The Costs and Benefits of Private-Pay vs. Insurance (A Therapist’s Honest Perspective)
Deciding to see a therapist can be a tough but rewarding choice to make, but this is only the first step.
Other things to consider can be the type of therapist you see, if they specialize in issues you’re facing, and most importantly, whether you can use your insurance to pay for these services or whether you pay out of your own pocket. There are pros and cons to both options. Unfortunately, often these options are not explained in entirety for others to know why you should or shouldn’t use insurance or private pay. This article will explain the pros and cons of both options as well as give you a therapist’s opinion on when and why you should use one over the other.
Using Insurance
Pro: Often, insurance is a more affordable option for people seeking therapy services.
Depending on the insurance, you may have your sessions covered, or at least a hefty portion of your sessions covered, with maybe a small co-pay. Many insurance companies (and/or general practitioners you may see with the same insurance) will refer you or provide you with a list of in-network providers, making it more convenient to find someone at a lower cost.
Con: You’re limited with choice of therapists.
Let’s say you find someone who you think may be a good fit or has a specific treatment modality that you’re looking to do, yet you see they don’t accept your insurance. You’re limited to choosing a practice or therapist that takes your insurance rather than being able to find someone you may connect with more. Another option for you to combat this would be to check if your insurance offers some level of out-of-network benefits, where you can receive reimbursement through a Superbill.
Con: Insurance can dictate the frequency and length of treatment.
Your insurance provider, because they are paying for most of your treatment, despite not being present in the session, has a say in how frequently you should receive treatment and how long your treatment should last. Depending on the type of insurance and program, this could mean your insurance may only pay for one session per week of 30-minute, 45-minute, or 60-minute sessions. Some insurances even have a maximum number of sessions allotted every year.
For example, companies that provide you with insurance may allow you 3-5 free Employee Assistance Program (EAP) sessions, and after this ends you may be required to pay the full amount or have a limited number of post-sessions. Also at any point, insurance companies could stop paying their portion for your services due to “no longer finding medical necessity” or once you’ve met the maximum number of sessions. Once this happens, you may have to wait until the policy calendar resets and begins on a new year before you can resume therapy services.
Con: Your medical record can follow you around, and you’re required to have a diagnosis.
For insurance to pay for your services, the service must be deemed as “medically necessary,” meaning you have a diagnosis given by a provider stating why they should pay – that’s required from the insurance company. This diagnosis, or diagnoses, will exist on your medical record and can follow you around to other avenues outside of your mental health visits, such as if you work for the military, police department, fire department, or any higher-level upper management positions.
Con: If you lose your insurance or your therapist stops taking insurance, you may have to find a new therapist.
Life changes happen. People change insurance. Providers may even decide to take on new insurance providers or stop taking insurance. When this happens, often people are left feeling hurt when they can no longer see their therapist due to these changes. They often stop therapy altogether or need to find a new therapist.
Bottom Line:
If self-pay is not an option you can realistically afford, use insurance. There are many great therapists and therapy practices that take insurance and have no issues with people who have had great experiences and found therapists they really connect with. Insurance is also great if you know first-hand you’re looking for a specific type of shorter-term treatment, such as Cognitive Behavioral Therapy (CBT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), or Eye Movement Desensitization and Reprocessing (EMDR) (to name a few). These therapies have a specific range or set number of sessions indicating a clear treatment end date (or at least a good estimate of one).
Using Private Pay
Private pay, also called or referred to as self-pay or out-of-pocket, means you are paying the full price for sessions with your therapist without involving your insurance.
Pro: You’re open to more options for therapists.
Often with insurance, many people are limited to their options with therapists if the therapist they may have in mind doesn’t take their insurance. With private pay, you have the flexibility and freedom to be able to choose between more therapists and find one that you feel you can establish a good connection with.
Pro: There is no limit to sessions.
With private pay, you (and your therapist) have more of a say when choosing how long you want to be involved in services whether that is a few months to even a year or more, and for higher frequencies such as multiple times per week or longer sessions (depending on the therapist). For some people, long-term therapy has been extremely helpful in processing through years of trauma, building healthier skills, and managing the processing of negative events. You also have the peace of mind in knowing that even if your insurance stops for whatever reason (change of life circumstances) or your therapist stops taking certain insurances, you don’t have to stop seeing your therapist.
Pro: Your medical record doesn’t follow you around and you’re not required to have a diagnosis.
Because the insurance company is not involved at all in private pay, your sessions are more confidential as your therapist is the only person seeing your session records and documentation. Also, your therapist is not required to give you a specific diagnosis, although they may have one in mind that helps them base how they structure their sessions, their treatment, and treatment goals with you. Your record, in turn, will also not follow you outside of your mental health visit so you can be assured that you’re getting the private, confidential help you need without interference or worry your record may follow or other people need to know your business.
Con: Private pay can be expensive.
Therapists understand that not everyone has the luxury of being able to pay $100 or more per session. Which is why many choose to get paneled with insurance. Some therapy practices will offer sliding scale sessions where therapy is offered at a more affordable rate, so it does not hurt to ask a therapist or therapy practice if this is something they offer.
Bottom Line:
If private pay is an option you can afford, go for it! You can guarantee privacy and peace of mind from a medical record not following you around forever, nor are you labeled with a diagnosis or diagnoses. Also, you have more of a say in who you get to see and work with making therapy a more personable choice where you have more of a say in the process.
Begin Therapy With A Miami Therapist Today
Regardless of if you go the private pay or insurance route, you deserve support with your mental health. Our team of caring therapists would be happy to offer support from our Miami, FL-based practice. You can start your therapy journey by following these steps:
Reach out to get matched with a Miami therapist
Get to know our team of caring therapists
Start receiving the support you deserve!
Other Mental Health Services We Offer in Miami, FL
Our team is happy to offer a variety of mental health services to help support your mental health. These include mental health services for children, adults, parents, and families. Our services include therapy for life transitions, grief, spirituality, trauma, and PTSD. Some of the techniques we use include ACT, CBT, and TF-CBT. All of these services are available both in person and through virtual therapy.
