Insurance vs. Private Pay
How you choose to pay for therapy can also be an important decision. There are pros and cons to both options, and understanding the differences can help you decide what works best for you.
Private Pay
I like to think of private pay as paying for more control and privacy in your treatment, allowing the therapy process to truly be yours. When you choose private pay, your insurance company is not involved in your care. This can give you and your therapist greater flexibility when deciding things like the frequency and number of sessions and the overall direction of treatment. Private pay can also offer greater privacy. Your therapist will still maintain a clinical record as required by law and professional standards, but information about your treatment and diagnosis does not need to be submitted to an insurance company for the purpose of processing claims. You may also have greater flexibility in the type of therapy and services you receive because treatment decisions are being made between you and your therapist rather than based on what an insurance plan will reimburse.
In short, with private pay, you are paying for more privacy, flexibility, and control over your care.
See: A Quick Guide to Therapy Approaches
Using Insurance
The biggest benefit of using insurance is usually cost. Rather than paying the therapist’s full fee, you may only be responsible for a copay, coinsurance, or deductible depending on your plan. The trade-off is that your insurance company becomes a third party involved in paying for your treatment. Insurance plans may place requirements or limitations on the services they cover, including session frequency, number of sessions, or types of services that are eligible for reimbursement. Insurance also generally requires your therapist to provide a clinical diagnosis demonstrating that treatment is medically necessary. Certain information about your treatment must then be submitted to the insurance company in order for claims to be processed. This doesn’t mean therapy through insurance is less effective. It simply means there may be a few more hoops to jump through and somewhat less flexibility than there is with private pay.
Can I Choose Private Pay If I Have Insurance?
Possibly!
Many people with commercial or private insurance may choose to pay privately rather than use their insurance benefits. However, insurance plans and provider contracts can have different requirements, so it is always a good idea to verify your options with your insurance company before deciding not to use your benefits. Government-funded insurance programs such as Medicare and Medicaid have additional rules regarding private-pay arrangements. If you have one of these plans, talk with your therapist and/or insurance provider before choosing private pay to make sure it is permitted in your situation.
What If My Therapist Isn’t In Network?
You may still have options. If you’ve found the therapist of your dreams but they aren’t in network with your insurance company, your plan may include out-of-network benefits. In that case, your therapist may be able to provide you with a superbill that you submit to your insurance company for possible reimbursement. Reimbursement isn’t guaranteed and depends on your individual insurance plan, so it’s always best to check your out-of-network benefits first.
Both Options at Leading Heart Therapy
Leading Heart Therapy offers both private-pay and insurance options. The best choice depends on your priorities, your insurance coverage, and how much involvement you want your insurance company to have in your care.
To see if Leading Heart Therapy is in network with your insurance provider, click here.
If you’re ready to discuss your treatment options and see if Leading Heart Therapy might be a good fit for you, schedule your consultation here.