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  • Insurance and Private Pay Options


    Insurance can be a confusing and ever-changing component of getting the help you need. My practice is generally a private pay practice. Below is information that might help you make the most informed decision about whether you choose to use your insurance when seeking services or go with a private pay option.

    Benefits of Private Pay

    No Psychiatric Diagnosis on Your Permanent Medical Record

    Health insurance doesn’t technically cover couples or marriage counseling, because “relationship issues” in itself is not a mental health diagnosis which is a requirement for health insurance to pay for therapy. In order to qualify for coverage, I would have to diagnose you or your partner with a psychiatric condition like depression or anxiety.

    But what if you don’t have a mental illness? After all, many people seek therapy for improve relationships, personal growth and exploration, not because they are depressed or anxious or have a serious mental illness. In the eyes of your insurance company, these are not valid reasons for seeking therapy on their dime. If you don’t have an actual diagnosis, they aren’t interested in paying for your sessions and will not continue to authorize future sessions.

    In private pay the stigma and label of a psychiatric diagnosis can be avoided as it is not mandatory.  And if you did request this type of assessment using private pay, your diagnosis would stay private.

    Your Private Information Stays Private

    Everyone knows that what happens in therapy stays in therapy. Your therapist is required to keep everything you say confidential no matter what, right? Wrong! When you use insurance to pay for services, I am required to provide your diagnosis and private health information to your insurance company in order to get paid. This undermines the basic premise of confidentiality and also gives a lot more people access to private health information about you.  This is one of the main reasons why I have a private-pay practice.  When we work without being under the microscope of insurance your private information stays private.

    Avoids Future Consequences of Sharing Private Information with Insurance Companies

    Even if you’re okay with your information being shared with your insurance company from a confidentiality standpoint, you probably didn’t realize that sharing this information can have unintended consequences in the future.

    • Increased Premiums. When it comes time to renew your health or life insurance or switch plans, your premiums could rise as a result of your “pre-existing condition.” More often than not, mental health diagnoses do not have a statute of limitations. So, the diagnosis follows you – and in some cases, permanently. Any documented mental health treatment filed through your insurance company will go on your permanent medical record. What this means is it can get flagged as a “pre-existing illness.” With Private pay insurance premiums and life insurance policies will not be effected as treatment remains private.
    • Used Against You In Court. If you do decide to divorce and/or end up in the courtroom the individual whose diagnosis was used for insurance coverage may be shared with the court – and could potentially be used as leverage (e.g., for child custody).
    In-Network You Have Loss of Control & Choice
    • Your health insurance may only cover for shorter and fewer therapy sessions. Insurance companies can dictate how long sessions run, and how many sessions they will cover. It can be very hard to get approval to extend after that preset amount.
    • You may only be covered for certain types of approaches. Ironically, the people who work in your insurance company and decide which methods of therapy can be used, are usually not even therapists! And they certainly haven’t met and assessed you personally to know what might work best for you.
    • With In-Network Your Pool of Therapists Becomes Smaller. Seeking private pay therapist significantly expands your pool of therapist to make sure you have access to a therapist who specializes in the services you need rather than the insurance company telling you who to settle for in their network.

    Most therapists in network will say they see couples and families but have not had the specialist training of a Licensed Marriage and Family Therapist to provide the specialist services you need. You will find even fewer therapists in network who like me have advanced training to teach and supervise others to become a Licensed Marriage and Family Therapists.

    Out-of-Network Benefits

    Although I am not in-network with insurance, out-of-network is an option to consider if you absolutely need to use your insurance. If either you or your partner have out-of-network benefits, you may be able to apply them towards counseling and therapy services with me.

    Pros of using out-of-network benefits:
    • You will receive partial reimbursement, which is more economical than no coverage at all. Typically, you will not save you as much money as using an in-network option would. However, with some PPO plans, the difference between an in-network copay and out-of-network reimbursement is very small!
    • You’ll have a larger pool of therapists available, since you’re not limited to just in-network providers.  This allows you the flexibility to choose a clinician with the specialist services you need.
    Cons of using out-of-network benefits:
    • You will also be responsible for paying the full cost of the session up front. Each month you will be provided with what is called a “Superbill” that will contain all the information you will need to submit to your insurance carrier for reimbursement. Your insurance company will mail you a check for reimbursement later.
    • Insurance company can still require proof of the diagnosis through case notes, which has the same potential ramifications as noted above. Please check with your insurance company if a mental health diagnosis is required for reimbursement

    It’s often helpful to call your insurance company for more information to make sure you fully understand your out-of-network benefits coverage.