Something I wasn't aware of when I first started looking for a therapist, was the differences in payment options for therapy and how they worked. Don't worry if you've been confused-it's NOT just you! I firmly believe people should be given full transparency around their options so that they can make informed decisions for themselves. This guide will help you assess your options for payment.

Common questions I get asked are: Why would someone want to pay for therapy out-of-pocket (self-pay) if they have insurance? What are the differences between in-network insurance benefits, out-of-network insurance benefits, and self-pay? What insurances do you take?

All these questions (and more) will be answered in the guide below!

In-Network:

I'm in-network with:

-Aetna

-Cigna (now Evernorth)

-Optum (includes United Healthcare)

This means I have a contract with the above insurance companies. If using any of these plans, you get a discounted rate for services and only pay your co-pay for services (after your deductible is met).

Look at your summary of benefits for in-network mental health services and call your insurance provider to see what this cost would be for you.

Out-of-Network:

If I don't take your insurance (meaning I don't have a contract with them), you can file for reimbursement.

To do this, you would send your insurance company the receipts (superbill) for our therapy sessions that you've paid for and they will typically reimburse you for part of your session fee. To see how much they will cover, you can look at your summary of benefits and look at your out-of-network deductible (the amount of money you have to pay before you are eligible for reimbursement) to see if this may be a good option for you.

Guide on submitting claims for out-of-network benefits: https://blog.zencare.co/guide-to-out-of-network-benefits/.

Private pay/Self-pay:

Rates: $150 per session

One of the main reasons clients choose to pay out-of-pocket (or self-pay) is because of privacy and confidentiality concerns. I feel like many people aren't aware (again, we don't have very transparent healthcare), but when clients use insurance, therapists must attach a diagnosis to use the client's insurance benefits. This diagnosis then becomes part of the client’s permanent medical record. Clients who wish to maintain their privacy, and are uncomfortable with the number of people who have access to their medical records, may opt to pay. Paying out of pocket means that therapists are not required to assign a mental health diagnosis or share medical information with anyone.

Comparing Different Types of Therapy Payment

Using In-Network Insurance

Using Out-of-Network Insurance

Private Pay/Self-Pay

PROS

-Usually the most affordable option (only owe your co-pay, once you've met your deductible)

-Easy option to use, the same amount of work as self-pay for the client

CONS

-When using insurance plans, therapists have to give a mental health diagnosis to provide services. Any diagnoses given, are put on the client's permanent record. *This is not to discourage people from using their health insurance (I've used health insurance to pay for therapy). My intention is to help you make an informed decision for yourself.

PROS

-Flexibility and choice in finding a therapist that is a good fit, not just one that takes your insurance

-If you have good out-of-network reimbursement, it could work out to be the same cost as an in-network therapist (and you get more choice in who you see)

CONS

-Same cons as using In-Network insurance

-This option is the most work for the client (submitting bills to insurance company)

-Wait times for reimbursement

-May still need to pay for the bulk of therapy costs, depending on your out-of-network benefits

PROS

-Privacy and confidentiality (no official record of diagnosis)

-Full choice in which therapist you see and find the specific skill set or therapy you are looking for

-You don't have to deal with insurance (co-pays, deductibles, etc.)

CONS

-Typically, the most expensive option

-You pay the full session fee

Insurance Terms to Know

Deductible — The total medical costs you pay every year before your insurance coverage begins. This means you'll pay the therapist’s full fee at every session until you've met your deductible amount.

Copay — The set fee you pay at every therapy session.

Coinsurance — a portion of the medical cost you pay after your deductible has been met. Coinsurance is a way of saying that you and your insurance carrier each pay a share of eligible costs that add up to 100 percent.

For example, if your coinsurance is 20 percent, you pay 20 percent of the cost of therapy (after you've met your deductible. Your health insurance plan will pay the other 80 percent.

Helpful questions to ask your insurance provider before starting therapy:

Do I have mental health insurance benefits?

What is my deductible and has it been met?

Is there a limit on how many sessions my plan will cover per year? If yes, how many?

What is my copay or co-insurance amount?

For more information: https://blog.zencare.co/mental-health-insurance-guide/