masters level student, I decided that I would accept insurance as a fully licensed clinician. The decision seemed obvious to me. People need therapy and insurance makes therapy more accessible. But it’s a bit more complicated than that.

While insurance companies can reduce financial barriers for clients, some insurance companies have rules that impact your therapy experience. For example, in many situations, you must receive a diagnosis to prove “medical necessity” of services. An insurance company might also set the maximum number of sessions, frequency of sessions, and treatment modalities allowed in sessions.

These rules don’t always take into account what’s best for the client.

Your therapist will likely cover the positive and negative consequences of insurance during your intake session. You might decide that the positives outweigh the negatives and elect to use insurance for therapy. You can also decide to opt out and use the self-pay option.

There’s not a “right” or “wrong” decision. It’s important to use your judgement and be realistic about your options. If your ideal therapist is private pay and you can afford the investment in your mental health, this will be an easier decision for you. But if private pay is not affordable, it’s wise to keep searching for someone on your insurance panel. The ideal therapist will not be helpful if you can only afford therapy once a month.

If you are seeking couples therapy and want to use your insurance, you must keep a few things in mind:

First, most insurance companies do not see relationship problems as “medical necessity.” In other words, your insurance company will cover the session if you have anxiety and/or depression BECAUSE OF your relationship problems.

Second, the therapist must prove that one of the partners has mental health symptoms AS A RESULT OF the relationship problems.

Third, the therapist must choose the “identified patient” to diagnose. This is usually the person who emails the therapist first to seek couples therapy.

It’s not impossible to use insurance for couples therapy. Make sure to discuss any concerns with your therapist.

The insurance versus private pay debate is not a black-and-white issue with clear heroes and villains. The most important point in all of this is to be well informed. Don’t be afraid to ask questions during your consultation and/or intake session. And don’t give up if you haven’t found a therapist within your search parameters. Keep in mind that great therapy can change your life so be patient with the process.

Disclaimer: This is not intended to be an exhaustive list and does not take the place of working with a licensed professional.