Insurance vs. Private Pay

Using your health insurance benefits to pay for therapy can be convenient and cost-effective for many people. However, before using insurance options, there are also some potential drawbacks to consider. Here are some pros and cons of using insurance verses self-pay for therapy:

Pros:

1. Reduced cost: One of the main benefits of using insurance to pay for therapy is that it can significantly reduce the out-of-pocket cost for clients. Depending on the insurance plan, clients may only be responsible for a copay or a portion of the total cost of the session.
2. Greater access to care: For people who cannot afford therapy without insurance, insurance can be the only way to access the care they need. Insurance plans often have a network of providers which can make the process of finding a therapist who accepts their insurance easier.
3. Increased accountability: Insurance companies often require therapists to document progress notes and treatment plans, which can help ensure that therapy is effective and that clients progress toward their goals.

Cons:

1. Limited options: Using insurance to pay for therapy may limit the number of therapists and treatment options available. Insurance companies often have a limited network of providers, making it difficult to find a therapist who is the right fit, has the same availability as you, and remains in network.
2. A limited number of sessions: Insurance plans get to do what they want. As such, insurance companies often limit the number of sessions or types of therapy they will cover. They may decide not to cover your therapy sessions if they believe that therapy is no longer a medical necessity for you. This can make it difficult for clients to receive the consistent care they need.
3. Privacy concerns: When using insurance to pay for therapy, clients must disclose personal information to their insurance      company, which can compromise their privacy and confidentiality.
4. Diagnosis: Insurance companies require a mental health diagnosis to cover therapy sessions, which can be stigmatizing and potentially impact future insurance coverage, including life insurance.

Ultimately, whether or not to use insurance to pay for therapy is a personal decision that depends on individual circumstances and preferences. It's crucial to weigh the pros and cons and choose the option that works best for you.

For those seeking services who may already have a "diagnosis" or are willing to be diagnosed to use your health insurance, we accept the following insurance plans through a billing system called Headway: 

Aetna   

Oxford

United Healthcare

Oscar Healthcare

Cigna

Please let us know prior to your appointment if you have any of the above insurance plans. 

The client is responsible for verifying insurance coverage, in network, or any out of network plan benefits as each plan provides vastly different benefits, copays, deductibles and benefits.

Paying out of pocket for therapy can offer some benefits and drawbacks. Here are some pros and cons to consider if you plan to self pay:

Pros:

1. Increased flexibility: Private pay therapy can offer greater flexibility in scheduling, session length, and treatment options. Without the constraints of insurance requirements, therapists may have more freedom to tailor their approach to the client's needs.
2. Increased privacy: Private pay therapy can offer greater privacy and confidentiality. Insurance companies often require      disclosing diagnoses and other personal information, which can compromise confidentiality.
3. Greater choice of therapists: With private pay, clients can choose any licensed therapist they wish rather than being limited to those who accept their insurance options. This can increase the likelihood of finding a therapist who is a good fit.
4. No diagnosis required: Unlike insurance, private pay does not require a mental health diagnosis in order to receive treatment. This can be beneficial for clients who may be concerned about stigmatization or future insurance coverage.
5. Superbill potential reimbursement for "Out of Network" or "OON" providers: Some insurance companies will allow the patient to submit what is called a “Superbill” after therapy sessions. This document is generated automatically by our Simple Practice system. The superbill includes the relevant codes, payment identification, cost, therapist name and licensing number, and business information. There are no guarantees that the insurance company will reimburse you, but if your insurance company accepts "Out of Network" claims, then you may have some coverage for therapy. It is always best to check with your insurance company first. 

Cons:

1. Cost: Paying out of pocket for therapy can be expensive, especially if therapy is needed over a long period of time. Without insurance coverage, clients are responsible for the total cost of therapy.
2. Limited financial resources: Some individuals may not be able to afford private pay therapy, which can limit access to care.
3. No insurance reimbursement: Clients who pay out of pocket for therapy are not always eligible for reimbursement from their insurance company and claims can be denied.
4. No accountability: Without the oversight of an insurance company, there may be less accountability for the therapist and less assurance that therapy is effective.

Whether private pay therapy is the best option depends on individual circumstances and preferences. It's important to weigh the pros and cons and make the most informed decision.