Private Pay Therapists: Pros and Navigating Out of Network Benefits

The most important determining factor of success and satisfaction with therapy is based on the relationship between the therapist and the client. This is someone you need to connect with, trust and feel comfortable with. After all, you are trusting them with very intimate details of your life.

To use insurance you must find an in network provider with your plan. This limits the options available to you and the process becomes less personal. The choice becomes about who is available and in network and less about who is the best fit for you.

In addition to a limited provider pool, insurance places many limitations on mental health treatment. 

Insurance has a say in what type of treatment you receive, how many sessions per year are covered, how often you meet with your therapist, and even the therapeutic approach used. When utilizing your out of network benefits, you have a lot more control of your treatment. You can meet with your therapist as often as you want, you can discuss topics important to you, and have more autonomy when it comes to the therapeutic approach and style you receive.

Insurance can cause disruptions in care before and during treatment. In network providers often have full caseloads and you may encounter a waitlist. 

During treatment, insurance can also decide to deny care at any time. This can lead to either a temporary pause in sessions while authorization is being obtained or termination of services completely.

An out of network provider typically has a smaller case load than in network providers, and may have more time and energy to devote to individual clients. This is important to consider in your search for a therapist. You want someone who is fully dedicated and committed to their work with you. 

If you are struggling with mental health concerns now, you may not want to wait or delay getting the help you need. An out of network provider may offer the flexibility you need so you can receive help and begin working on your goals sooner.

Your mental health records are not private when you see an in network provider. Insurance can request access to your mental health records to approve coverage of therapy sessions. This includes confidential information such as diagnosis, case notes, treatment plans and treatment type. Insurance obtains this information to determine if your mental health needs are medically necessary and that this type of care is covered under your policy. Seeing a private pay therapist grants you more privacy and control when it comes to your mental health record.

In order for insurance to cover mental health services, you have to receive a diagnosis which becomes a part of your permanent mental health record.

Many people who come to therapy do not have a mental health disorder or are seeking services for other reasons. This includes working on personal growth and goals, coping after a breakup, struggling in a relationship or wanting to make a career change.

If you are worried about the implications of a diagnosis on your mental health record, or are wanting therapy for another reason, a private pay therapist may be a better fit for you. Out of network providers are not obligated by insurance contracts to provide a diagnosis.