It’s nice to have the financial assistance that health insurance can sometimes provide (and for many people this assistance is very 
necessary). However, the use of in-network insurance to cover part of therapy can often cause more stress and problems than people often realize upfront. If you’re in the position of being able to afford therapy without the use of in-network insurance, many actually prefer to go this route because of the multiple issues insurance companies cause, which are the most experienced at the in-network level.
In-network benefits the insurance company, but not necessarily you
The first issue to be aware of is that insurance companies benefit the most from keeping you in-network. But, even though the copay is lower, staying in-network for you comes as a great cost to your therapy. In fact, staying in-network often creates more mental health distress for something that is supposed to be supporting your mental health. Make no mistake, insurance companies try to push you to stay in-network because it costs them less than reimbursing you for going out-of-network, even though out-of-network therapy is generally more favorable for you.
Out-of-network gives people more say and control in their own therapy
People often don’t realize they may have coverage out-of-network on their insurance plan that can reimburse you a significant amount for your sessions (often between 30-100% of the fees can be reimbursed by your insurance, depending on your plan details). This opens the ability for you to choose your own therapist, to be more separated from the insurance company’s influence, and still be reimbursed even if the therapist doesn’t take insurance at all in their practice.
What are the benefits of choosing not to use your in-network insurance, and choosing your own therapist out-of-network?
There are several benefits to going out-of-network, or even leaving insurance completely out of therapy if you have the means.
- When starting a relationship with a therapist, it is generally important to be able to build a relationship with a therapist who you can grow with over time. When you are in-network, your insurance company actually controls your ability to sustain a relationship with a therapist. This is because in-network therapists actually work for the insurance company first and foremost. Insurance companies pay therapists so poorly who are contracted in-network that most are looking to leave the network as soon as possible. So even if you find someone in-network, the question is how long they will remain in the network.
- Adding onto how insurance companies control the therapy in-network, keep in mind that an in-network provider only goes as far as your insurance does. Meaning, if your employer, or wherever you are receiving your insurance from changes insurance carriers (which can happen annually or every other year in some jobs), or, if you yourself change jobs or insurances for another reason, then you may have to change therapists if your therapist isn’t in-network with the new company.
- Insurances can cut you off. While it’s incredibly unethical, it does happen much more often than people realize. Insurance companies review your therapy
frequently when you’re using therapists in their network, and at their discretion will decide to stop covering you if they find a way to say your therapy isn’t medically necessary enough for them. Again, their main interest is to stop covering you any way they can because they don’t want to pay for your treatment. Obviously these kinds of actions only undermine your mental health — and yes, it is unethical — but this doesn’t stop them from doing it. - Due to these reviews these reviews, as mentioned above, it compromises your confidentiality. They reserve the right to review your treatment whenever they want.
- If you are looking for a therapist, it likely means you are struggling and are needing the best support you can find to help you. So you should be aware that almost all seasoned, highly experienced therapists, and therapists with the requisite levels of training to effectively provide psychotherapy don’t tend to work with insurance companies in-network since insurances pay providers so low (at an unsustainable level), and providers are not treated well by insurance companies in a variety of other ways, as well.
- In order to use your insurance, it means submitting a diagnosis to the insurance company (as therapy to them means you’re in treatment for a diagnosable disorder that you’re working to bring into remission). This also is the case when using your out-of-network coverage as well, which is another reason many people choose to pay out of pocket and avoid insurance use at all. (However, at an out-of-network level, you’re still much more in charge or your own therapy, who you see, much more remove from the insurance company). Many are okay with diagnoses being submitted to receive their out-of-network reimbursements. But some prefer to go fully out of pocket to avoid submitting diagnoses, as it could theoretically impact future insurance coverages of different types if they have pre-existing condition clauses. This can include life insurances and/or disability insurances as well as future health insurances. It’s unclear how often this happens still, but something worth being aware of.
When avoiding insurance, you have control over your therapy
The above is a partial list of in-network issues and why staying removed from the insurance company is better for your therapy, if you can. But suffice to say that dealing with in-network insurance as part of therapy adds complications across the board. In-network isn’t a stable way to have therapy or to sustain a relationship and grow over time with a therapist. Sure, it is 
better than nothing at all if you’re in a financial position where you absolutely must stay in-network. But my general recommendation is that if you’re looking for a therapy setup that has a stable foundation for your mental health, I would not go in-network unless it is fully a need. Because, unfortunately, it does make a significant difference in how you will experience your therapy, and the amount of stress that will come from the insurance company’s intrusion in your space.
While on occasion some things can also come up at times with out-of-network coverage, it is generally much less frequent when this happens because out-of-network therapists aren’t contracted with them — so insurance companies really don’t have as much control, and even if in the worst case scenario they were to attempt to stop reimbursing you, seeing an out-of-network therapist would give you the option to still figure things out together, in a way that can’t be done with an in-network therapist without complexity (because they are contracted with the company).
Empowering yourself to move forward
The cleanest and easiest way to avoid all of this is to consider making the investment to pay out of pocket for your therapy, if you have the means for it. (Of course, many don’t, and that’s why these other options exist and can still be quite helpful. This is more to say that the further from the insurance company’s control you can be, the better for you. This isn’t to assume everybody has these means). If the person you want to work with is charging a higher rate than you can afford, ask them if they can slide their fee for financial need. Some will, some won’t. But when you’re paying out of pocket, there is no dealing with filing claims, managing allowed amounts, deductibles, coinsurances, limits, etc. You choose your provider, and you have your therapy. Clean and easy.
If you can’t fully go out of pocket, using your out-of-network benefits is a good second option. It allows you to pay the therapist their fee, and then receive reimbursement, without nearly as many complications as happens in-network.
People I work with have actually expressed relief by adding some extra out of pocket responsibility, and not having to deal with the hassles of insurance. Many have even acknowledged that this has increased their sense of empowerment to see that they are prioritizing themselves and investing in their well-being in a way they may not be used to doing. People have also expressed an increased feeling of independence by being the master of their own self-care, not having to answer to insurance all the time.
Leaving insurance out of the therapy generally pays off in more ways than one. If you’d like to discuss your situation and see how we can address your needs here, you’re welcome to contact me.
