Why Pay Out of Pocket for Counseling Services If I Have Insurance?

Paying out of pocket gives you the most confidential care. When you see a therapist through your insurance, they are required to provide information to the insurance company to justify the validity of the services they provide which at the very least includes a psychiatric diagnosis, but also can include your treatment plan, therapy notes, and duration of the problem. Once this information has been given to the insurance company, the therapist has no further ability to control the dissemination of that information and it becomes part of your permanent record. Unfortunately this can impact future health, life and disability benefits and premiums should you be unemployed, self-employed or need to purchase your own benefits. 

Paying out of pocket means will be able to find the most qualified counselor for your particular concern which can lead to fewer sessions, quicker results, and potentially lower out of pocket costs in the long run. Additionally, because insurance companies pay a fraction of their normal fees, many counselors must have a very high caseload to stay in business. What that can mean for you is your counselor may have less to invest in your care with less mental space to remember your story (while no counselor’s memory is perfect, if one counselor sees 20 clients per week and another 40, there is no doubt who will likely be able to remember more), less money in their practice to get new, high quality trainings, less time to plan for your counseling sessions to make the most of them, and even fewer resources for their own self-care (goodness knows we want our own counselor to be at the top of their game). 

Beyond the benefits of paying out of pocket, other questions one might consider is what sort of mental health coverage your insurance offers if any. Unfortunately many plans don’t start covering mental health services until you’ve met a very high deductible and in those cases, it makes more sense to go to an out of network specialist for the above reasons I just mentioned. Though I don’t take insurance, as an out-of-network provider, many PPOs and HMOs will cover all or a portion of my fee using your out-of-network benefits, and I can provide a superbill for you to submit to your insurance company if requested. Additionally if you have an HSA, flexible spending account or medical savings account, you may also be able to use these funds. Should you like to use your insurance, please contact your company and ask if you have out-of-network coverage for mental health and ask they send you a copy of your coverage so that you can use this when you submit documents to them in the future. Other questions you may ask are:

• Are outpatient counseling sessions covered through my insurance, and what is the cost?
• If I have a plan with a deductible, what is it and has it been met?
• How many sessions of counseling per year does my health insurance cover if any?
• Is approval or referral required from my primary care physician?

Please feel free to contact me if you have any other questions regarding this or if I can be of further support.