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Choosing Private Pay vs. Insurance

     Many people have asked me what insurance companies I would partner with, and have been surprised when I state I choose to accept private pay only. Paying out of pocket can seem like an overwhelming cost, however, what value do you place on your wellness, mental health, or sanity?

Insurance companies put a value on health, and charge you upfront monthly to cover any future larger issues, but are often limited to specific providers, treatments and number of visits.  Typically, these insurance companies cover preventative care, regular assessments or check-ups and treatment for injuries and illness. However, with mental health care, they often only pay for your treatment if your therapist can provide a diagnosis and establish a "need" for treatment.

    Diagnosing clients is a complex part of a therapists job.  We have to gather information, ask questions and really get to know clients to do this accurately.  Insurance companies (managed care) insist this needs to be completed in 1-2 sessions so they can pay for further sessions. Assessments have helped to focus and speed up this process, but can take time, money and don't cover every issue a person might experience. Labeling someone with a diagnosis may cause or exacerbate stress of the client, guide or misguide treatment goals, and can follow a person for the rest of their life. It should be a thorough process.  If we are examining wellness, and someone wants to come in for counseling for regular stress or frustrations, even preventative counseling, this model of care doesn’t support coverage. Preventative medicine is pushed by insurance companies to catch medical issues early and keep a person in better health and ultimately save them money, so why is this not also applied in mental health prior to a mental health diagnosis?   Mental health treatment is more effective when started prior to the point where things become unmanageable, just like any other medical treatment. 

    On a positive note, managed care provides a level of supervision for your counselors, peeking into the workings of all businesses, assessing effectiveness and ensuring researched therapies are being used.  While this can help reduce the number of unethical practices, it also opens your medical records to be viewed by many different professionals, while they try to gauge these things and whether or not they will pay for your services.  Private Pay files are maintained by your counselor only. Private pay does not have the same level of supervision, however counselors are monitored in many different ways. Complaints can be filed through professional entities who manage licensing, and gauge the counselor’s ability to follow to set guidelines for ethical behavior. Diligent counselors will ask for feedback on their performance, and check in with clients on progress, in addition to continued supervision with other experienced professionals in the field.

    In choosing to accept self-pay only, I empower the client to take charge of their mental health and collaborate on their goals for treatment, whether or not they have a mental health diagnosis.  My goal is to foster a more direct relationship with the client, which is not distracted by time spent trying to recoup costs from insurance companies. I feel better suited to meet my client's needs by focusing on clients instead of insurance claims.  You as the consumer of counseling services have rights and have a choice in picking the best therapist for yourself, whether they accept insurance or private pay. Feel free to ask your counselor many questions about their techniques, worldview, education, continuing efforts in the field, costs, etc. If you do not align with what they say or their business model, find a different counselor.  Your treatment will be most effective with a counselor you connect with and meets your needs, and YOU are what matters. 

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