Lisa Curtis, LCSW, CASAC, HWC

The Move to Private Pay

You might have noticed more and more clinicians are moving over to private pay rather than to take insurance, if they ever did. And you might have wondered about this decision. Are they getting greedy? Arrogant? Feel like insurance is beneath them? For a vast majority of clinicians none of the above are the motivating factors.

There is no doubt that paying for therapy, on an ongoing basis, is going to be an investment in yourself and your well-being. It will be both physically and emotionally challenging. Unless and until you’re able to make the financial commitment it is wisest to seek out a clinician from the start who accepts your insurance. You can re-visit your decision later but to get started and then have to stop for financial reasons puts an undue burden on you.  

Working with a clinician means, in an ideal world, that you’re allowing a great deal of your history to be exposed, not to mention your current stressors and challenges. An insurance company has the right to ask about this history and what’s going on for you in the present tense, with an eye toward keeping their own costs low. When working with a provider you will be signing away your rights to privacy in this area. When you work with a provider on a self pay basis, your provider is ethically and legally bound to keep your information private. Yes, there are exceptions such as imminent self harm or danger to another or endangering a minor but those are discussed in advance when possible and surely in everyone’s best interest, wouldn’t you agree?

Insurance companies also have the right to dictate a timeline on which they expect you to ‘get better’. They can, and will, tell your clinician what they believe to be reasonable levels of care. And, although it takes a great deal of time and energy to keep track of all this, these companies have no problem asking clinicians to provide this information and participate in lengthy phone calls without reimbursement for their time and professionalism. 

And, here’s one that really catches people by surprise; you have to have a diagnosis. As in, you either fit the criteria for a problem or you run the risk of not being covered. Wanting to talk things through or get support through a particularly difficult time in your life or perhaps feeling the ongoing support and insights you gain from your therapist are not considered covered services. Some types of therapy is not covered nor are there any guarantees that the emergency appointment you had last week after you got fired or found out your significant other was hiding something huge, will be covered. 

For a clinician it takes a great deal of time to bill an insurance company, call or fill out paperwork to get authorization to see you, call back to dispute a claim or correct an error. All that and to find out the visit won’t get covered nor can the clinician collect the payment or difference from you, our client, because the clinician is ‘paneled’ with the insurance company are only some of the reasons clinicians are leaving insurance. 

Insurance companies are not evil and they serve a role in our healthcare setting but, like everything else, it is important for the consumer to be aware of the value as well as the limitations of this resource.

We want to provide excellent services at fair and reasonable fees. We want you to feel relief and support. And to do that clinicians are finding more and more frequently that the best route for all involved is to keep it simple, private and effective. 

I hope this sheds some light on what is becoming a very complicated and often emotionally charged issue.