Why Self-Pay (versus accepting insurance)?
Advantages of Self-Pay:
1. Paying for psychological therapy out of pocket minimizes the exposure of your protected health information (PHI). Whenever you use insurance benefits to cover therapy, the provider, albeit with your consent, has to release certain types of information to the insurance carrier in order to a) verify your eligibility for coverage, b) pre-authorize services (if applicable), and c) to process claims to obtain payment. As the result, the provider informs the insurance carrier of such personal matters as the nature of the issues you struggle with (presenting problem), psychiatric diagnosis, your treatment plan and prognosis. With Self-pay, your therapy remains completely private (with the exceptions to confidentiality such as in the event of harm to self or others, etc.) and there is no session limit determined by a third party.
2. Self-Pay includes the fact that no records of therapy exist in the Medical Information Bureau, which could potentially compromise your ability to get current or future life, health, disability, or long-term care insurance. Therefore, self-pay therapy does not require a psychiatric diagnosis code. If, however, you were using your insurance benefits, you would have to be assigned a psychiatric diagnosis in order for the provider to justify the medical necessity for the services provided. Once such diagnosis code is recorded by the insurance, it becomes part of your health care record.
3. Self-pay permits you to have control over your treatment. For instance, certain treatment modalities such as couples and group therapy may not be covered by your insurance, such as relationship or couple’s therapy or group therapy. Self-pay allows you to also determine the counselor of your choice instead of having to choose from “in-network providers, the length of your treatment based on your needs rather than on the basis of the allotted session benefits.
Benefits of Private/Self-Pay
Clients who pay directly for their counseling needs gain the following benefits:
You gain confidentiality and privacy. If you use insurance, your insurance company has the right to review your clinical records. This is called a diagnosis code. This creates a paper trail that others besides you and your counselor might view because mental health professionals are required by law to submit this code when requested when you use insurance. This is especially true in the case of children.
You get to choose the right counselor for your personal concerns and are not limited by in-network providers.
Out of pocket medical expenses are in-part tax deductable.
You do not need to worry about whether further sessions will be approved (you make that decision, not the insurance company).
You will likely feel more responsible and invested in the counseling process, seeing results quicker due to increased motivation.