Choosing Between Insurance and Private Pay for Therapy

Pros, Cons, and How to Decide

I often hear from new patients that they are unsure whether to use their insurance benefits for therapy or pay out-of-pocket (sometimes called “private pay”).  Both options have advantages and considerations, and the right choice really depends on your situation, your goals, and what feels most comfortable for you.

Here is a breakdown to help guide your decision.

Using Your Medical Insurance Benefits

Pros:

1. Lower cost per session:  depending on your plan, your copay (or other out-of-pocket cost) may be lower than the full session fee.
2. Access to your insurance’s provider network:  insurance can give you a list of therapists in your area that you might not have found otherwise.
3. Covered mental health care:  many insurance plans cover therapy (or a portion of therapy) as part of mental health benefits, making it more affordable for ongoing care.

Some Things to Keep in Mind:

1. Limited provider choice:  you may need to choose from therapists who accept your insurance (i.e., are in-network), which can sometimes limit options for style, specialization, or approach.
2. Privacy considerations:  using insurance requires submitting diagnoses and session information to your insurance company.  Some people prefer to keep their therapy entirely private.
3. Session limits or requirements:  some plans limit the number of sessions or require pre-authorization for ongoing care.

Paying Out-of-Pocket (Private Pay)

Pros:

1. Complete choice of therapist:  you can choose any therapist, regardless of network participation.  This might make it easier to find someone you connect with personally and professionally, and allows you to focus on the approach, specialty, and personal connection that feels like the right fit for you.
2. More privacy:  no insurance paperwork means that your sessions remain fully confidential.  You will not need to provide diagnoses or session notes to a third party.
3. Flexible scheduling and treatment plans:  without insurance rules and constraints, we can tailor the frequency, length, and style of sessions to what works best for you.

Some Things to Keep in Mind:

1. Higher upfront cost:  paying out-of-pocket can be more expensive, especially for longer-term treatment.
2. No or limited insurance reimbursement:  unless your plan covers out-of-network providers, you will be responsible for the full session fee.
3. Financial planning required:  to make therapy consistent, it helps to budget for the cost of sessions.

How to Decide What is Best for You

Here are some questions I often encourage patients to consider:

• Budget and affordability:  can you comfortably pay out-of-pocket, or would insurance coverage make therapy more accessible?
• Therapist fit:  is it important for you to work with a specific therapist who may not take your insurance?
• Privacy concerns:  are you comfortable sharing a diagnosis and session notes with your insurance company?
• Frequency and long-term needs:  are you looking for short-term support for a specific issue, or longer-term ongoing care?
• Insurance plan details:  does your plan have limitations, such as session caps, high deductibles, or copays that could affect your care?

Tip:  sometimes a combination works best.  Some patients start with insurance to manage costs, and then switch to private pay if they want more flexibility, confidentiality, or a particular therapist.

Final Thoughts

There is no single right choice.  The best option depends on your goals, financial situation, and the type of therapy experience you want.  Whether you choose to use insurance or pay out-of-pocket, the most important step is that you are taking action to prioritize your mental health.

Let’s Connect

I currently welcome private pay patients, and accept select insurance plans, including Blue Cross Blue Shield (BCBS) and Oregon Health Plan (OHP; Oregon’s state Medicaid program).  Soon, I will accept Moda Health. 

For out-of-network patients, I can provide superbills to help with reimbursement.  I encourage you to verify with your insurance provider if out-of-network benefits are an option, as many of my patients have a considerable portion of my fee covered by their out-of-network benefits. 

If you are unsure, we can discuss your options during your complimentary introductory call and first session.  I am happy to help you determine which approach will work best for your situation so you can feel confident moving forward.  Together, we will find the payment option that best fits your needs!

Let’s start with a complimentary 15-minute phone introduction: