Jennifer Bailey
When choosing to seek therapy, the next decision is not necessarily which therapist to choose; it is whether to pay privately or use insurance.
Both private pay and insurance have their benefits and challenges, which is why it is imperative to explore both options to decide which is best for your financial situation.
When using insurance to pay for therapy, the insurance company may cover part of the cost while the patient may be responsible for a copay, coinsurance, deductible or other cost-sharing, depending upon the plan.
To use your insurance, you need to find a therapist who accepts your insurance; this is known as being an “in-network” provider.
You can find an in-network therapist by contacting your insurance company. According to Mental Health Match, that insurance billing may require a diagnosis to establish medical necessity, depending on the plan and coverage requirements.
A diagnosis required for insurance billing does not by itself indicate the severity or duration of a person’s condition. In outpatient therapy, many diagnoses may involve conditions that are mild, situational or temporary.
The diagnosis is used for documentation and billing purposes, not to indicate the severity of a mental health condition.
Using insurance may require sharing certain health information with the insurer for payment and coverage purposes, including a diagnosis and dates of service. Psychotherapy notes are generally maintained separately from the medical record and receive additional privacy protections. Access by an insurer may require additional authorization, depending on the circumstances
According to WebMD, insurers may deny claims for services they determine are not medically necessary.
Paying privately means covering the full cost of therapy directly. Choosing private pay can be costly, as average private-pay therapist fees vary, with sessions ranging from $100 to over $200, according to GoodRx / if you do not use insurance.
According to GoodRx, some insurance plans may offer out-of-network benefits that may reimburse part of the cost after a patient pays a therapist directly. The patient may then submit a claim to the insurer for partial or full reimbursement, depending on the plan. Not all plans provide out-of-network benefits or reimbursements.
Whether paying privately or using insurance, accessing appropriate help and support can be part of caring for your mental health.
Jennifer Bailey is a licensed clinical social worker and registered drama therapist.
