Finding the right therapist can be a frustrating task, especially if your insurance isn’t top-of-the-line.
Then again, some well-meaning friends will tell you to seek out a private pay therapist anyway because “all the good therapists don’t take insurance.”
Is that true?
What’s the difference between private pay vs. insurance when it comes to getting the right therapist? Let’s see if we can get a handle on this question and give you the info you need to make the right decision for yourself.
Are Private Pay Therapists Really Better?
First of all, it is definitely not true that therapists who take insurance are less capable. There are many factors that go into therapists’ decisions to take insurance or not. Many very skilled therapists are committed to accepting as many insurances as they can in order to make therapy accessible to people of all income levels.
The reason that many equally skilled therapists don’t take insurance is because insurance companies often don’t pay as well, but also because they are maddeningly difficult to deal with (as you may know from trying to work with them on the consumer side).
So the insurance question alone doesn’t tell you whether a therapist is any good. (Unfortunately, there are all too many lousy therapists out there, both insurance-based and private pay.) To find the right therapist, you’ll want to look at other factors.
So Then Why Go Private Pay vs. Insurance?
If insurance-based and private-pay therapists aren’t qualitatively any different, why would you ever pay out of pocket for therapy?
Well, there’s a few good reasons.
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Privacy
Insurance companies not only know who you’re seeing for therapy and why; they get to look at your treatment plan and progress notes too. That may or may not bother you. (Maybe it bothers you more if you’re in therapy for erectile dysfunction or sex therapy or something like that…)
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Risk
When a therapist bills insurance for their services, they are required to submit a mental health diagnosis to justify their work. Meaning, you are getting labeled with a mental illness, whether you are actively psychotic or just looking for some help with (normal) arguments in your marriage.
This goes in your medical record, and that record might be called upon in various normal circumstances—for example, if you are applying for life insurance, they’ll want to see your medical history, including mental health diagnoses and treatment.
Likewise, here in Maryland, it’s common for people who want to work in the federal government to seek security clearance. If you’ve been to therapy through your insurance, the government can see that, including the diagnosis you were given, and can require you to grant them access to the therapist and their records. (Private pay therapists do not necessarily assign you a diagnosis, and outside entities won’t even know you saw a therapist unless you reveal that.)
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Control
Insurance companies get to decide whether you “really” need therapy, and how much of it. If they feel your condition doesn’t justify their paying for therapy, or if the procedures your therapist is using don’t meet their standards, they don’t have to pay.
Even if they do pay, they can tell you they’ll only pay for X number of sessions. If you and your therapist feel there’s still work to be done—tough luck. Insurance says you’re all better! Likewise, if you’re in a crisis and need more than one session a week, that’s up to your insurance company, not you, and not your therapist.
Are There Benefits to Going Through Insurance?
Of course, the main benefit of using your insurance is that it saves you money—potentially quite a lot of it. Not everyone can afford paying hundreds of dollars a month for therapy. This is especially true when the situation just doesn’t seem that dire—you’re feeling down, but not terrible; your marriage isn’t great, but you’re doing okay.
In those situations, it can feel hard to justify the extra expense if you’re not financially very comfortable. Having insurance to pay for it can make it easier and more palatable to seek help in the first place.
And hey, if you’re not planning to get security clearance, already have life insurance, and don’t really care about some guy hundreds of miles away reading your file among the scores he’s already read that week—and I would consider myself in that category!—insurance really does make a lot of sense.
In Sum
The long and the short of it is, when it comes to private pay vs. insurance, it’s a personal decision. If finances are tight, going through insurance makes a lot of sense.
On the other hand, if you have the means and are concerned about privacy and/or autonomy in your therapy, private pay could be the better fit.
Either way, you still have to find the right therapist for you—and you can certainly find good ones both in your insurance network and outside of it.
Need more help connecting with the right therapist? Feel free to reach out. We’re happy to help, even if you choose not to book a session here!
