Insurance coverage typically involves a monthly premium you have to pay. This is the set amount you pay each month, either out of your paycheck or out-of-pocket, to have access to a health insurance plan. Of course it makes sense you would want to use it! It is important to know the benefits of your particular plan. Your deductibles and co-pays are especially useful to know in advance as these are typically out-of-pocket costs. 

Let’s start with defining a few terms:

In-network– providers that your insurance plan has an agreement with to charge you a certain rate. (Often after your co-pay)

Out-of-network– providers that your insurance plan does not have a set agreement with; your plan may not cover the full cost of care or there is no pre-negotiated rate so you pay the provider’s rate. 

Deductible– a set amount of money your insurance plan requires you to pay before your plan starts to pay for your care. 

Co-pay– set cost that you pay for various providers before and/or after you have already paid your full deductible. Co-pays often vary depending on the type of provider. Specialists, including therapists, usually require a higher co-pay.

Out-of-pocket costs- all the payments you make yourself that won’t be reimbursed by insurance, these include but may not be limited to deductibles, co-pays, and coinsurance. 

HSA– Health Savings Plan, an account that you contribute to before taxes that is specifically designated to paying for health related services and goods. This account is typically through your employer.

Many licensed therapists are out-of-network, meaning they do not take any insurance. Why might you choose an out-of-network therapist? Let’s go through a few reasons. Finding a therapist that is the right fit for you is paramount. A therapist who specializes in modalities you are interested in or in the concerns that have brought you to counseling may be the most important reason for you to consider when talking to potential therapists. It may be in your best interests to choose to see a therapist out-of-network if they meet your needs and you feel comfortable with them. 

You paying for your own mental health care keeps you in control. Insurance companies require certain information, including a diagnosis, to pay for therapy. Your insurance company will need your diagnosis, what type of sessions you have, when and where, and they may also request your therapist’s confidential progress notes. Opting to pay without insurance increases your confidentiality as there is not a third party company requesting any information. All information is kept solely by your therapist. You are not required to have a diagnosis, meaning you and your therapist have control over what goes in your records. 

Insurance also may introduce limitations on the care you can receive. There may be an increased wait time to be seen by a provider who takes your insurance. Time limits for the sessions, a limited number of sessions, who provides care, how often care is provided, and in some cases the types of care that is covered are all possible limitations. Self-pay allows you to decide how and when you want to meet your goals. It allows you to find and choose the provider that is most qualified to meet your unique needs. This means that you may need fewer sessions, gain results quicker, and in turn potential lower out-of-pocket costs. Since a deductible is often needed to be met before insurance starts paying, you may never reach the threshold for insurance to pay. This means you may have relinquished control over your care and decisions with no financial benefit. 

You may not meet the specific criteria for a diagnosis. Deciding to pay yourself also means that a diagnosis is not required. This means your therapist does not have to find a less than accurate clinical diagnosis to put in your chart just to appease insurance companies. It also means that a diagnosis will not follow you, you will not have a pre-existing condition on your insurance record. In order to use insurance, you must have a diagnosis for a mental illness, meaning that could be on your insurance record. This is important to note since a pre-existing condition could make future insurance more expensive.

Self-pay is your choice and keeps the focus on your needs. Your therapist is not spending time battling your insurance or making a diagnosis fit. Rather than researching insurance requirements, your therapist is doing research on ethical resources and modalities that will best support you. 

Licensed providers are able to generate superbills for services rendered. You may submit these to your insurance company for possible reimbursement, how much would depend on your specific plan. I have chosen to partner with Thrizer to offer you help in navigating your out-of-network benefits for possible compensation for my services. Thrizer is a platform that helps clients get money back on out-of-network therapy sessions. If you have out-of-network benefits, Thrizer will file claims and handle the insurance paperwork to make sure you get reimbursed. They charge a small fee per upfront claim or no charge at all if you choose to wait for reimbursement, and have helped people get money back every year. You can sign up as a client through my practice. Though they are a third party, they do not have the right to request your confidential information nor do they require a diagnosis.

Thrizer’s goal is to save you time and money. It’s completely optional, and as your therapist I do not benefit in any way from your participation.

There are also platforms that have calculators for possible out-of-network reimbursement. These platforms also offer services that deal with out-of-network claims for you. This means they save you time by dealing with the insurance companies for you. These are third party companies but have no right to your records. If you do choose to submit a superbill for reimbursement to your insurance, on your own or through a third part company, the superbill will most likely have a diagnosis on it. If you need a superbill from me, I am more than happy to explore this option further with you. 

The takeaway here is that you should be in control of your health care. Mental health professionals are there to listen and guide you. Meeting your insurance requirements may have financial benefits, in-network payments may help you meet your deductible. It is important to note that plans with a high deductible may offer no financial benefit. Self-pay benefits include increased confidentiality, increased flexibility, more control, options for types of therapy, a provider who is the right fit for you, and finding care that best meets your specific needs. 

Out-of-network benefits may give you the best of both worlds. You have all the control and benefits of self-pay and also can submit for reimbursement from your insurance plan. You can ask for a superbill and contact your insurance company to find out about their specific path on how to submit claims. This can be a headache and time consuming for many people. As mentioned above, there are out-of-network claim handling companies that make this process much easier for you for a small fee, often a 3-5% cost of the fee your provider charged you. This means if your provider billed you $200 for a session, the processing fee would be around $6 to $10 to get possibly up to full reimbursement depending on your plan and deductible. 

It can be beneficial to think of paying for therapy as an investment in your health and future. 

A note on couples counseling: Insurance companies do require a reason for therapy. Unfortunately, relationship issues or communication issues are often not classified as a reimbursable reason for therapy. What that means for you is, that even if you have great insurance coverage, your in-network benefits may not be applicable for couples counseling. 

Self-Pay pros	Insurance pros
More control	Possible financial benefit
Increased confidentiality	May help you meet your deductible
Increased flexibility
Increased options for types of therapy
Choose the provider you want
Best care to meet your needs
May apply for out-of-network reimbursement, simplified by using Thrizer
Self-Pay cons	Insurance cons
Will not apply to in-network deductible	Less control
Possible extra step to apply for out of network reimbursement with a superbill	Loss of confidentiality
	Diagnosis required, pre-existing condition label
	Limited options of therapist
	Possibility of longer wait times
	May have set number of sessions allowed
	Not all types of therapy are included (ex: couples therapy)
	High deductible plans may never be met, leading to no financial benefit