This may come as a shock to some, but there are actually several reasons why someone may choose not to use their insurance for counseling services. Of course, whether you use insurance or not, it is important for you to receive the care that you need. This article will discuss six of the most common reasons someone chooses not to use insurance, as well as alternatives to using insurance, so that you can make the best informed decision for your care.
1. insurance requires you receive a diagnosis
Yep, in order for your therapist to bill insurance, you must receive a diagnosis. Let’s be clear– struggling with a certain mental health condition is okay. It does not make you a bad person, defective, or any other negative word out there. However, this can be a difficult thing for clients to feel comfortable with at times and can be a permanent part of their health record. Worse is that this diagnosis has to be made fairly quickly by a therapist, typically within just a few sessions, AND it has to show a clinically significant reason for therapy. That means that certain issues that pop up which you may reach out to therapy for may not be covered or deemed “necessary” by insurance companies (e.g. grief, relationship issues, communication issues, etc). As therapists, we only want to diagnose a client with a mental condition if it is beneficial to them. This means in cases of insurance coverage or to receive specific medical care. You are NOT your diagnosis. You are a human being who should not be reduced to a label simply for billing purposes.
2. Insurance can deny your claim or cut services at any time
This is a difficult one to grapple with both as a clinician and as an individual. There were so many situations during my time as a primary therapist at a residential and PHP program in which the client was actively involved in the work and then insurance cut on them. It is heartbreaking. When someone is showing up, doing the hard work, and insurance cuts it can shake their trust in the system. Vulnerability is essential to therapy, without it we can’t really get anywhere. In order to be vulnerable we must have a sense of trust and safety. Feeling as if your insurance could stop coverage at any point can erode that sense of trust and safety. Instead of feeling like you will stop when you feel ready, insurance tells you when you’re going to stop–regardless of if you feel prepared to yet.
Even in an outpatient setting this can be a challenge. I’m sure we’ve all experienced that surprise bill from an insurance company 1-2 months after services that we thought were covered, but ended up not being covered. Often times it’s something we didn’t plan for financially because we thought we were good. Imagine going for weekly sessions (at your therapist’s full rate) and then having insurance spit that back at you down the road. Had you known it wouldn’t be covered you may have opted for a sliding scale option or adjusted your sessions to bi-weekly instead.
3. You don’t have to worry about meeting a deductible or high co-pays
Every January 1st our deductibles roll back around. This can be a shock for some. You’re going to therapy, doing the work, paying your co-pay and all of a sudden you now have to meet your massive deductible. This can be a shock and a deterrent to seeking services during the beginning of the year. Unfortunately, this often coincides with some of the hardest times of the year for mental health.
In addition, some people may discover that their co-pays are actually pretty high. With co-pays ranging from $10-$100+ it can actually make more sense to use private pay or sliding scale options with your therapist instead, depending on how much they charge.
4. Loss of Confidentiality
When you use insurance for therapy services, they kinda get to be all up in your business. What I mean by that is that they get to see basically everything: session notes, treatment plans, goals for therapy, and especially any documentation regarding mental health symptoms deemed clinically significant that interfere with your overall functioning. They want to see everything to prove that, according to their standards, you “need” therapy and also to approve what course of therapy you are receiving. Sometimes it can be hard to be vulnerable if you feel like a third-party will be reviewing everything that comes up in therapy.
5. Losing your therapist if you switch insurance companies
The therapeutic relationship is one of the most powerful factors in determining if someone will have success in therapy. This has been shown in study after study. If you don’t trust your therapist, you won’t trust the process. If you don’t at least semi-like your therapist, you probably won’t want to devote 50 minutes of your time talking with them. Needless to say, matching with the right therapist is essential.
So what happens when you find a really great therapist, but you change/lose a job or join your spouse’s insurance? Unless your therapist happens to take the new insurance, you may have to stop seeing them.
6. You have more therapy options with private pay
As we can see by now, insurance can hinder your power in the therapeutic process. Another thing is that it can also stop you from accessing a whole group of therapists that aren’t covered under your insurance. These are therapists who are strictly private pay or that are covered under other insurance companies, but not yours. These therapists practice a range of different therapeutic modalities as well that aren’t covered by insurance companies (btw there is a whole wonderful world beyond the old “talk therapy” concept).
Finding someone within your affordable price range allows you to pick your therapist, the therapy type, and exactly how long and how often you want to go. While most people feel like therapy may be too expensive for them to afford, there are actually a lot of options. Many therapists even hold spots for sliding scale clients that are unable to pay their standard rate. Some therapists, like myself, can also use your Health Savings Account card to pay for sessions — which allows you to use insurance without the hurdles.
In conclusion, I know starting therapy can be a big decision and the financial aspect isn’t something we want to think about. However, I hope that this article has helped give you a clearer picture of what your options are when it comes to paying for therapy and what that means for your care.
Remember: You are worthy. You are capable. You are enough. ❤
Best, Jess
About the author
Hi, I’m Jess. I’m an EMDR therapist here is St. Louis, MO. I use EMDR in combination with CBT, attachment theory, and family systems theory to help adult individuals, adolescents, couples, and families work through the issues that have been holding them back from the life they want. I specialize in working with clients experiencing attachment issues and negative core beliefs–those pesky feelings of being “not enough”, “bad”, “unworthy”, and more. If things have not been feeling “quite right” in your life, let’s chat! Give me a call at 314-484-1196 for a free 15 minute consultation or send me an email at jkraemer@psychservstl.com.
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