Insurance vs. Private Pay in Therapy: What’s the Difference?
Are you wondering what’s all the fuss with finding a good-fit therapist? Just call your insurance and get a list of providers and call it a day, you’re probably thinking.
What are the benefits and disadvantages of using your insurance vs private pay in seeking mental health care?
If you need a hair trim which entails…ummm…trimming, you probably look for someone who knows how to handle a scissor and a comb and who can trim your hair rather than your ears. This person need not specialize on hair trimming because its not a specialization.
Psychotherapists do therapy.
But if you like Pink’s funky hair-do, shaven on the side with a bunch of hair tousled with the right length before it hits your chin, you might need someone who specialize on this craft.
Not all psychotherapist can give you this type of hair-do.
WHAT’S A GOOD-FIT THERAPIST FOR ME
Private pay means partying out of pocket for a service rendered by your practitioner. It’s possible that even when you’re psychotherapist is considered out-of-network (does not take your insurance) that a portion of your out-of-pocket can be reimbursed by your insurance. You can check your benefits by calling your insurance company.
Insurance pay means you’re using the full benefits of your insurance. The psychotherapist therefore is credentialed with your insurance company. You may or may not pay a co-pay which is usually paid directly to your provider. On average, this can range from $5-20; call your insurance for payment accuracy.
If you like your Pink’s hair-do and what to keep it for as long as you can. It’s likely that you’ll keep coming back to the same stylist given that she renders good result and you kinda’ like her. We all know that second to the therapist, stylist and barbers get an earful of our woes in life.
There’s no way around it. You got to like her in many ways, the way she talks, style her own hair, even the way she smells (you’re in close proximity). This is not judgement but preference as a consumer.
Research tells us that the most effective therapy is one where the client and therapist have good rapport. Client feels that she is listened to, held in high regard and esteemed for who she is.
A good-fit therapist for you depends on many variables, here are some:
- Your personality. Do you prefer fast-talkers or slower-talkers as an example.
- Your learning style. Are you into movement? Art? Do you like to write things down?
- Your personal biases. If you have qualms about seeing a male therapist, don’t see one. If you prefer a colored therapist, follow that. If you like seeing a Filipino Therapist, explore the net.
- Your reason for seeking therapy. Some people in the beginning of therapy may benefit from telling their stories over and over again. Some therapist are a better fit than others. In general, insurance may allow longer-term care (for example, 24 sessions or more) which may give leeway to the client and therapist to see each other for a longer duration.
I am a therapist that collaboratively works with clients to cut out time in therapy (which is my best reward!). For me, time is cost. I prefer to see client short-term, usually 3-4 months and usually no longer than 6 months. If you’re interested in how I work with clients, check out the blog on Story Therapy.
- Therapist Style (modality). There are many ways practitioners work with various populations. Many use talk-therapy and many others use adjunct creative approaches like sand tray therapy, hypnotherapy, dance movement therapy and so on. Some incorporate so-called evidence-based approaches like Cognitive Behavioral Therapy (CBT), Dialectal Behavior Therapy (DBT), Emotion Focused Therapy ( EFT) and many others.
I am a therapist that use a combination of approaches in therapy like narrative therapy, hypnotherapy, sand tray work, using projective images for story-telling, EFT and many more. I lean more on the creative and playful side of being a therapist. Clients who are willing to be playful in the therapy room are a good-fit for me. If you’re open to creativity in the therapy room, schedule a complimentary session with me.
What’s common in people who have depression and/or anxiety is that there bodies have learned to be rigid and stiff. As you watched children play, you can just imagine what this type of engagement in the therapy room can do for you.
Even when you’re using your insurance, contact the practitioner that interests you and asks for a complimentary consult. This ranges from 15-30 minutes. If you’re wondering if we’re a good fit, you can book a 30 minute consult here.
ADVANTAGES AND DISADVANTAGES OF INSURANCE USE
Most of the clients I see are private-pay but I’m credentialed with two insurances reserved to serve lower-income Filipino women/families. Again, policies can change so you’re best bet to get the most accurate summary of your benefits is to call your insurance.
Most therapist (not all) that utilize insurance-based clients may be called generalist. Psychotherapists who do therapy. There is no indication in the latter statement that they are less effective than private-pay only therapist. You have to decide if they’re the best-fit for you.
Traditional therapy is 50-60 minute per session. To claim for insurance payment, your therapist needs a diagnosis that qualify you for medical necessity. Insurance follows a medical-model treatment, so in lay-man’s term, you need to be sick of something to get treatment. The mental health diagnosis justify this for the insurance company.
Personally, I appreciate that people that need the care would get it. But, I don’t diagnose client just on the basis of meeting their insurance requirement. This is a choice you can make whether to use your insurance or not.
Insurance company also has the right to perform quality assurance on the client in their database. This is a positive move to ensure that practitioners are following protocol set forth by the insurance company. During this process, insurance may solicit progress notes from the therapist (therapist can provide a summary) which exposes client information. Quality of care is a gray area to quantify, usually quality means a therapist is providing care they’re claiming money for.
In managed care (insurance use), your confidentiality is not just between you and your practitioner. The word “practitioner” may take a broader definition to mean, “the insurance carrier company.”
I’m quite particular in keeping my client information safe and secure and refuse to fax documents to company for their asking. I prefer to use HIPAA (tech that take extra care to keep your information safe) compliant platforms. That’s why I can use zoom for free but opt for a more secure therapy session platform.
I’ve mentioned a few advantages with using your insurance such as the quality assurance portion. Here are more advantages:
- Your insurance can provide you a list of providers so you can point your finger to a name that feels good to you.
- Since most therapist who take only insurance-based clients are generalists, there are many to choose from. Specialists (those who are specific to their expertise) have smaller pool of practitioners to pull from using your insurance carrier.
- You don’t pay or may menial out of pocket cost. This may be helpful to those in a tight budget.
- If you prefer longer-term therapy or at least be eligible for it.
This is a start-off list. You can drop me an email to add more to this list.
ADVANTAGES AND DISADVANTAGES OF PRIVATE PAY
Private pay opens up options for you to be seen by a therapist that can score ala Pink’s hair-do design. This means you can design your own wellness journey to your liking by finding a psychotherapist that specializes in you.
Specializations can either be about an issue, for example, anxiety, intergenerational trauma and many others. Specializations can also be about a particular population, for instance, working with first-time moms or military spouses.
In my practice I specialize in seeing Filipino women, couples and families. I don’t see non-Filipino clients unless they are spouses of Filipino women.
In doing this, I tailor my work and continue to study modalities and styles of wellness that work with the Filipinx population in mind. It allows me to be focus, intent and effective as a therapist.
Private pay keeps your confidential information sacred. Unless there is a court order, a therapist keeps your information between you and her/him (see limits of confidentiality here).
You also don’t need to be diagnosed. Many people I see in my practice have symptoms of depression, anxiety, and trauma but don’t qualify for a clinical diagnosis. Many others, may not have trauma history but needed to heal from stories that they’ve believed themselves. Check out Story Therapy here for more information.
Please know that a diagnosis can be helpful to others seeking answers and in some cases allows a practitioner to seek out the best treatment. But our over-diagnosing culture can also fortify our disease-laden collective story especially in the Western societies.
Let us be slow in diagnosing ourselves consequently, others.
Private pay therapy/coaching is a cost. A therapist who sees a client for a 50-minute session can charge from $120-250 per session. But, in my experience, private pay is usually shorter-term, meaning, you don’t have to be in therapy for a looooong time.
Bomber, I know.
When figuring out cost, figure out the duration rather than just focusing on the out-of-pocket per session. It’s possible that you may be paying less for therapy that lasts short of six months compared to being in therapy for a year or more. Make sure to factor in your own time as money and make the right decision for you.
The cost is both an advantage and a disadvantage in using private pay. The advantage is as noted above and the disadvantage is setting up money for your care.
In my practice, I use the third party called ADVEKIT where you’d put in your information and in less than 10 minutes and you’ll get information on how much you’ll pay for my services minus the amount your insurance is willing to cover. Pretty, cool. I though so.
If you’d like to play with your numbers using ADVEKIT to see me, click there or here.
FINAL THOUGHTS
Choosing to use insurance and/or private pay has both pros and cons. As mentioned, even though I see mostly private pay clients, I use a third-party payor so that the cost for seeing me may be off-set by your insurance. If you’re interested how much therapy with me will cost you, put in your information under my profile in ADVEKIT, and immediately see your cost.
The privilege of having extra bucks in the bank to afford a specialized therapist can be a source of argument. You must be informed that insurance pays therapist so much less than I think they deserve.
This is not your burden. Systems need to change and alas, it’s changing slowly.
Whether you prefer to stick with your insurance or seek a private pay practitioner, please be guided that you deserve quality treatment either way.
The best way to find out is to ask for a complimentary consult. If you’re interested to see if we’re a good fit, schedule a complimentary session with me.
Roanne has been a Psychotherapist for more than 15 years. She has frequented at least 500 Filipino homes and counting. She is the author of the Ebook: 5 Pinoy Love Languages and the creator of the presentation entitled: Filipino Core Values & Considerations in Culturally Responsive Care. To access self-paced courses and other resources, enter the Kalamansi Juice Academy.
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