Insurance Versus Private Pay

Individual Counseling & Therapy | Marriage Counseling & Couples Therapy
Columbia, Missouri

Quick Note: There’s a video of Tara (the practice owner) detailing the pros and cons of each at the very bottom of this page. Letting you know in case you’d prefer listening/watching to reading!

First and foremost, if you’re in the wrong place and just want to know about counseling services we offer (including individual counseling and therapy or couples therapy and marriage counseling) or you just want to learn about our fabulous team, then feel free to explore other pages and return at your leisure!

Secondly, there are pros and cons to both insurance/managed care and private pay/self-pay. I’m going to refer to these as “insurance” and “private pay” from here on out, but there are additional ways people reference them (just as an fyi). The purpose of this page is to clarify some of the pros and cons of each. I’m sure that this won’t be an exhaustive page and it’s super important to note that this page is written in generalities!!

I repeat, this page is written in generalities!! In other words, there’s no possible way to clarify each specific insurance provider and plan type, so we’re speaking in broad brush strokes. This is a starting point and your experience might be slightly different, which is expected and okay.

The Pros and Cons of Using Insurance for Mental Health Care: An Overview

This will start with a super brief overview of pros and cons of using insurance, at which point it’ll shift into details of each bullet point. Take and leave what you might need to, and also make sure you contact us directly if you have any questions, concerns, or confusion about any of this. We’re always happy to answer any questions and make sure you get the information you need before deciding on services!

Okay, so let’s break this all down a little bit more. Here are more thorough descriptions of the above bullet points. Let’s start with private pay pros and cons so that we can clarify why this might be a good idea and why it might not be, and then segue into insurance pros and cons!

Private Pay Con

Possibility of More/Higher Out of Pocket Costs (After Hitting Deductible [if you have insurance])

This seems to be the biggest reason people prefer to stick with insurance and we get it. Yes, you’re correct, counseling will cost funds out of pocket. Here’s the catch, though.

1. We offer a sliding scale to help with this cost.
   Bottom line: our goal is not for cost to be a barrier for people to receive counseling or therapy services. One of the ways we offset being private pay is by offering a sliding scale for most of our clinicians (please note: not every clinician offers this sliding scale, but the majority do).

2. In some cases (depending on your insurance), you can still use these costs to hit your deductible and/or be reimbursed by your insurance.
   If you have out-of-network benefits, then you can typically use some, if not all, of the money you paid for counseling services towards your deductible. Further still, once that deductible is met, you can submit information to your insurance company and they’ll reimburse you directly for some of the money you paid for counseling services! All of this can be done via a “superbill.” Think of a superbill as a detailed receipt. This is super easy to do and something that your provider can provide for you on a weekly or monthly basis.

We absolutely understand that cost is a factor in counseling and rest assured that we don’t take this aspect of things lightly. We know it’s a financial commitment and we respect your time and money and energy.

Private Pay Pros

Flexibility in Choosing a Provider (Including One Who Specializes in Your Problem)

This is my favorite pro. It’s also what I would argue is one of the most important pros to private pay services. In short, you, as the client, get to decide who you work with, period. And that’s just it. While this may seem simple or not that big of a deal, research would show that having a good relationship with your counselor and feeling safe/heard/validated/seen is one of the biggest predictors of therapeutic success. Yes, seriously. In essence, if you feel especially confident in your clinician and you feel empowered to choose the ‘right’ one to work with, then your chances of “success” (whatever that looks like for you) are going to increase. Freaking amazing, right?!

No Parameters on the Length or Type of Counseling or Therapy

Private pay also affords you the opportunity to do as much or as little counseling/therapy as you’d like to do. This isn’t dictated by anybody other than you and your clinician through a very collaborative process.

Services Can Be ‘As Needed’ and Not “Medically Necessary”

This one is harder to explain, but short version is that insurance requires services be “medically necessary” for people in order for them to cover the therapy. So while it’s definitely the case that clients come in and services are medically necessary, it’s not a prerequisite to doing counseling/therapy. That’s the difference. As private pay, you (and your clinician) aren’t required to submit any information to a third party, like insurance, in order to justify to them that counseling/therapy is needed. It’s up to your discretion. And if you primarily feel good, but want a session to check in, then you’re in the clear and won’t be obligated to justify that decision.

Insurance Pro

Lower Out of Pocket Costs (After Meeting Deductible)

Here’s the long and short of it. Most types of insurance coverage require you to meet your deductible before they reimburse you for services. On one hand, you can rest assured that all the money you’ve paid for counseling (and any other medical needs) will go to your deductible. On the other, if you’re only coming through for counseling, then that might mean lots of money at the outset before you start to see any of the reimbursement.

It’s less common (but not unheard of) that insurance coverage completely covers mental health services prior to deductible. If this is the case, bonus for you! That’s amazing, honestly, and we’re happy when it works out for people in that way.

Insurance Cons

Less Flexibility in Choosing a Provider

This basically counters my favorite pro for private pay. When you are strictly using insurance, you immediately limit your choices to those clinicians who accept that insurance. Let me be clear - there are wonderful clinicians who accept insurance. By no means are we dogging those clinicians. The point is that you, as the client, are now limited in your choice, and that’s just one of the cons of sticking with a provider who accepts your insurance. You have less flexibility in choosing the clinician of your dreams, and you might not find somebody who’s both a) paneled with your insurance, and b) specializes in the problem you’re coming in with. It’s trickier.

Diagnosis is Required

There’s no other way to say this than insurance requires a diagnosis. And soon. And if you’ve ever done any counseling or therapy before, then you might understand how tricky this is and how ridiculous it is that a diagnosis is required so quickly out of the gate. Mental health diagnoses aren’t quite the same as acute illnesses. For example, if you have an infection of some sort, you go to the doctor and they prescribe you with antibiotics. Seems simple and straightforward.

But what if you just feel “off” or have a general fatigue that won’t go away and it’s hard to pinpoint what the problem is? Then what? Well, then the doctor spends more time with you, might order special testing, might have you wait a little longer, or might usher you out the door with a “call if it gets worse.”

Counseling/therapy is generally way more like having a sense of something being “off,” but not knowing what it exactly is. You know how you want to feel, but without knowing what led you to feeling bad, it’s hard to make changes. Your clinician should be able to eventually pinpoint what the problem is, but it’s not something that can be done immediately in all cases. And “off” isn’t a diagnosis. So what can end up happening for clients is that they’re ushered through what could be a beautiful process based on insurance needing a diagnosis to justify services. Yuck.

Insurance Can Dictate Length or Type of Treatment

In essence, your insurance provider has some level of control over how long you can see your clinician. Better worded is that they have control over how much they’ll reimburse you for you seeing your clinician. If they disagree or don’t see merit in your continued services, then it’s likely that they’ll not cover you attending.

Out of Pocket Costs Until Deductible Is Met

Unless you have insurance coverage that includes stellar mental health services, then the likelihood is that you’re going to be paying for services out of pocket until you meet your deductible. On one hand, this cost is based on the agreed upon rate between your clinician and the insurance company. On the other, it still cots you out of pocket. In most cases (can’t speak for all, of course), only when your deductible is met does your copay kick in. And so services still end up costing some money out of pocket.

One Last Note

I’m sure I said this above, but it’s worth saying again. If you have any questions, please contact us directly and we’ll get back to you as quickly as we can. We really do want you to receive the best services you can (whether that’s with us or not!), and hope that you feel comfortable reaching out if needed.

Lastly, this may not mean anything, but please know that the decision to be a private pay practice was not taken lightly. It’s one that is consistently thought about, reflected on, and grappled with, and it continues to be a difficult one purely because it negatively impacts some people who want to see a clinician with our practice but can only use insurance. As it stands, private pay is appropriate for us for right now.