Self-pay vs. Insurance

 Why don't you take insurance?

There are a variety of reasons I do not work directly with insurance companies. My highest priority is to serve you with the best possible care. One of the main reasons I do not take insurance is my belief that paying out-of-pocket allows me to give you the best possible care.

Many people do not realize that when you use your insurance, there is another person in the room - your insurance company. In order to use your benefits your therapist has to disclose, with your consent, your personal information in order to verify your eligibility, pre-authorize services, and process claims to obtain payment.
This includes such things as:
-the nature of your issues for counseling
-psychiatric diagnosis
-your treatment plan
-how long you will have the problem.

If I submit a bill to the insurance companies on your behalf, your confidential information is processed by the insurance company and then stored in a database. Anyone who is involved in the processing or handling of your claim may have access to your records and anyone who has a legitimate reason to access the medical database, such as insurance companies and future employers, can view your confidential records.

So what does this mean?

For couples and family therapy, one person must be given a mental health diagnosis to utilize benefits, and the other partner or family members are brought in to support the "mentally ill" client. Typically in couples therapy the diagnosis is about the relationship. Most insurance does not pay for this type of diagnosis. 

At times clients simply need to check in with someone to get a new perspective, learn some new skills, or explore some different strategies to try at home or work. Others want to work on their relationship with their partner or on being a better parent. These type of diagnosis are typically not covered by insurance.

Although receiving any diagnosis that is reported to insurance when appropriate can be extremely beneficial, it does come with its fair share of unfortunate consequences, such as compromising your ability to obtain life, health, disability, or long-term care insurance. The advantage of self-pay for therapy is that your information is not released to the Medical Information Bureau, so even if you do receive a diagnosis for treatment purposes it is kept confidential between you and your therapist and shared only with whom you chose to share it with, within the laws of confidentiality.

I want you to be actively involved in determining what your goals are, how we will work together, and when we are finished. With insurance, many of your choices and my treatment options are limited, as they determine what is "medically necessary" and what is the most efficient treatment. However, it is always a personal choice whether or not to use your health insurance to pay for therapy. For some, using insurance benefits is the best choice and others will find they like the freedom paying out-of-pocket gives them in their journey towards mental wellness.

Out-of-Network Insurance Benefits

Though I do not take insurance directly many PPOs and HMOs will cover all or a portion of my fee using your out-of-network benefits.
If you have an HSA, flexible spending account, or medical savings account you may also be able to use these funds. If you would like to use your insurance, please contact your insurance company and ask what coverage you have to see an "out-of-network provider". If possible, ask them to fax or email you a copy of your coverage so that you can use this when you submit documents to them in the future. 

It will be helpful to ask them the following questions:

  • Do I have mental health insurance benefits?
  • What is my deductible and has it been met?
  • How many sessions per year does my health insurance cover"
  • What is the coverage amount per therapy session?
  • Is approval required from my primary care physician?

I will then start to provide care to you and you will pay for the sessions as we go.  You will be given an itemized bill that you can submit to your insurance company for reimbursement to you directly.  I do not have contact with your insurance company.


Where Therapy Meets Convenience