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Why Private Pay for Therapy Instead of Insurance? And How to Use Your Out-of-Network Benefits

More Privacy

Insurance companies require detailed paperwork as a condition of payment. This can compromise your confidentiality as paperwork containing your private information can be passed through various representatives before reaching its final destination. Because I'm private pay, you don't have to worry about me sharing your information with anyone except in very rare circumstances involving your safety (which we'll talk about in our first session).

More Flexibility

Insurance companies can influence treatment decisions such as the duration, the frequency of your treatment, or even the type of therapy provided. They also limit the types of therapists you can work with to those who are paneled with their plans (AKA "in-network). At Root to Rise, we'll have complete freedom over your care.

No Diagnosis Necessary

Insurance companies require "medical necessity" as a condition of payment. This means you must receive a diagnosis from the DSM V in order to qualify for covered care. In my experience, most clients cannot be simply categorized into a predetermined set of criteria. Furthermore, diagnoses become part of your medical record and follow you for your life; they can affect you if you are applying for certain kinds of employment, insurance, or are going through certain kinds of background screening. We can talk about diagnoses if that's helpful for you, but otherwise I don't need to pathologize you to help you.

A Present Therapist

Unlike settings where therapists work as employees, private practice therapists are self-employed. This means there are a variety of considerations for us involving the "business side" (including money flow) of our practice.​ As a therapist in private practice, my fee includes:

  • Overhead costs

  • Cost of medical insurance and lack of other benefits such as paid time off, medical leave, etc.

  • Ongoing training, licensure, & liability insurance

  • Keeping my caseload a reasonable size because each of my clients deserves me at my best!​

Using Your Out-of-Network Benefits

If your insurance plan covers out-of-network treatment, most out-of-network (like me) can can provide a superbill for you to submit to your insurance provider for partial to full reimbursement. Check the Summary of Benefits that is typically included in your member information packet or on your insurance company website. Call your insurance company to verify. Ask them:

  1. What is my out-of-network deductible for outpatient mental health care?​

  2. How much of my deductible has been met this year?

  3. What is my out-of-network coinsurance for outpatient mental health care?

  4. Do I need a referral from an in-network provider to see someone out-of-network?

  5. How do I submit claim forms for reimbursement?

For Couples Therapy:

Ask your insurance provider if they cover CPT code 90847. A potential barrier you may run into is that many insurance plans, unfortunately, will not reimburse for relationship therapy (couples, family, etc.) because healthy relationships do not meet "medical necessity" (see more below)

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