If you have insurance, it makes sense to want to use it. You’re paying for those benefits, and therapy is an ongoing expense.
I don’t participate in insurance networks or bill insurance directly. That means you pay me for our sessions. It doesn’t necessarily mean you can’t use your insurance to help cover the cost. If you have a PPO or another plan with out-of-network benefits, you may be able to get reimbursed for part of what you pay. I can provide a superbill for you to submit to your insurer.
Here’s why I work this way, how reimbursement works, and what to consider when deciding whether to use your benefits.
Why I don’t take insurance
Working with insurance companies meant spending increasing amounts of time on billing problems, coverage disputes, and demands to return payments for services provided long before. Low reimbursement rates and pressure to accept reduced payments also made it harder to sustain an independent practice.
Leaving insurance networks has allowed me to spend less time managing those disputes and more time on serving and supporting my clients, doing the clinical work that really matters.
Private payment makes it possible for me to maintain a smaller caseload. That has given me more availability and flexibility for longer sessions, more frequent appointments, or additional contact between sessions when needed. We can discuss those arrangements together, based on your needs, my availability, and the cost, without having to fit them within an insurer’s coverage requirements.
Can you use your insurance to work with me?
Possibly. PPO plans often include out-of-network benefits, which allow you to seek reimbursement for care from a therapist who doesn’t participate in the plan. Other plans may offer these benefits too, but you’ll need to check your specific coverage.
You pay me directly, request a superbill, and submit it to your insurer. The superbill is an itemized receipt with information used to process a claim, including a diagnosis. Your insurer decides whether and how much it will reimburse you; providing a superbill doesn’t guarantee payment.
Before relying on those benefits, ask your insurer:
- Does my plan cover out-of-network online psychotherapy with this provider?
- What deductible would I need to meet?
- How much would you reimburse, and what amount is that calculation based on? (Your plan’s allowed amount may differ from my fee.)
- Do I need authorization, and how do I submit claims?
Using out-of-network benefits still means paying upfront. Reimbursement may be limited or delayed, and you may be responsible for the full cost if a claim is denied. Also, an arrangement we agree would be helpful—such as a longer session—may not qualify for reimbursement under your plan.
Should you use your insurance?
If your plan offers reimbursement, the next question is whether you want to use it.
The biggest advantage is affordability. Getting some of your expenses reimbursed may make regular therapy more manageable. If you need a lower upfront cost, seeing an in-network therapist may be a more practical option. There are excellent therapists who accept insurance, and paying privately doesn’t automatically mean better care.
The main drawbacks are coverage requirements, sharing information with your insurer, and the influence coverage decisions can have on your treatment. Depending on your plan, authorization requirements or coverage reviews may affect which services are reimbursed and how often. You and I still make clinical decisions together, but what insurance will pay for can shape which options are financially workable.
Insurance claims generally include a diagnosis and information about the services you received. Insurers may request additional clinical information, although separately maintained psychotherapy notes have special protections. That doesn’t mean they routinely receive everything you discuss in therapy. HHS explains these protections.
Submitting a superbill shares the information it contains with your insurer. If you pay privately and don’t submit a claim, those sessions aren’t billed to your insurer. I still keep clinical records, and the usual legal limits to confidentiality apply.
For some people, reimbursement is worth those tradeoffs. Others prefer to keep their insurance company out of the payment process. You can consider both the financial benefit and your comfort with sharing information.
Making the cost workable
We’ll discuss fees during our introductory conversation, before you decide whether to begin. If you aren’t using insurance, you generally have the right to a written Good Faith Estimate of expected charges. Learn more about Good Faith Estimates.
You’re welcome to ask about fees, superbills, session frequency, or contact between appointments. Finding someone you feel comfortable working with matters. So does being able to afford the work without creating more financial stress.