Why Might a Client Prefer to Self-Pay (pay out-of-pocket) as Opposed to Use Insurance?

• Self-pay enhances confidentiality and privacy by allowing psychological services to remain private between a provider and a client, which can promote trust and open communication in the therapy setting. Alternatively, insurance claims require the disclosure of sensitive health information, such as a diagnosis, which become a part of the client’s permanent health record. Some clients fear potential repercussions should their diagnosis be disclosed, such as difficulty obtaining certain employment.

• Insurance may dictate the type of therapy and number of sessions covered. Self-pay offers greater flexibility and autonomy by enabling clients to solely collaborate with their provider on their care, without insurance restricting care in anyway. Self-pay fosters a more individualized treatment plan that is better tailored to the client’s therapeutic response and needs.

• Insurance typically has a network of approved providers, which can limit a client’s options when selecting a provider. Insurance networks may not include certain specialists who a client prefers, such as providers with expertise in certain areas or with specific interventions. Self-pay allows clients to choose a provider based on any factors important to them, such as compatibility, expertise, and personal preference. Given the therapeutic relationship is a main factor in psychotherapy success, the ability to select a provider who fits well with the client’s needs and values can significantly impact treatment effectiveness.

• Self-pay allows beneficial therapies, techniques, and approaches that may not be covered by insurance to be integrated into a client’s care plan. Incorporating alternative practices promotes a more robust and holistic approach to mental health, which enriches the therapy experience and may better address the client’s needs and preferences.

• Using insurance often involves navigating organizational and administrative processes, such as obtaining pre-authorizations and utilizing select providers who may have limited availability and waitlists. Self-pay greatly reduces these barriers, allowing more immediate access to care.

• Navigating insurance claims can be time-consuming, stressful, and distracting to the therapeutic process. Dealing with administrative obstacles, denied claims, and arbitrary session limits can interrupt and delay therapy sessions. Self-pay circumvents these risks, allowing clients to fully focus on the therapeutic process maximizing therapy benefits.

• Some providers not in private practice, such as those in larger mental health companies are often overworked, underpaid, and burned out. Thus, making it difficult to provide the highest quality of care to their clients. Conversely, providers in private practice have far more control over their practice and can dedicate greater time to their clients’ cases and to their own self-care.

• Insurance claims require a diagnosis, and some insurances may only offer coverage for certain diagnoses, but not others. With self-pay, meeting criteria for a diagnosis or a specific diagnosis is not required.

• Without having to provide diagnostic and treatment justifications for insurance claims, self-pay enables providers to focus on the client’s overall well-being rather than narrowly targeting specific symptoms. This holistic approach promotes self-discovery, personal growth, and building resiliency and life satisfaction, as opposed to only considering specific symptoms. Thus, creating the freedom to support any and all facets of wellness, and not just the insurance-covered mental health diagnoses.