Privately Paying for Therapy
There are several reasons why you might be interested in paying privately for therapy or using your out-of-network benefit. You can have increased privacy, receive more unique services, and might even save money depending on your insurance plan. This page will give you a better understanding of the benefits of private pay therapy, budgeting, and using your out-of-network benefit.
Increased privacy and confidentiality
Many clients choose not to involve insurance companies in their mental health care. Their psychotherapy is not limited by the diagnosis, treatment plan, or session limits that health insurance companies allow. Insurance companies can limit the number of sessions and even the type of therapy used in sessions.
To have therapy services covered under insurance a mental health diagnosis is required. This becomes a part of your permanent health care record. This can cause denial for quality life insurance or health insurance later on. Since a mental health diagnosis must be made to obtain reimbursement, the insurance company has to know a lot of information about you to be covered. The insurance company can review all of your records at their discretion.
By paying privately or out-of-pocket, we can assure private pay clients of the highest degree of privacy, confidentiality, flexibility and control of their mental health record allowed by Michigan state law, since records are exempt from insurance reporting and random compliance audits. Our work is off record. You have the control, not the insurance company.
Also, many insurance companies require a deductible to be met before they start paying, so you may be paying out of pocket for your visits regardless.
You are unique and so is your therapy
We often do not consider seeing therapists outside of our network, and assume it would be easier and less expensive to see an in-network therapist. However, that is not always the case and often looking for an in-network therapist that meets your specific needs can be a long process. Here are some reasons you might want to look for a therapist out-of-network and not be limited by your insurance.
You are looking for a therapist with unique skills. If you are looking to meet with a specialist who address a specific challenge it might be best to go out-of-network. Private pay therapists often have niche practices and if you find a therapist who meets your specific needs it's worth considering them.
Your relationship with your therapist is the most important aspects of the healing in therapy. By only looking at in-network therapists you might be eliminating therapists who would be a good fit for you and might be able help you feel better faster. If an in-network therapist is unable to help you then it will be a waste of money. It can be helpful to consider what your budget is for therapy.
You want highly personalized services. Therapists are constrained by only providing services that they can bill to an insurance company. They are often able to spend more time and creativity coming up with the perfect treatment plan with you. More frequent sessions and longer sessions can be offered for those who are looking for fast results. Also, non-traditional approaches can be offered.
To better understand your out-of-network benefit, call the number on the back of your insurance card and ask to speak to a specialist who will help you understand your out-of-network benefits for outpatient mental/behavioral health services.
Sometimes it is less expensive to use your out-of-network benefit. If you have a high deductible plan sometimes your out-of-network benefit covers more. The deductible is the amount you have to pay upfront before insurance starts coving your visits. If you have a $5,000 deductible and you do not utilize any other medical expenses through insurance, you are going to be responsible for paying the $5,000 in therapy session fees out-of-pocket before your copay/coinsurance applies. However, if your insurance has good out-of-network benefits your insurance company may reimburse you as much as 80% of each session fee depending on your plan and therapist's rates. In some situations, your out-of-network can be more affordable.