Many health insurance policies include coverage for mental health therapy. While insurance is a cost-effective option, there are several advantages to paying out-of-pocket instead of using insurance benefits.
"I don't want anyone to know my personal business"
In order to submit an insurance claim, the therapist has to include, at a minimum, a mental health diagnosis. Sometimes the insurance company requires that the therapist provide more detailed information about the reason services are being requested. This information becomes part of your health record. As a client, you may prefer to pay out-of-pocket in order to avoid sharing your private information with your insurance company.
"Why do I need a diagnosis? I'm not sick"
As mentioned above, when an insurance claim is filed, it includes a diagnosis. While a diagnosis is helpful in determining the course of treatment of someone who experiences a mental health issue, not everyone meets the criteria for a qualifying diagnosis. You may be seeking therapy to improve a relationship, learn new skills, or to prevent a problem from getting worse. As mentioned above, even if you do meet criteria for diagnosis, you may not want a diagnosis to become a part of your health record. Paying out-of-pocket allows you to seek therapy on your own terms.
"I want to choose my own therapist"
Most insurance companies have contracts with healthcare providers who are called "preferred providers" or "network providers." Some insurance companies do not provide coverage for you to receive services from a provider who is not part of their network. Others will reimburse you at a lower rate if you choose to see an out-of-network provider, but only if you have met your annual deductible. If you pay out-of-pocket for therapy, you have a wider selection of therapists to choose from regardless of your insurance plan.
"I don't want a company to decide what services I can get."
Your insurance company may have restrictions on the type of therapy allowed under it's plan, or the length of therapy. Some policies limit the number of sessions allowed in a calendar year. Self-pay allows you to choose the type of treatment you want for the duration that you and your therapist determine is appropriate.
Deciding whether to use your insurance benefits is a personal decision that may depend on a number of personal factors. Before scheduling a therapy session, be sure to contact your insurance company to verify your coverage. The following questions may be helpful in determining whether to use your insurance or to pay-of-pocket:
Simone D'Amore is a Licensed Professional Counselor practicing in Beaverton, Oregon.