I frequently encounter a lot of people who don’t understand why I chose to be a private pay therapist which means that I don’t accept insurance payments.

Why. Would. I. EVER. Do. That?

Don’t I pay a lot for my health insurance?? Now I can’t use it when I see you?? That’s infuriating Tasha! Why would you do that?

Actually, for quite a lot of very well-informed reasons. Let’s talk!

To start, most insurance companies in America don’t even cover mental health services. For something that’s almost at epidemic proportions right now, insurance companies are very much behind the ball. To show you how much insurance companies devalue mental health practice, let me tell you how this normally goes for individual practitioners like myself.

First, we as clinicians pay the insurance company to be paneled. These panels aren’t cheap either and are usually a monthly payment. Then, say you charge $80 a clinical hour. The insurance company (if they even cover your services) will give you something like $50 and take $30 (some are better than others, some are worse than others). So in reality, your therapist, who you think you’re paying a lot for, doesn’t actually receive as much compensation as you think they do even though they charge so much.

As a private pay therapist, I can lower my price to whatever works for my clients without having a middle man to negotiate with. This is called a sliding scale and I always reserve a certain number of slots for clients who need my stated price lowered because mental health should be a right, not a privilege. Being private pay allows me to accommodate this better.

Why do you charge so much? In fact, why do all of you therapists charge so much?

Because we went to graduate school to receive real, clinical, empirically validated training to do what we do and provide a high quality of care. We’re not life coaches. We were trained in legitimate cognitive, behavior, experiential techniques to do what we do. So at least, when you invest the money with a licensed therapist, psychologist, or social worker, you’re getting your money’s worth and you’re getting someone who paid for an education that is standardized and streamlined by accrediting bodies such as the American Counseling Association (ACA) or the American Psychological Association (APA). For example, I went to school at Denver Seminary which is accredited by The Council for Accreditation of Counseling and Related Educational Programs (CACREP) who is overseen by the ACA.

I promise you, this is a quality program that turns out many highly skilled and very qualified clinicians every year and I stand by what I charge because I went to such an amazing school to get my master’s degree.

CACAREP also keeps a close eye on the standards they hold and change them based on constant research to stay relevant.

Life coaches do the work with me. You and I just meet in your office once or twice a week. Why would I pay for services like that and not a life coach?

Again, I am trained in legitimate techniques that create nuerological change. These techniques are at their most effective (such as coping skills) when you practice them at home on your own! The processing work we do in my office creates legitimate, neurological change similar to the way certain neurophramaceutical drugs do. You and I will process together in session, but the real work comes down to you maintain the changes you want when you go home after session. That’s why it’s not trite when therapists say “you did all the work. I just got to witness what a strong person you are.”

This ideology makes sure that you aren’t reliant on anyone but yourself for empowerment and change in your life.

So wait. That’s great. Continue with why you don’t take insurance again. I’m not entirely convinced.

I assume most people don’t know what goes into making a formal insurance diagnosis for mental health. Having worked a lot of time in mental health agencies (which are amazing resources and have taught me much of what I know as a mental health practitioner now), I’ve spent a lot of time with the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (DSM-5) and speaking with insurance companies and utilization review (UR) departments. For those of you who don’t know, UR departments are those people who fight your insurance company for coverage.

Yeah. We have to do that.

Because insurance companies don’t tend to listen very well when a certified, licensed, highly educated professional makes a health recommendation for an individual’s treatment.

Yes, it’s infuriating for everyone.

If you ever meet someone who works in UR, buy them a coffee, give them a hug, etc. They’re the reason your insurance company does much of anything beneficial for you.

The way it goes is the clinician will make a recommendation for treatment and devise a treatment plan. This will get run past the insurance company who usually denies coverage for part or all of the plan.

Furthermore, when a formal diagnosis is made, that sticks with the patient for the rest of their time with that insurance company and can directly impact decisions made about the client’s care. This can also have greater implications for future careers.

For instance, someone diagnosed with a mental illness can be barred from certain professions such as the military, police force, airlines employment, etc. While this can be a very good thing, imagine if that diagnosis were incorrect or needed to be amended. The original diagnosis is still left on the record. This is why I take diagnosis VERY SERIOUSLY and do not make a formal diagnosis even when I don’t have to deal with insurance companies until at least 5 weeks into treatment with a client because you can’t really know someone’s diagnosis until you’ve really worked with them for that long.

Relationships, even therapeutic ones, take time! Most insurance companies require a diagnosis within the first session. While this can be labeled as “provisional” and later be changed to a more accurate diagnosis, it sometimes isn’t.

Also, imagine if your insurance company “doesn’t cover services for that diagnosis.” I kid you not, I’ve been told this to my face and have been asked to change the diagnosis so that my client can receive services. That’s called insurance fraud and my answer to that is always no.

This is honestly just a short list as to why I take private pay only.

I hope you can understand. As a way of still making insurance somewhat relevant, I utilize a practice called superbilling which is essentially a fancy term for receipt reimbursement. Some forward-thinking insurance companies understand the dynamic I just described and will honor receipts from mental health providers and compensate clients a certain percentage based on their outpatient mental health benefits. Other insurance companies just count it towards your deductible, but at least it’s something.

Don’t write off private pay therapists! By not accepting insurance, we are less at risk to being overworked, underpaid, and burn out.

Please feel free to reach out to me either in the comment section or via email if you have any questions about how any of this works. I am always happy to engage in further discussion.