I provide services to clients on a self-pay basis only. At first glance, use of insurance may seem beneficial, as it may lower your out-of-pocket costs. However, there are significant downfalls to the use of insurance when it comes to mental health services.
First, insurance companies do NOT see you as an individual with needs that are unique. In order to be eligible for services with insurance, you must be given a diagnosis. In certain cases, you may just need help navigating your current life or family circumstances, such as help with parenting, communication between you and your child, or assistance with typical grief reactions; this does not in my opinion necessitate me diagnosing you with a “disorder”, per se. Once given a diagnosis, the insurance companies dictate that treatment goals focus on your diagnosis, not necessarily on the many other factors which may have brought you to therapy in the first place.
Second, insurance companies dictate session frequency and length. In some cases, they provide you with only a handful of sessions, and have the right to terminate services at any time for various reasons. As the client, this leaves you suddenly without mental health care, sometimes without notice. In terms of session length, although my sessions are typically 50 minutes, I have had circumstances where a family needed more time with me, and with self-pay, I am able to offer this option. When utilizing insurance, your session lengths are pre-determined and neither you nor I have control over that.
Finally, with self-pay, I can assure you that your records and information are completely safe and held in strictest confidence. With insurance, your mental health (and required diagnosis for treatment coverage) become part of your medical record. This may have an effect on future medical coverage or even life insurance coverage, and aspects of your health record may be accessible by other agencies. With self-pay, your records stay with me only, and are not shared except in the case of your express written consent, or in cases protected by law (e.g., your safety or the safety of others is at risk).
The most effective treatment occurs when both you and I can coordinate and determine your services together and make any decisions necessary to promote success; not when a managed care company dictates the decisions we make.