Why I’m a private pay therapist and how that might benefit you

As a “private pay” therapist, I have gotten a lot of questions about how or why someone might choose that route over finding a therapist on their insurance panel. Therapy can be expensive, along with everything else these days. I’ve felt “sticker shock” practically everywhere lately: restaurants, gas stations, grocery stores, and the vet. Insurance is also deeply confusing, and adding the extra layer of “out-of-network” benefits might feel like too much.

You Get to Choose Which Therapist You Work With

Choosing a private pay therapist means you have many more options available to you when selecting a therapist. If you’ve never had a therapist who wasn’t a great fit, you might not understand how crucial this is. I do. I’m a therapist who has done my own therapy, and I’ve had great experiences and some terrible ones. I also know from both the client and therapist side of the chair how vital it is to have a strong relationship between therapist and client. If we aren’t meshing, that puts a limit on how much you are going to get from therapy.

If we have a strong “therapeutic relationship” as we call it in the profession, the odds are far greater that you will get better—regardless of what therapy approach we use. This is why the choice of therapist matters. Yes, the approach a therapist uses matters as well, but the relationship is the magic ingredient. You might get lucky and find a good fit with a therapist who takes your insurance, it’s true. With private pay, you can be a discerning consumer and find a great fit.

Shorter Waits When You’re Ready to Start

You also may not have to wait as long to see a therapist. Often, therapists on insurance panels end up with lengthy waitlists. That’s totally fine if you don’t feel like your world is falling apart or you’re struggling at work or in your relationships. Being able to get in quickly to see a therapist is helpful when you’re struggling and, if you’re looking for a therapist, that probably means you’re motivated to start doing the work. If you have to wait 2-3 months, that motivation might fade.

Privacy & Confidentiality

Confidentiality and privacy are also strong reasons to consider a private pay therapist. I’m not saying in-network therapists don’t maintain confidentiality–they absolutely do. But billing insurance gives the insurance company the right to audit treatment records and request progress notes. That means an insurance company might see your information, including your diagnosis. And while insurance companies shouldn’t release that information again, we live in an era of constant data breaches. I can’t tell you how many times I have gotten a notification of a data breach in the past few years. The fewer people with access to my confidential information, the better. This concern comes up a lot with healthcare professionals and employees who are in therapy to deal with workplace challenges.

The “Six Degrees of Kevin Bacon” Problem

Therapists, in particular, may find it challenging to find an in-network therapist they don’t already have a pre-existing relationship with. I live in a city with a lot of therapists, so you might think it was easy to find a therapist for myself. I’ve been in the field for over 20 years, which means I know a lot of people in the therapy community. I’ve learned from them, trained under them, taken classes with them, worked with them, become friends with them, trained them, interviewed them, and supervised them.

I found an in-network therapist who was a great fit for me—someone I had no previous connection to. Then my health insurance changed. Twice. It was worth it to me to submit superbills rather than return to searching for an in-network therapist I didn’t have 6 degrees of separation from. Yes, I’m comparing myself to Kevin Bacon in this example. And really, it’s more like 2-3 degrees of separation for me with other therapists in Portland and Oregon.

More Flexibility in Diagnosis & Treatment

Private pay therapists have more freedom in regard to the type of diagnosis and treatment plan they create. If I’m not billing insurance, you don’t have to worry that insurance will decide your diagnosis isn’t “severe enough” to justify the frequency of therapy that actually serves your needs. We can create a plan that works for you and helps you achieve your goals—not what an insurance company says is acceptable or appropriate.

Superbills: Private Pay & Out-of-Network Aren’t Opposites

One clarification worth making here: choosing a private pay therapist and using your out-of-network benefits aren’t actually opposites. I don’t bill insurance directly for any of my clients. If you want to try to get reimbursed, I can give you a superbill to submit yourself. Submitting it yourself, rather than having your therapist bill insurance directly, means you keep more control over your own information. [I break down exactly how that works—including what insurance companies can and can’t request—in “What’s the difference between in-network and out-of-network benefits for therapy? And what’s a superbill?”.]

A Sliding Scale Without the Interrogation

Lastly, as a private pay therapist, I have the freedom to create a client-friendly sliding scale. I want therapy to be accessible, and to do that, I have a limited number of sliding scale (reduced fee) slots. Because I am not on any insurance panels, I can make fee adjustments without having to worry about violating insurance contracts. Insurance panels require their providers to charge every client the same fee. That means I couldn’t easily offer a sliding scale to someone who lost a job or hit a rough financial patch—even if they really needed it.

I also don’t have to ask invasive financial questions to justify a sliding scale. This helps people who don’t picture themselves as the “typical” sliding-scale client. We all go through lean times. It matters to me that I can make therapy more affordable without asking my clients to justify their finances to qualify for a sliding scale spot.

Ready to Talk?

Are you ready to take the next step? Let’s talk and see if my private pay therapy practice is the right fit for you. Schedule a free consultation.