Paying For Therapy With Insurance: Is It Really Worth It?

Have you ever considered paying for therapy out of pocket?

If your health insurance covers counseling, probably not. Before I was a therapist I never thought about paying for any of my healthcare out of pocket either, especially if I could get everything taken care of with a measly $25 co-pay. Now that I’m on the other side of the table, I actually pay for much more of my healthcare instead of relying on insurance. If you’ve read this far you’re probably wondering, “Why pay more when my insurance can pick up the tab?” I understand the allure of having health insurance cover the majority of session fees, but do you know what you give up for that co-pay? If not, allow me to shine light on the truth.

1. If you use insurance, your therapist must give you a diagnosis. This is probably a lesser known fact and it’s one I didn’t know until I began my profession. Insurance companies require a diagnosis so they can decide if they will pay for therapy or not. This means your therapist must give you a diagnosis that your insurance will cover even if you don’t really need a diagnosis. And these diagnoses follow you. In many cases, mental health diagnoses do not have a statute of limitations meaning they will follow your forever as “pre-existing illnesses.” As a client it is rare that you ever even know your diagnosis, so I would consider this to be one of the most motivating reasons to pay out-of-pocket because when you do, your therapist does is not required to give you a diagnosis.

2. Health insurance companies choose your therapist for you. Have you realized that you can only see therapists who have a contract with your insurance company? This isn’t always a huge problem especially if your plan is with a major insurance company with a vast network of therapists. However, I’ve had clients who have changed insurance mid-therapy to a company with whom I was not contracted. The client had the choice to pay out of pocket or find a new therapist who was in their network. Not the biggest problem in the world, but it is a limitation that I believe many overlook.

3. Your time and treatment is controlled by an insurance company. Again, it is probably an overlooked an unknown fact that insurance companies determine the time intervals that they will pay for and the therapy models they will accept. In most cases this isn’t a major issue if you’re a therapist and client who can wrap it up in twelve, 50 minute sessions. But what if you need a longer treatment period? If your insurance hasn’t given authorization for more sessions, then your therapist will not be paid for the additional time. And what if you want a therapy that is alternative, new, or off the beaten path? It’s unlikely that your insurance will cover that treatment. You and your therapist are bound by the insurance companies’ belief about what is an appropriate length of time to resolve issues and what therapies are best for you.

For some people it makes sense to use health insurance, but if you can afford to pay out-of-pocket it’s worth considering how much you value your privacy and control over your own treatment decisions. Many therapists have reasonable session fees and will even negotiate for more affordable rates. If you prefer to keep your health information private and in your own control, then talk to your therapists about rate options.

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