- Stigma. To use insurance, you must have a diagnosed mental health condition in the vast majority of cases. This becomes part of your health record. This also perpetuates the medical model of therapy, which increases stigma. Like most therapists, I want to do everything I can to reduce stigma and lament that stigma is attached to mental health diagnoses, but I respect that some clients want to avoid a diagnosis as well!
- Choice. To use in-network insurance, you are limited to the providers that have chosen and/or been allowed to panel with your insurance provider. If your job changes or your life changes, you may have to change therapists or you may see a change in your insurance rate. Specialists in particular may not be in network with your insurance or may have longer wait times if they do.
- Privacy. When using insurance there are limited protections to your privacy, your diagnosis, and your clinical codes. Personal Health Information (PHI) is protected; however, insurance companies receive your diagnosis, how often you are seen, for how long, and they may request your records at any point in order to approve or deny services. Read more about healthcare data security and privacy here. When you utilize private pay, no one but you and your therapist have any access to your information. This can only be challenged by a court of law in very specific situations.
- Flexible. Insurance providers limit your access to the type of service you can receive. Insurance typically only allows therapists who are in-network to bill a set amount of service types for set amount of lengths. The standard session is typically 50 min. However, many types of mental health services are better delivered in longer (or shorter) sessions. For example, EMDR is advised to be delivered in 90 minute sessions. Family therapy is better delivered in longer visits. Child centered therapy may be better delivered in shorter increments. Your therapist and you should be able to choose the length of session that is best suited to your therapeutic goals. Insurance may also limit the number of sessions you are allowed.
- Location. This relates to choice and flexibility. Insurance pays for sessions delivered in an office. Almost exclusively with minor exceptions for home based sessions in some cases that require extensive prior authorizations. Some therapy offerings work better delivered in other locations. You can get insurance in your home, the local park, I've even delivered therapy in Target for parent coaching! Also new ways to deliver therapy are supported by research including therapy while hiking, driving, walking, or sitting in a park!
- Predictable. Insurance billing is complicated! It is complicated for your provider and often for you! With out of network or self-pay, you pay the exact same amount every time. It is straightforward and predictable and there are no surprises. It is not uncommon for a client to believe that insurance will pay for services and then get a bill they were not expecting.
- Cost. Most people assume that using insurance for therapy will lower their cost. The reality is more complicated. Therapists who are not on insurance panels have more freedom in setting their rates. Therapists who are in-network with insurance are disallowed from offering a better rate- they could be found guilty of insurance fraud for doing so. Therapists who are out of network may offer sliding scale rate spots, which may be lower than your in-network benefits. Additionally, just because a provider is in-network, does not mean you really get a fee reduction, especially for high deductible plans. You may end up paying just as much out of pocket towards a deductible as if you had gone out-of-network or self pay!
If you have any more questions on how or why to forgo using insurance or utilizing out of network benefits please reach out to us or comment below! I'm happy to help in any way I can!