If you are interested in pursuing therapy with me, at this time I offer the option of paying for your sessions-out of-pocket or using insurance to cover for therapy. In deciding which option to take there are a few things that you should consider.
a) Insurance companies require that clients be diagnosed.
Most insurance plans base their reimbursement of mental health services on what is called “medical necessity.” This means that you must carry a mental health diagnosis in order to justify treatment. Some people may feel uncomfortable with carrying a mental health diagnosis, as this diagnosis will become part of your permanent medical record, which could impact you in the future in terms of employment prospects or eligibility for future health or life insurance. When you self-pay for therapy there is no need to give a diagnosis, thus eliminating any of these concerns.
b) Insurance plans place restrictions on the type of therapy clients can receive.
For example, insurance plans do NOT reimburse for couples counseling unless one partner is diagnosed with a disorder and the joint sessions are meant to help the “identified patient” to make progress in treatment or to prevent worsening of current symptoms. When you pay for therapy yourself you and I can decide what type of therapy is most appropriate without having to worry about restrictions dictated by your insurance.
c) Insurance companies dictate the length and frequency of sessions.
For example, they may only pay for 45 minute sessions and not for 60 minute sessions. I often hear my clients lament that sessions are “not long enough” or wish they could have “more time,” yet, insurance typically does not permit for longer sessions. Similarly, insurance plans may only allow one session per week, or they may place a limit on the number of sessions a client may have in a given year. There are also considerations such as deductibles and co-payments which may change every year.
In therapy, sometimes clients may need or want longer or shorter sessions, or they may want to come in more than once a week. I have created customizable service packages, including a 6-month, unlimited session package where clients can decide how many sessions to have and how frequently to have them, based on their own circumstances and preferences. Clients can also pay in a single payment or in monthly installments, rather than per-session, so that treatment can be continuous, cost-effective, and not dependent upon ability to pay each week. Having these options could help to make treatment truly optimized to meet each client’s needs, in addition to making it more time-efficient and cost-efficient. However, these flexible options are not available with insurance reimbursement.
d) Some insurance plans do not cover online video sessions, phone sessions, or in-between session communication.
In order make my services as convenient as possible for busy moms I offer a variety of flexible options such as in-person, phone, online video sessions. This can facilitate continuation of treatment even in situations such as if you have a sick child, you're sick, the weather is bad, you're short on time, or simply prefer not to come into my office. In addition I offer self-paying clients the option to stay in touch with me via secure messaging in-between sessions (Monday through Friday) if they have questions or concerns.
While some insurance companies are now allowing what are called Telehealth or telemedicine sessions (via phone or video), not all insurance plans offer this option. Even when the option is available there may be certain special criteria or codes to make the claim payable. In addition insurance does not cover for in-between session contact between therapist and client, (except in emergencies and still subject to certain restrictions).
e) Insurance companies require electronic transmission of protected health information (PHI).
Despite of security measures and the implementation of HIPAA, data breaches occur all the time, which means that there is a potential of client information being accessed by third parties. In addition, sometimes insurance companies require that therapists release to them a client’s treatment record, for purposes of assessing “medical necessity” and determining whether the treatment is eligible for reimbursement. Also, once these records are in possession of the insurance companies they may be accessed by third parties in the future. For example, they may be accessed by other service providers, or by certain potential employers which require background checks, such as if you want to become a pilot or a government official. Paying out-pocket offers the advantage of maximizing confidentiality and privacy by not sharing any information with outside third parties (there are exceptions to confidentiality, however, based on potential harm to self or others, or criminal investigation).