Finding a Therapist in Chicago: What are the benefits of paying for therapy out of pocket?
What are the benefits of paying for therapy out of pocket?
Paying for counseling services is an important aspect of the therapy process and, in many cases, the decisive factor when choosing a provider. In the last part of my mini-series “Finding a Therapist in Chicago,” I’ll go over common ways to cover counseling services, outline common payment methods, and discuss the benefits of paying out of pocket for therapy.
How to pay for therapy in Chicago
Your financial resources are a significant component to consider when choosing a therapist. When deciding how to pay for therapy, it’s important that the counselor you choose connects with your “why” and shows competency in the areas that matter to you. A $20 fee or even “free” therapy would be too much to pay for someone who is not the right fit!
How to pay for therapy with insurance
In-network coverage
If the therapist or counselor is “in-network,” they will have a contract or be “paneled” with your insurance. PPO plans are the most popular and commonly accepted by therapists. HMO plans have certain specifications that may limit your options, and therapists tend not to accept this type of plan.
When using your insurance, you would generally pay a copayment amount, or coinsurance after the deductible (if any) is met. Because insurance plans vary, it is helpful to contact member support to learn more about your in-network benefits.
To search for an in-network provider, include the name of your insurance in your online search. For example, “relationship counselor in network with ____.” You could also search for a provider in your insurance’s directory, or contact the member support number on your card.
If you find a therapist you like and are not sure if they are in-network, you can contact them directly and confirm if they accept your insurance.
Out-of-network coverage
If a therapist or counselor accepts out-of-network coverage, this will probably be with PPO plans. These plans offer out-of-network benefits that cover mental health providers who don’t have a contract with them. On the other hand, HMO plans don’t usually cover services by providers who are not in their network.
If you use your out-of-network benefits, you will pay the therapist’s full fee at the time of service and submit documentation to your insurance for direct reimbursement. Depending on your plan benefits, the insurance will reimburse a percentage of the fee you paid.
A therapist who accepts out-of-network coverage will provide you with a Superbill — a special invoice for your insurance. Click here to ask your insurance company how to get reimbursed for therapy.
How to pay for therapy without insurance
Paying out of pocket
Paying for therapy out of pocket is considered private pay, and the insurance company is not billed. You would pay the full fee at the time of service.
Sliding scale
This option is usually offered by not-for-profit organizations, where your income is considered to determine a low-cost fee. Some therapists have several sliding-scale spots available. During the initial consultation, you can ask if this is an option.
Payment method
Whether you are paying out of pocket for therapy or not, you can generally use debit/credit or HSA cards as well as cash or checks.
Benefits of paying for therapy out of pocket (private pay)
Sometimes going the private-pay route may be your best bet. Here’s why paying out of pocket for therapy could be a better fit for you:
Increased confidentiality: You have more control of your clinical information because it is not shared with a third party — in this case, your insurance company. This is especially beneficial when/if a diagnosis is granted.
Please note that to bill for out-of-network reimbursement, the insurance company requires a diagnostic code and may request access to clinical information.
A diagnosis is not always applicable: A diagnosis, required by insurance companies to bill for services, becomes part of your record and may not always apply. A diagnosis helps inform optimal treatment plans and care; however, many times it is not necessary.
Best care and services for you: As an out-of-network provider, for example, I would have to see a higher number of clients a week to accept insurance. Instead of investing valuable time and energy in managing claims and communicating with insurance companies directly, I like to focus on providing the best services possible by participating in clinical consultations, receiving continued education, and having the flexibility to offer longer sessions.
Freedom in the amount and length of sessions: With insurance, sessions can range anywhere from 45 to 55 minutes, and on occasion, only a certain number of sessions would be covered. When not using insurance, therapists can set the duration of the sessions without restriction. In my practice, I offer full-hour sessions, with an additional 15 minutes for couples sessions when needed. The option to book longer sessions, when necessary, can also be discussed and accommodated.
Integrative care and flexibility: There are therapeutic services that are not covered by insurance. Paying out of pocket for therapy can give you the flexibility to access special offers, discounts, and packages otherwise not available if using insurance.
Investing in yourself: Considering therapy as an investment can help you get better outcomes. Paying the full fee adds another level of commitment to session attendance, and including it in your budget can be beneficial in increasing intentionality, value, and accountability on your investment.
