Insurance vs Self-Pay Information

Insurance vs Self-Pay: Things to consider.

When considering a therapist, how you plan to pay may make a difference. Exploring the differences between insurance vs self-pay may impact which options you choose. After all, cost is a consideration when examining treatment options. Many patients aim to find the most economical approach possible which often means going through their health insurance. We at Neurocove Behavioral Health, LLC strongly advocate for our patients, and actively encourage anyone who feels they might benefit from therapy to seek out care, regardless of using insurance or self-pay. We also want to provide prospective clients with the opportunity to consider a few advantages of paying privately.

Benefit 1: More therapists and treatment Options.

Insurance companies often state they have vigorously vetted therapists, counselors, and psychologists through a rigorous screening process to ensure only the best providers are allowed to enter contract agreements. Insurance companies also frequently indicate that certain therapists, counselors, and psychologists have actively chosen not to work with your insurance company. 

In reality, insurance companies often only contract experienced providers into their network, and when they do accept new providers, prioritize providers with convenient locations and lower fees. With large HMOs, a “one size fits all” method of treatment can often severely limit access to mental health coverage. This may mean that you will not find a provider who is a good fit for you as the pool of potential therapists has been arbitrarily limited. Further, many extremely qualified providers may refuse to work with insurance panels because quality therapy requires additional resources to provide, which insurance will rarely cover.

Benefit 2: Control over your therapy

Those who privately pay for counseling sessions also retain greater control over the number of sessions they can have with their therapist. Under many insurance panels, care may be limited to a specific diagnosis. If your care or session does not correspond with your diagnosis, your insurance company may decide no further treatment is required. In addition, with many insurance providers, you have a limited number of sessions. If you exceed your allowable number of sessions, your insurance company may request a review of your mental health records to ensure the treatment you were provided was appropriate.

 

Benefit 3: Confidentiality

Insurance companies require specific documentation before they will pay or reimburse for your therapy or counseling sessions. All therapists, counselors, and psychologists are directed by federal law to keep confidential records. Failure to do so may result in penalties or forfeiture of your provider’s license. 

When you use your insurance company, counselors/therapists usually must you sign a waiver that allows us to share confidential information with your insurance. At a minimum, this confidential information includes dates of service and mental health diagnosis. In the event your insurance company requires preauthorization for treatment and/or reviews your file, additional information, such as therapeutic session notes, may be required and reviewed by your insurance company.

This information may become part of your insurance record and could be used by insurance companies to raise your insurance premiums as well as prevent you from being able to obtain life insurance, disability insurance, as well as future private health insurance should you make the decision to become self-employed in the future.

insurance vs self-pay

Insurance companies are members of the Medical Information Bureau (MIB) and medical conditions and mental health disorders are reported by the insurance companies to the Medical Information Bureau. This information, including mental health diagnoses, may not only have an effect on your future insurance coverage but it can also affect your eligibility to enlist or commission into the armed forces and can even negatively affect your driving record and ability to participate in risky sports. When you apply for health insurance, life insurance, or disability insurance, your prospective insurance provider obtains a report of your records from the MIB.

Because insurance reimbursement rates are low, paperwork is time-consuming, and coverage is tightly managed and limited, more and more counselors, therapists, and psychologists are making the decision not to participate in managed health care insurance networks. This may affect your ability to get the best care possible.

Another thing to keep in mind when considering using insurance vs self-pay is that contrary to popular belief, therapy does not have to be a never-ending process. In fact, long-term therapy is increasingly shown to become counter-productive. Cognitive-behavioral therapy (CBT) is time-limited and typically consists of between 8-12 sessions. With CBT, your therapist works with you to learn new coping skills and once you master these skills and see positive changes in your life, therapy concludes.

Are you ready to begin? Start here.

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