10 Mar

Today health insurance allows many who might not be able to afford  psychotherapy, have access to behavioral healthcare.  So why would anyone choose to pay their therapist privately?

1.     Protecting Privacy

In today's world personal information is shared with lightning speed.  As a therapist, I do my best to protect my patient's confidentiality.  Of course there are exceptions, if someone is going to hurt themselves or someone else, it must be reported. Once a claim is submitted to an insurance company, it increases the potential number of people that can see it. There are billers, insurance company's employees and auditors, other doctors, other insurance companies, courts  attorneys and various agencies.  Now of course we have to sign to release this information, but we do  and often don't realize the amount of information that is gathered on us.

2     There are no limits to amount of sessions or times. 

Insurance companies have limitations on how often you can see your therapist including, how many times a week, how long, how many times a year and even how many services on the same day.  To make an analogy, is somebody wanted to get physically fit, would they do it faster by going to the gym 1 time a week for 45 minutes or 3 times a week for 2 hours.  This is not to say that more is always better and like the gym, you need to rest your muscles, so going every day is not necessarily healthy, but you can choose what level of treatment is right for you.  A good ethical  therapist is not going to let you schedule more time than you can benefit from.

Insurance companies want therapists to use Evidenced Based Practices but won't pay for Double sessions.  Very effective treatments like EMDR or hypnosis are recognized as evidenced based practices but usually require more than an hour, leaving it difficult for a practitioner to use these tools and keep within the insurance company's limits.

3. Having skin in the game.

Research shows that clients who have to pay for treatment have more positive results because they are more invested.  If you are paying for treatment, you are more likely to be there, be on time and more  willing to do assigned activities.

4.    Diagnosis

Insurance companies require a diagnosis and that diagnosis is submitted into your permanent health record.  As a private pay client, there is not a need for a diagnosis  

5.      Medical necessity. 

Insurance companies require that therapy be 'medically necessary'.  They pay for treatment because  they want to prevent costly hospitalizations.  If you want to work on introspection, self improvement and self actualization, or even to just try to understand why you do what you do, I'm afraid that's on your dime.  Anyone who has watched a Woody Allen movie knows 10 sessions is just the tip of the iceberg.

6.     You can choose the focus.

When the insurance company is footing the bill, they want the focus to remain on the treatment plan and addressing whatever the patient has been diagnosed with.  As a private pay patient, you can not only focus on problematic  issues, but you are free to explore all parts of yourself, such a spiritual or moral exploration. 

7.    Choose the therapist that is best suited for you.

We've all been there.  Going on our insurance panel's website and to find a provider and seeing a list of strangers that we would never pick, except that they are in network with our insurance plan.  Of course the provider our friend raved about isn't on there.  When you are a private pay patient you pick whatever therapist  meets your needs and is best suited for you.  This isn't an eye exam, this is someone you are going to tell your deepest thoughts and feelings to. Shouldn't it be someone that you are comfortable with?

8     Increased rates or denial for different insurances.

Because insurance rates required diagnosis, and that becomes part of your health record.   This can affect rates on items  such as life insurance.

9.    Less Documentation.  

I admit, this one seem like it is a win for the therapist and it most definitely is, but it is also a win for the client.  Going back to privacy, the less written the less that can be discovered.

10. The best therapists don't take insurance.

As therapists , most of us want to be accessible to as many people as we can, but we are also human and need to make a decent living.  Many therapists, once they are experienced and established, stop taking insurance.   When a therapist is getting paid by an insurance company they work harder for less money, less than someone of their education is worth.  It also allows us to take pro-bono clients and sliding scale.  Insurance companies see giving some clients in need a break  as fraud because  their discounts are based on our highest rate.  If we give a discount to someone else, then the insurance sees it as no longer getting that discount.

I am in no way discounting the advantages of using insurance.  without insurance many people would be unable to see a therapist.  I believe people need to weigh many factors in when choosing a therapist, such as choice, privacy, motivation, focus as well as financial.  If you are having trouble finding the right in network therapist, consider paying privately.  You can also consider a community center or checking with your insurance company to see what they will pay out of network.  

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