Pros and Cons of Using Insurance for Therapy

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Many people have concerns about the cost of therapy, especially in NYC where the average rate can be between $150-300.

If you’re concerned about the cost of therapy, staying in-network and using insurance for therapy can seem like the best option when seeking care. However, many people don’t know or consider the benefits of working with a private-pay therapist that may be worth the additional investment.

Additionally, many insurance plans offer out-of-network coverage that can help reduce the overall cost of therapy – making the final cost comparable to seeing an in-network therapist.

Knowing the pros and cons of seeing an in-network versus out-of-network/private-pay therapist can help empower you as you search for the right therapist for you and make a decision that feels right and fits your needs and budget. Being informed is powerful, and it will make the process of finding a therapist easier and help you feel more confident in the process.

How Does Using Insurance For Therapy Work?

There are a few different ways using insurance for therapy can work:

  1. You can choose to see an in-network therapist and pay a co-pay, just like when you go to the dentist or your primary care physician. This is someone who your health insurance company has a contract with and has agreed to pay a pre-negotiated rate. In this scenario, you are responsible for the cost of your co-pay.
  2. You could also choose to see a private-pay therapist and use your out-of-network coverage, typically between 50-100% of the usual and customary rate (UCR) to get a significant portion of the fee reimbursed. In this case, you would pay your therapist directly upfront and be responsible for the remaining portion of the fee after the processed claim.

Many people incorrectly assume that using insurance for therapy means they must see an in-network provider. However, there are many plans that offer out-of-network coverage that allow you to have more freedom when it comes to finding a therapist. Ideally, you can expand your search and choose a therapist based on what feels like a good fit versus being restricted to only in-network providers.

insurance for therapy
When browsing online, you can expand your search and choose a therapist based on what feels like a good fit versus being restricted to only in-network providers. Out-of-network coverage allows more freedom when it comes to finding a therapist.

What Are The Benefits of Seeing a Private-Pay Therapist?

1. Easier time finding a good fit

One of the most significant determining factors in your success and satisfaction with therapy is the relationship you develop with your therapist. Remember, this is the person who you have confidence in and feel safe enough with to explore many private and sensitive thoughts and feelings.  This helps you identify your focus when searching for a therapist who you can build an alliance with.

Not only is selecting a therapist that you connect with and trust critical, it may also accelerate the work and possibly result in a shorter treatment period in the long run.

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Not only is selecting a therapist that you connect with and trust critical, it may also accelerate the work and possibly result in a shorter treatment period in the long run.

If you are limiting your search to the small pool of in-network therapists, you may end up settling for a less-than-ideal fit. This can potentially result in less satisfying therapeutic experience and possibly lead you to the difficult decision of having to switch therapists in the future.

Starting over with a new therapist and building trust takes time and courage, so you want to feel confident that you’ve made the right choice versus making a decision that was restricted to a limited network.

2. The power to determine your treatment method and length

When you use your out-of-network benefits, your network and search pool expands. As a result, you can seek therapists who specialize in specific treatments that interest you and choose how long you want to stay in therapy.

Whether you want to pursue a therapeutic approach that requires a specific skillset, or meet with your therapist more frequently, you’re in control of your treatment. You’re more likely to have the power to find a therapist and a process that works for you.

The power to make this choice can be very empowering and expands your horizons.

expanding options for using insurance for therapy
You can expand your horizon when you use your out-of-network insurance benefits.

3. The ability to get help when you need it

As with the previous dilemmas, staying in-network can, unfortunately, greatly limit your options when it comes to finding a therapist. Many therapists who are in-network with an insurance company are often full because the cost of entry is usually more attractive to many clients who wish to remain in the network.

In-network therapists generally have a full caseload, which is important to consider if you’re looking for a therapist with substantial energy to dedicate to individual clients. In-network providers may be dealing with fuller schedules, which potentially means greater stress and less accessibility.

Seeing an in-network provider means you may have to join a waiting list. A prime example of this is evidenced by a study that found the average wait time to see a psychiatrist in a major metropolitan area was 25 days.

If you’re dealing with mental health concerns and struggling in the present to the point that it makes it difficult to function in your daily life, you’ll be better served by not delaying or having to wait to get help.

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If you’re dealing with mental health concerns and struggling in the present to the point that it makes it difficult to function in your daily life, you’ll be better served by not delaying or having to wait to get help. You shouldn’t have to suffer alone and seeing a therapist with more flexibility could help you  get help sooner and at a time when you need it.

The good news is that if you are open to using your out-of-network benefits and seeing a private pay therapist, you’re likely to find a therapist who is accessible and available to provide timely help.

4. Greater control over your medical information

Anytime an individual uses their insurance benefits, they are inviting the insurance companies to potentially have a say in the course of treatment.  Not only do insurers have a say in who you can see and how frequently you can see them, they also have the right to ask for access to your mental health records.

Insurers can request confidential information – including your treatment type, diagnosis, and progress notes. This information is fair-play when using insurance for therapy to see an in-network provider, since insurers determine if your mental health care is medically necessary and covered under your policy.

If you feel uncomfortable knowing that your private medical information is accessible to your insurer at any point in time, going with a private-pay therapist can give you more privacy and, therefore, peace of mind.

5. The opportunity to work with less emphasis on diagnosis

In order for insurance companies to reimburse you for therapy, your therapist must assign you a diagnosis for the sake of the claim. However, there’s a good chance you may not be seeking treatment for a specific condition or medical reason. You could be seeking help to further your personal growth and to reach your personal goals.

In that case, you may not want to be assigned a formal diagnosis from your therapist that would be added to your medical record. If you have any worries surrounding the impact of a mental health diagnosis on your record, it may be worth looking into an out-of-network/private pay therapist who isn’t contractually bound to an insurance company the way an in-network provider is.

6. More options if you have specific needs or criteria

If you’re someone with a unique circumstance or need, you might be interested in seeing a specialist who is familiar with your issue or situation. In-network providers may not be as prolific or offer as highly specialized services such as:

Having a therapist who is a trained specialist in the areas that matter the most to you could mean the difference between an okay therapy experience and a transformative one. Choosing a specialized therapist is a step you can take in order to set yourself up for success in therapy.

Choosing a specialized therapist is a step you can take in order to set yourself up for success in therapy.
expanding options for using insurance for therapy

I’m Not Using Insurance for Therapy – How Should I Be Thinking About the Cost?

 

So now that you know a bit more about the difference between in-network versus out-of-network coverage -you may be wondering how much therapy costs with insurance after you consider the pros and cons? You might find that you would prefer to pay more for the peace of mind and accessibility that comes with a private-pay therapist.

If you do decide to pursue and experience the freedom of working with a private-pay therapist, there are many ways that you can reduce the cost of your sessions. 

1. Consider putting funds into a Health Savings Account (HSA) or Flexible Spending Account (FSA).

You can put away a significant amount of money into your HSA and FSA at the beginning of each year. This is tax-deductible money that you can use to pay for your therapy sessions.

2. Ask therapists if they offer sliding scale services. 

Some therapists at our practice put aside a number of slots for clients  in financial need and offer them at a reduced fee. Directories like Psychology Today and Open Path can also help you find therapists who offer low fee sessions. You can check a therapist’s website to see if they mention a sliding scale fee. Even if they don’t you can always reach out, explain your situation, and ask if they could work with your budget. There’s no harm in asking.

3.  Look for therapy training programs and community mental health agencies.

Many university training programs for mental health clinicians have clinics where members of the community can get low-cost therapy. You can Google “therapy training programs near me” to see if any come up.  

There are also many community based mental health organizations that provide services at a low cost. They are usually funded by federal, state, and/or local government programs. You can find these by asking your doctor’s office for recommendations, searching on Google, or calling your county health department.  

Is Paying for Therapy Worth It?

Imagine one thing that you’re currently struggling with. Maybe you’re having trouble communicating honestly with your partner. Maybe you’re feeling “stuck” in life. Perhaps you’re dealing with feelings of guilt for not being the person you think you should be.

Whatever it is that you’re dealing with, therapy can give you a safe space to explore your thoughts, feelings, and worries about the issue. Eventually, therapy can help you identify where these feelings are coming from and give you the tools to either prevent or cope with these feelings in a healthy way.

This is just one example of both the short and long-term benefits of therapy. Depending on your personal goals, therapy can help you:

  • Increase your self-esteem
  • Quiet negative thoughts
  • Communicate more effectively with others
  • Connect more authentically and honestly with others and yourself
  • Gain insight into what fulfills you and makes you truly happy
  • Reduce stress in your day-to-day
  • Learn to respond more mindfully to certain situations

Above all, therapy is an important investment in yourself and your emotional health and wellness. Working with a therapist on your current or past struggles is the equivalent of exercising and eating right for your physical health. Your emotional health matters.

Mental wellness doesn’t come by chance or luck – it requires that you feel safe, secure, and courageous enough to put in the work so that you can see and feel the many positive benefits and results therapy offers.

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Mental wellness doesn’t come by chance or luck – it requires that you feel safe, secure, and courageous enough to put in the work so that you can see and feel the many positive benefits and results therapy offers.

We can all use support and a little bit of help in life. There is no shame in creating space for yourself, be it due to sadness, stress, or wanting to simply develop insight and improve the quality of your life with therapy. Remember that no one can do or be expected to do everything by themselves.

To learn more about how we help clients navigate their out-of-network benefits visit our How Insurance Works page. If you’d like help verifying your out-of-network benefits, simply submit your insurance information through our Check your Benefits form and our billing team will be in touch shortly. Please don’t hesitate to contact us with questions and to learn more about how we can help you.

Want to explore the freedon of going out-of-network? Share your preferences on our Therapist Matching Questionnaire to connect with a therapist who would be a good fit for you for a free consultation.

Dr. Logan Jones

Dr. Logan Jones is a Psychologist and Founder of Clarity Therapy. Sign up for his free 30 Days of Gratitude email series and follow him on Instagram at @drloganjones.

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