Benefits of Private Pay for Mental Health Services

Several of you have read, “The difference between Insurance and Private Pay for Mental Health Counseling.” Recently, I have chosen to accept BCBS and BCN insurance and would like to tell you about my experiences with billing insurance. Let’s get started with the Benefits of Private Pay for Mental Health Services:

• You choose the therapist best suited to your needs rather than the insurance company telling you who to see.
• Expansion of mental health providers in your area that specialize in the services you need.
• Flexible scheduling and availability
• No insurance equals less documentation. This results in more quality time to focus on therapy.
• If your therapist is in network for your insurance and you choose to pay private pay, rates are reduced to match that insurance rate.
• Mental health diagnosis is not mandatory and not submitted to your private health records.
• More services are allowed without restrictions such as online counseling and tele-counseling.
• No limit on amount of sessions or time of your session.
• You are guaranteed privacy and confidentiality.
• Stigma of some diagnoses can often be avoided.
• Private pay clients are able to choose the focus, duration, and frequency of therapy. You are even allowed to choose the length of sessions.
• Research shows that clients who have to pay something for their treatment have more positive outcomes that those who receive free treatment.
• Sliding scale rates can be offered to clients paying private pay. This means that privately paying clients can actually pay less than those who pay with insurance.
• You or your child won’t be labeled with a mental health diagnosis unless you request this type of assessment.
• Insurance premiums and life insurance policies will not increase based of mental health diagnosis and treatments.
• You won’t have to worry that your health records will be included in the MIB and create problems for you or your child in the future.
• You will be able to stay with your therapist even if your insurance plan coverage changes.

Benefits of Insurance for Mental Health Services

Insurance is wonderful when it comes to emergencies, hospital visits, surgeries, prescriptions, and specialists that may cost a fortune out of pocket. Here are some benefits of utilizing your mental health benefits through your insurance:

• Depending on your insurance policy, you may have a $0 to small co-pay only to pay out of pocket.
• The Affordable Care Act makes it illegal for insurance companies to deny you coverage for pre-existing conditions, including a mental health condition.
• Ability for therapist to accept clients who need to pay via insurance.
• No large up front out of pocket pay (unless your deductible must be met before co-insurance applies.

Disadvantages of Mental Health Insurance Plans

Let’s take a look about the disadvantages of using mental health insurance plans from the viewpoint of a therapist and the client:

• Therapist must make a case that therapy is “medically necessary” which involves labeling the client with a mental health diagnosis.  This is often required after the first visit, and then becomes part of the client’s permanent health record.
• Clients are limited to quality and quantity of providers and their availability for new clients.
• Does not guarantee that you will be able to visit the most qualified therapists for your presenting problems.
• Not all insurance plans cover online and tele-therapy, specific diagnosis, and unlimited visits.
• There is a significant amount of documentation that needs to be completed per session, therefore, if you see your mental health provider on their computer or taking notes, creating treatment plans or consistently updating documentation; it may seem as if they are not listening. They indeed are, but in order to bill insurance, a significant amount of documentation must be completed each session.
• EVERY SUBJECT that you discuss will need a diagnosis or fall under the criteria in which the therapist is billing insurance and shown upon your treatment plan. Otherwise, a goal and diagnosis must be established (resulting in more documentation).
• Insurance policies change per year and for some clients, this may result in higher premiums based on your mental health diagnosis.
• Insurance providers require a co-pay and a large deductible to be met when seeking treatment.
• Coordination of care may be required with your primary care physician.
• Medication may be required in order for insurance to provide coverage.
• You may have difficulty finding providers that accept your insurance.
• Many insurance companies provide payment only for certain approaches of therapy (short-term and problem-focused).
• Many issues (such as martial problems, life stress, or personal growth) are not covered by insurance.
• Parent skills training is not covered by insurance.
• Insurance specifies time restrictions for individual and family sessions. Some insurance plans do not even cover family or couples counseling.
• Mental health records may limit your ability to qualify for health or life insurance or require that you pay substantially higher premiums in the future

There are several Benefits of private pay for mental health services. I am not saying that insurance is bad, in fact it can be quite beneficial, however has many limitations and stipulations regarding your mental health qualifications.

Despite the benefits, many people simply can’t afford to pay out-of-pocket for therapy services. While private-pay may not be right for everyone, many therapists reserve a few low-fee spaces in their practices, both as a way of giving back to the community and in order to work with individuals who have complex cases but can’t afford the treatment they require.