Private Pay Therapy

I'm proud to offer private pay therapy to my clients. If you’ve ever wondered why many therapists don’t take insurance, you aren’t alone. I am committed to transparency and wish to answer this as best I can. This answer can be complicated as insurance has many problems that are systemic in nature and cannot be solved by just one clinician.

The simple response is that your mental health matters more than insurance companies can dictate. By working with a private pay therapist, you have more control over your care and are less likely to face the limitations and restrictions that often come with insurance.

In the interest of transparency, my top six reasons for not accepting insurance are listed below. 

1) PRIVACY

Did you know that insurance companies have access to all of your notes and treatment materials? With this information, they decide whether or not you are “sick enough” to receive services. Additionally, all of this information goes into your permanent medical record. If therapists keep their session notes vague, insurance can deny coverage. Your medical record can determine whether you’re eligible for future services, like disability, life insurance, or FMLA. Healthcare changes yearly and there is always uncertainty for the future. I am committed to upholding confidentiality and keeping your record completely private.

2) INCONSISTENCY

Insurance can decide to stop paying for your services at any time. The only way we know if a service is covered is by waiting for approval or denial of a claim. This can leave you with a large, unexpected bill if after approving your sessions insurance suddenly declines them.

Imagine going to work and not knowing if you’re going to get paid for your hard work. Insurance takes a while to approve or deny claims. So therapists often don’t get paid for weeks or months after your session.

Early into 2024, a cyber attack prevented medical professionals from getting paid for services rendered for months (and also leaked sensitive medical records). I know therapists who still haven’t been paid for sessions that happened 6 months ago. Their hands are tied and there’s nothing they can do but wait.

3) DIAGNOSING

Insurance will not cover therapy services unless you have a diagnosis from session one. 50 minutes is not enough time to ethically diagnose anyone. If you are having difficulty at work or a hard time in school, therapists have to diagnose you with something even if you don’t meet the criteria. This is unethical and can be considered insurance fraud.

In my work, trauma is highly individualized, and sometimes someone who is struggling doesn’t neatly fit into a diagnostic box. There is also no current diagnosis code for someone struggling with relational abuse or codependency.

4) RETROACTIVE DENIALS

Imagine you go to work and you get paid and then years later you have to pay back your entire paycheck, and then some. This is a retroactive claim denial, also known as Insurance Clawbacks, and is remarkably common. Insurance companies can and will audit therapists to determine whether a session they already covered was necessary or not. They can deny a session they paid for years later based on trivial things (e.g. did you include the time the session ended in your note). The most I’ve heard of a therapist needing to pay back to insurance is $30,000 eight years later.

5) TREATMENT LENGTH

I’ve seen clients for months and, according to insurance, they weren’t progressing “fast enough.” The solution, that someone without a therapy background determines, is to reduce the allowed amount of sessions per year. That’s right - insurance determines how frequently, or not, you can be seen.

Insurance also dictates how long you can be seen. Insurance will not cover sessions longer than 60 minutes. Sometimes people benefit from extended sessions such as EMDR or other types of therapy or by more frequent sessions.

By electing a private pay therapist, you are in control of how often and how long you would like to be seen depending on what works best for you, your struggles, and your schedule.

6) LOW REIMBURSEMENT RATES

Your therapist has, at minimum, a Master’s degree. This includes 4 years in undergrad and 2-3 years in graduate school. Most likely, we all have thousands to repay in student loans (I know I do) and the rate that insurance reimburses for a one-hour session is not a liveable wage. This reimbursement can be as low as $60 per session. At a manageable client load of 20 clients a week and a $60 reimbursement rate, that comes out to $15/hour (about minimum wage) for full-time work (40 hours a week).

You never know what you’re going to be reimbursed until you’ve already signed a contract with the insurance company. (Pst… we’re also not allowed to talk about our reimbursement rates as it goes against our contract). It can take months to “prove” to insurance companies that you’re “worth” a higher rate, and sometimes they’ll decide to lower it instead. Imagine never getting a raise, as the cost of living and inflation increase, and then one day you’re told your pay decreases.

To make a liveable wage while taking insurance, many therapists need to see 25-30 clients per week. By not accepting insurance and making my full rate, I can see fewer clients and reduce the likelihood of burnout. That means that I can focus on your quality of care instead of stressing over everything listed above.

So…. What do we do?

Good question! What many therapists, myself included, choose to do is not accept insurance until policies change for more inclusive and accessible mental health care and benefits. Ultimately, this is a systemic issue and I alone can’t fix the system. I’ve chosen what’s best for me and my own mental health while I support my clients’ needs. Because of these difficult decisions I’ve made, I am confident in my ability to focus on your care and help you thrive.

Did you know you can also get reimbursed for your out-of-network (OON) therapy sessions by your insurance? That’s right! Your therapist can get their full rate and you can get reimbursed for 60-100% of what you paid.

I’ve personally dealt with OON reimbursement and it’s easier than it sounds. That doesn’t take away how OON reimbursement can be overwhelming and scary if you’ve never done it before. That’s why I created this guide on how to manage and handle your out-of-network benefits to aid you as much as I can.

There are also services out there to help you submit OON claims for a small fee (less than $10) such as Mentaya, Reimbursify, and Thrizer to make it as easy as possible. 

My fee also allows me to offer a limited amount of sliding-scale spots for individuals who are in need but are unable to afford my private pay rate. Contact me for information about sliding-scale appointments.