With everyone needing to pinch their pennies and keep their wallets sealed with rising costs, one might wonder, “is it worth it to go out of my insurance coverage and pay a therapist directly?” We all must ultimately balance what is best for ourselves in line with our financial situations, but if you are on the fence, here are some reasons that may shed light on why many therapists have opted out of taking insurance and charge what they do, forcing you to do the work of recovering your out-of-pocket expenses:
1. The private pay world is not exclusive to therapy and refers to any medical or therapy provider who would normally be covered by insurance, except the provider has forgone registering in-network with an insurance company. Instead of the provider collecting a co-pay and waiting for the insurance to send the balance, the client pays in full. There are many reasons this option is more attractive, but the most obvious is that getting paid can be challenging. Insurance companies reimburse at varying rates that are subject to change and can take weeks to send the provider a check which may even be an incorrect amount. If this were not enough, insurance companies audit notes from time to time and require certain types of treatment that the therapist may wholly disagree with. One of the worst things that can happen is a claw back; imagine yourself in the position of having to give back a chunk of money after the insurance company believes the treatment was unwarranted. In all these cases, fighting with insurance companies (who seem to think they know what is best for a client) is time not eagerly spent by most professionals.
2. Like any business, therapists have overhead. It costs to have the following: an office space including all the expenses within an office setting, a billing system (which charges a hefty credit card fee), a place to write session notes after every visit which will also allow a client to obtain a superbill for insurance reimbursement.
3. There are also costs related to licensure and malpractice insurance in addition to staying up to date with the latest developments in the field. Every two years, for doctoral level psychologists, we must take 30 continuing education credits which not only require a financial investment, but also time away from seeing clients. And while we are talking about education, the financial investment in a higher-level degree can be staggering. If your therapist is a PsyD (a doctorate in psychology), these programs are about $120,000 in tuition.
4. Clients require varying levels of preparation, but at a bare minimum, a therapist will read the session note from the previous week and formulate a loose plan on how to continue and evolve from the last session. Often, I find that my couples therapy clients require more time for me to consider ways in which to tweak my approach. But prep before the session is the least time consuming of the activities. What takes the bulk of my out-of-session time is consultation for which I pay two separate psychologists to go over information about my cases. This is meant to help me see things about my clients that I am missing because I am too close to the case. In addition to these two consultants, I am a part of weekly group supervision sessions where my colleagues and I take turns thinking through cases and helping one another work through stuck points. Whether the cost is in time or dollars, it is a very important choice for me to do this weekly work so I can give my clients my very best. Keep in mind that sharing information about a case involves adhering to principles of confidentiality.
Stay tuned for Part II of this article next month.
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