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                                                  Benefits of Being a Private Pay Client


1. You choose the therapist you think is the best fit for you. You are not limited to the insurance panel options.


2. Many health insurance companies require that every client be diagnosed with a specific mental health condition in order to receive treatment. To be approved for therapy, the therapist must make a case that therapy is “medically necessary” which involves labeling the client with a mental health diagnosis.  This is often required after the first visit, and then becomes part of the client’s permanent health record.

In addition to this, health insurance companies usually limit you to discussing only issues that pertain directly to your diagnosis. Unfortunately, this oftentimes means that insurance companies won’t cover issues you may need to address (such as relationship or work issues). Private pay therapists don’t need to provide a diagnosis in order to provide services. Therefore, a private pay therapist is able to work with you on any presenting issue.


3. You aren’t restricted to a certain number of sessions


4. Your therapist has the freedom and flexibility to think outside the box and engage in therapy options that may not be approved by health insurance companies.


5. Your mental health records won’t be used against you. 

All therapists, counselors and psychologists are required by federal law to keep confidential records. When you choose to use your insurance company, your therapist must ask you to sign a waiver that allows them to communicate this confidential information to your insurance company. This confidential information includes dates of service and a mental health diagnosis. In the event your insurance company requires preauthorization for treatment and/or reviews your file, additional information, such as therapy session notes, must be provided to your insurance company.


Something else to consider is that this information becomes part of your record and could be used by insurance companies to raise your insurance rates, as well as prevent you from being able to obtain life insurance or disability insurance. It could also prevent you from obtaining future private health insurance should you make the decision to become self-employed in the future.


Furthermore, the personal details of therapy are often entered into a database called the Medical Information Bureau (MIB) by your insurance company. The medical information of millions of people is currently housed in this database. Other providers, insurance companies and even non-medical services like personnel departments may have access to this information for the purposes of evaluating you.


                                                    Out-of-Network Therapist Option:


If you want to secure your own therapist but would like to utilize your benefits, you can pursue an out-of-network therapist. If you have a high deductible plan or good out-of-network benefits, you may actually find it more affordable or comparable in cost to utilize your out of network benefits.


A deductible is the amount you have to pay upfront before your insurance coverage kicks in. If you have a $7000 deductible and you haven’t had any other medical expenses yet in the year, you are responsible for paying up to $7000 in therapy session fees out-of-pocket before your standard copay applies.


However, if you have good out-of-network benefits, your insurance company may reimburse you as much as 80% of each session fee, depending on your plan and the therapist’s rate. This means that in some situations, using your out-of-network benefits can actually be more affordable or comparable to your standard copay to see an in-network therapist.

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