Paying for Therapy:

Frequently Asked Questions 

My insurance policy has mental health coverage. What do I need to do to use these benefits? First, you’ll want to find out if the therapist you wish to see is an “in network” provider. The insurance company can help you determine this, though you should also check that the therapist is accepting new patients from your particular insurer. Also, some insurance companies require that you get preauthorization before seeing the therapist for the first time. Your insurance company can tell you how many you visits you are allowed and what your out-of-pocket costs will be.

I found a therapist who comes highly recommended but she is not a provider for my insurance. Can I still get insurance to pay the cost of seeing her? Many companies will pay a percentage of the cost for seeing an “out of network” provider. Typically, in this situation, you pay the therapist their full fee at the time of service. You then file the claim to your insurance company who sends the reimbursement directly to you. If you choose this option, ask your therapist for a receipt that contains the required information to file for reimbursement.

I’ve heard that some people choose NOT to use their insurance. What are the advantages to paying for therapy out-of-pocket? There are many reasons why people choose to pay for therapy out-of-pocket. The three main reasons are as follows:

1. When you pay for therapy yourself, you maintain control and freedom of choice regarding your health care. You make your own decisions regarding frequency of appointments, number of sessions, length of sessions, etc. This freedom allows you and your therapist to develop an approach that is tailored to your wants and needs.

2. Unlike therapy that is paid for by an insurance company, when you pay for therapy yourself, your therapist is NOT required to give you a mental health diagnosis or prove that treatment is a “medical necessity”. Thus, you can avoid any associated stigma that may arise from such a diagnosis and it does not become part of your medical record

3. Your privacy is compromised when using insurance to pay for therapy. The therapist must disclose information regarding your case to your insurance company. With the increased use of computerized databases to store information and internet technology to process claims, many are uncomfortable with the number of people who can (or could) have access to their information. Additionally, your information may be stored in the Medical Information Bureau (MIB) and may be used to deny or limit your insurance coverage. 

For more information about medical privacy visit:

     Medical Privacy Rights

     Electronic Privacy Information Center

     Medical Information Bureau

I don’t have insurance and I can’t afford to pay for therapy out-of-pocket. Can I still get help? Don’t give up! You deserve the professional help you are seeking! Some therapists reserve a limited number of slots at a reduced fee. Also, there are community organizations that provide counseling on a sliding scale basis*. Some people are truly unable to pay for therapy at the current market rate. Others choose to spend their money on different priorities. Remember that therapy is an investment in your future. You and your loved ones will reap the benefits of therapy for the rest of your life. 
 

*Call 211 for more information.