While it’s nice to have the financial assistance that health insurance can sometimes provide (and sometimes this assistance is very 
necessary), the use of 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 insurance, many actually prefer to go this route because of the multiple issues insurance causes.
In-network benefits the insurance company, but not necessarily you
The first issue to be aware of is that insurance companies will try to push you to stay in-network. However, this doesn’t help you. It only helps them save from having to reimburse you more for going out-of-network (if you’re covered out-of-network on your plan). In-network therapists are often quite difficult to find since there are so many in-network-only plans, and there tend to be very few in-network providers because the insurance companies do not pay the providers adequately.
Out-of-network gives people more say in their own therapy
People often don’t realize they may have coverage out-of-network on their insurance plan that can reimburse a significant amount for sessions. This opens the ability for you to choose your own therapist, and still be reimbursed even if the therapist doesn’t take insurance.
Is there a benefit to choosing not to use your insurance, and choosing your own therapist, even if out-of-network?
Yes. There are several benefits to leaving insurance completely out of therapy.
- When going in-network, your treatment becomes at the mercy of your insurance and all of its built-in fluctuations. The allowed amounts change, the deductibles come back every year, and insurances balk at payments (both to you and/or to the
therapist), which often leaves people vulnerable to higher charges than expected, or even having to pause treatments to sort out insurance issues. It can be difficult sometimes to know from one month to the next if your out-of-pocket amount may change, one way or another — which can also lead to several months of unresolved bills while you and your therapist wait to understand your coverage. It’s also not uncommon for plan details to change again after finally understanding the original details. - Insurances can cut you off. While it’s at times questionable how ethical this is, it does happen much more often than people realize. One day you’re covered, and then suddenly you’re not covered for a particular service anymore. They may not even tell you, as well. They may just stop reimbursing and make you continuously fight for your reimbursements.
- Using insurance makes it much harder to choose your own provider, and makes you limited to not only just those who accept your insurance, but also to those who actually have room in their practice. Sure, you can choose a name from an insurance list, and hopefully the name you choose will have space for you. But it has become more and more difficult for people to find available therapists in their network lately because so many individual plans are in-network-only now. It’s questionable if the demand of in-network providers can realistically be met.
- Also, because insurances are so difficult to work with and pay so poorly, providers are often leaving the networks to go out-of-network. But this means if you are trying to stay in-network, you often may find yourself restarting with new therapists repeatedly until you find someone who is out-of-network and doesn’t take insurance. It may cost more overall, but it also puts you in charge of your therapy, and you have the comfort of developing a longer term relationship with someone who can grow with you over time.
If you already have a relationship with a therapist, becoming dependent on your insurance for the treatment means that at any point, the treatment could end because the insurance could stop covering. (Insurances do periodic reviews of cases, and they essentially determine if they’re going to continue to cover your treatment or not).- If you use insurance, it compromises your confidentiality since the insurance company has the right to evaluate your case for continued coverage.
- Using insurance means submitting a diagnosis, which may 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.
- Many seasoned and highly experienced therapists don’t work with insurances since insurance pays providers very low, and providers are not treated well by insurance companies.
- High deductibles mean you’re paying fully out of pocket for months before your insurance coverage even kicks in. Is it worthwhile to choose a random therapist from an insurance list when you’re going to have to pay out of pocket anyway? This is also complicated by high copays. People can go from paying fully out of pocket to high copays that almost makes using the insurance worthless.
- If you switch jobs (and end up at a job with a different plan), or if your job switches plans, you may lose your coverage for a particular provider.
When avoiding insurance, you have control over your therapy
This is a partial list. But suffice to say that dealing with insurance as part of therapy adds complications across the board with who you can see, how long your therapy will be covered, how much will be covered, going back and forth from being covered to not being covered (deductibles), confidentiality, and more. It essentially takes the therapy out of your control and puts it in the hands of the insurance company if you’re using your insurance. While this may be fine for some types of medical care, therapy is an incredibly close and personal relationship. It’s a significant risk to put this type of relationship in the hands of an insurance company, who from day one would like nothing more than to stop spending money covering your treatment.
The best way to avoid all of this is to consider making the investment to pay for your therapy out of pocket. 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. However, it’s much easier to find a rate you can both agree on than to deal with the continuous problems of insurance. The impact can even take over the therapy itself, at times, which is an intrusion no one appreciates. If 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.
Empowering yourself to move forward
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 it’s increased their sense of empowerment to see that they can do this without the outside help — increased independence and being the master of their own self-care, not having to answer to anyone else. So leaving insurance out of the therapy may pay off in more ways than one. If you’d like to discuss your situation, contact me today.
