Being a self-pay client: Why it actually benefits the client.

Mar 21

Seeing a therapist that does not accept insurance or not having mental health coverage in your health plan may make someone want to put off going to therapy. Sessions with a therapist can range in price with a standard being around $125-$150 per session. Some therapists offer a sliding scale plan for individuals who cannot financially afford the fee. It may make a client more willing to go to a center that offers insurance and sit possibly for months on a waitlist in order to get sessions covered.

I understand completely why someone would want to make that choice. What if I said there are actual options out there and that it could actually be a benefit to a client to pay the out of pocket cost. Did you know that a client may actually be able to get reimbursement from their insurance carrier for their out of coverage costs? It could also apply to their deductible which is helpful if they regularly have medical bills to pay for. Submitting a claim through insurance could be fairly easily especially after it is done the first time Many individuals have FSA or HSA accounts that they can use for their mental health care. There are some companies that actually will help assist with the claim submission process for out of network benefits. I actually partner with Mentaya for my clients which will do all the legwork for the client. I can verify their out of network coverage, send them the information for Mentaya so they can get enrolled, and they can submit my superbills to Mentaya and will submit all the information to the insurance company. By using Mentaya, they actually increase the reimbursement rate and make it so much easier on myself and my client by doing all the extra work.

But in the end, why should a client see an out of network therapist?

They often have a smaller caseload. Due to them not taking insurance, they often will be able to get their full rate and not take a smaller rate through the insurance. This benefits the client because they can have better assurance that their therapist isn’t getting overly burned out from having to take on the extra clients to fill in the gaps on top of needing to spend extra admin time submitting claims to insurance, preapprovals, checking benefits, etc. They get to spend the time doing what they love: helping client reach their goals and have improved, better quality lives. They can have that extra time being able to prove their clients.
A client can have a more customized service delivery. Insurance companies offer restrictions. They allow a certain amount of sessions per month, they limit the kinds of modalities that are used and expect a certain treatment plan in order to justify services. The therapist and the client can decide what works without having to justify it to an insurance company.
There doesn’t have to be a worry about a diagnosis following someone around. The reason why therapists have to diagnose is for insurance purposes. Insurance wants to know what is wrong in order to justify payment and services. A client is then stuck with a label they often do not want. In some cases a diagnosis is appropriate such as if it is needed for applying for disability services, school-bases 504 or IEP plans, needing extra supports, etc. An out of network therapist can still provide a diagnosis but it is not necessary in order to provide services. Also, it gives the therapist time to not rush a label and can get to know the client for more than a 50 minute session. Not having to bill insurance provides more privacy to the client.
The client has a high deductible plan. If there is a high deductible with little to no medical expenses, chances are the client will be paying out of pocket for services anyway and have it applied to the deductible. When a client sees a therapist out of network, they are still having to pay out of pocket, but then there are not the amount of restrictions that are set by being with an in-network provider such as the kinds of modalities that are needed, diagnoses, and the frequency of care.
There is the possibility for a more “boutique” level of care. Therapy is very personal and often a complicated journey. Maybe the feel of a clinic is right for certain clients but others may want something that feels more boutique and calming. I know my goal as a self-pay therapist will allow me the ability to provide little luxuries, provide an office space that feels tranquil for that road to healing and wellness. When you pay a little more, you get a little more.

There is the good chance the client will be able to receive reimbursement for accessing those out of network benefits. We are here to help you with that process so that therapy does not have to be a worry. Please contact us at 912-483-1136 or info@azaleacounselingsav.com to set up an appointment today!