Why Paying Privately for Mental Health Services is Worth It

Mental health treatment works. What is less clear is how to pay for it. For those of us with insurance, it seems logical that we would use it for treatment. But that isn’t always the best idea. The following are benefits to paying privately.

1. Confidentiality

The decision to see a counselor is very vulnerable and personal. You may not want to share that decision with anyone, much less explain why you need to see a professional. But, once you involve the insurance company, your privacy has significantly decreased. The reason is pretty simple. For the insurance company to pay for your treatment session, you have to get it approved. It’s often referred to as prior authorization.

That means you’ll have to explain to the company exactly why you feel you need treatment. Typically, you’ll fill out some forms or at the very least, you’ll talk to someone on the phone. Those people now know what struggles you’re facing.

2. No need for a diagnosis

Insurance companies mandate a diagnosis before providing coverage for treatment expenses. Similar to presenting paperwork confirming a broken leg for surgery coverage, mental health treatment necessitates a counselor’s submission of a diagnosis for insurance coverage. The challenge lies in insurance covering only treatment deemed medically necessary.

Approximately 57.8 million adults in the U.S. in 2021 struggle with mental illness annually, including serious conditions like schizophrenia and bipolar disorder. For these individuals, obtaining counseling considered  “medically necessary” might not pose a challenge.

However, a significant number of people struggle with managing stress, coping with loss, or dealing with job-related issues. They may require crisis counseling for support, but these concerns might not meet the criteria for being medically necessary. Additionally, millions of couples seek marriage counseling to salvage relationships, which typically doesn’t qualify as medically necessary. Private payments eliminate the necessity for a diagnosis to engage in services.

3. Mental Health Treatment does not become part of your permanent record

Let’s say you visited a psychologist to talk about the issues you’re facing, you received a diagnosis and the insurance company agreed to pay for Cognitive Behavioral Treatment to deal with childhood trauma. All that information is now a part of your permanent medical record. It can be accessed by other insurance companies if you have to switch to a new one. If you’re applying for a job that
requires a specific security level, the employer may have access to the records from your mental health treatment. Your mental health issues are now considered a preexisting condition.

4. More control over your treatment plan

When the insurance company approves your treatment, it also approves a specific duration. That means, the insurance company determines how many sessions you need. You and your psychologist don’t get to decide how often you see each other, or for how long.
The insurance company also has the right to review your treatment records any time to monitor your progress. The company can decide when your treatment should end, regardless of what your psychologist says.

5. You can avoid long wait times

Finding the right counselor can be challenging. Finding one that takes your insurance is even more difficult.

6. Episodic treatment sessions

You may seek treatment to help you cope with specific events or triggers that don’t affect your daily life. For example, you may struggle with anxiety every time you go home for a visit with your extended family. Outside that, you feel great. It’s unlikely that insurance will cover one or two sessions every couple of years, even if you and your counselor feel it would be beneficial for your overall mental health.

7. Insurance Companies Can Withdraw Approval

Even if your insurance company approves coverage for your treatment sessions, it’s not a guarantee. It’s possible the company can withdraw approval, even before you’ve finished your sessions. You are ultimately responsible for payment, so you could be on the hook for hundreds of dollars if your insurance company backs out.

8. Pay for Value

Paying for value prioritizes the results of therapy, such as improvements in mental health, rather than just completing a set number of sessions. This approach encourages the counselor to focus on achieving meaningful progress. Some argue that private pay clients might receive more attention and care since the therapist isn’t constrained by insurance reimbursements or
session limits. This can lead to a higher quality of care and potentially better outcomes.

Final Thoughts

Some mental health treatment providers will offer something called a sliding scale for people who need help paying for treatment. In this case, the counselor might give you a lower rate, if you can demonstrate financial need. We’re here to answer any questions you have about the therapeutic process or to schedule an appointment. Please contact us at any time. We’re here to help.

This article was contributed by College of William & Mary Clinical Mental Health Counseling Master’s Student, Rachel Bradley.