When going through personal struggles or living with a mental disorder, therapy is an excellent option for validation, support, and healing. However, the question that comes up when seeking therapy services is “How will I pay for it?” Insurance is often the first thought, but some plans still do not offer mental health benefits. Depending on what your insurance will or won’t cover, you can use this option or explore private paying for therapy services.
Insurance: There for a Reason
Due to changes in insurance regulations, many plans now offer some form of mental health coverage. If this is the case, your insurance company can help you find a provider or let you know if the one you have in mind is covered under your plan. Positives include decreased costs of treatment, and access to services your plan may provide for, such as nutrition or physical well-being programs that complement therapy.
Questions to ask your insurance include:
- Plan deductible and how much has been met
- In-network and out-of-network coverage levels
- Co-pay or co-insurance requirements
- Number of visits
- Conditions/types of therapy not covered
Be aware that if in-patient treatment is needed coverage will be different and should be verified before admittance. If at all possible, it’s best to call your insurance or have your provider’s office call to verify the coverage; more information is always preferable to less.
Some cons to using insurance can be a limited number of visits, denial of some types of therapy services, limited access to therapists due in- and out-of-network coverage, and being subject to high deductibles or co-pays. If these limitations concern you, ask your therapist about other payment options.
Private Pay Could Be a Better Way
Private pay may be a better option if your insurance does not offer mental health coverage, or if you are on a high-deductible plan. Therapy services are based on diagnostic codes submitted to insurance, and the billed amount is based off this code. Insurance plans often require the deductible to be met before they will provide mental health coverage, which means that you will be required to pay the full price for the visit (out of your own pocket) until that amount is met. The private pay rate offered by your therapist could be lower than what they would typically bill insurance, which can reduce your personal costs.
Other positives of private paying for therapy include a wider access to therapists in your area, especially if you’re seeking couples therapy or another therapy service not covered by insurance. Also, insurance companies require that you be diagnosed with a mental illness for them to pay the cost of therapy. This means that if you are seeking therapy in an effort to work through a life transition or general life problem, rather than a mental illness, insurance will likely deny coverage.
Another benefit of paying for your therapy without insurance is a reduction in your personal information being disseminated. As explained above, most insurances require a specific diagnosis to cover services, but if your counseling is for short term period a counselor may be hesitant to provide you with a label that can follow you for years. By choosing private pay, your privacy is protected as no diagnostic information is required for billing, and you can pay for therapy services using your flex or health care savings account meaning you can have as many sessions as you feel you need.
The cons of private pay include is the personal cost. Those without a flex or health care savings account must find money within their budget to pay for services, which can be hard to accomplish at times. If therapy is part of your long-term mental health treatment plan, you may start off with private pay and re-explore what your insurance plan covers at a later date. Another option is to explore secondary coverage options that can help offset the cost, or search for health care sharing groups that can offer benefits based on religion or financial need. You can also ask your therapist if they offer sliding scale rates, which are usually based on the client's ability to pay. Lastly, you can seek therapy at one of the following places in San Antonio that offer considerably reduced rates and/or free counseling services.
- Family Service Association
- Jewish Family Service
- Rape Crisis Center
- Ecumenical Center
- St.Mary's Family Life Center
- UTSA Sarabia Family Counseling Center
The important thing to know is that you have choices. Not just for therapy, but for other types of medical services as well. Knowing the options for payment can open up new doors for treatment plans and lead to better personal health throughout life.
I currently accept Blue Cross Blue Shield, United Health Care, and Deer Oaks EAP at my office. I also work with clients who wish to pay privately for therapy. And, for those who have limited ability to pay, I offer income based sliding scale rates. Call me if you think you may want to schedule a therapy appointment at my office.