Private health insurance may be the default in the United States, but does it work? Does it help you? Does it have your needs in mind? The short answer is kind of, and sometimes not at all. Insurance companies exist to make a profit, and they make money by charging you more than you get back, on average.
Here are the most useful benefits of paying for mental health care directly instead of through insurance:
Privacy
Insurance requires a diagnosis on day one. That means we are required to provide them with your personal and private information, protected health information, and a mental disorder that fits your symptoms based on very little conversation. A one-hour session really flies by. I generally advise against needless diagnosis for multiple reasons, but the biggest is that a diagnosis becomes part of your permanent health record. It can limit you from certain careers and can be used against you in court.
Freedom
Choose who you want to see, and how long or often you want to see them. No visit limits or referral requirements.
Better care
Insurance companies require that providers use “cost-efficient” treatment plans and techniques. This means that many individuals with their own unique issues get funneled into the same treatment style. This goes completely against contemporary therapy philosophy. To quote Irvin Yalom: “The therapist must strive to create a new therapy for each client.”
Stability
With private pay, your insurance company will never send you a retroactive bill. You won’t have to worry about copays versus coinsurance, or maximum out-of-pocket versus deductible. In short, way less crazy-making. You’ll also receive a Good Faith Estimate of what care will cost before it starts — that’s your right under federal law, and we take it seriously.
The middle path: out-of-network benefits
Private pay doesn’t have to mean paying full price. Many PPO plans reimburse a meaningful share of out-of-network mental health care. We give you a superbill after every session, and our partner Thrizer can check your plan and file the claims for you. Here’s exactly how it works.
Diagnoses: the pros and cons of labeling unique experiences
Many people come in wanting a diagnosis. This is understandable. It’s what I wanted when I first came to therapy as well. I think I wanted to know that my situation was not normal. I also wanted to know which kind of not-normal it was. Like many others, I thought a label would help me fix my problems. Looking back, I was lucky enough to go to a good therapist who danced around the question artfully when I asked, “Do I fall into anything diagnosable?” She responded by telling me that what I was dealing with could be overcome with the right tools and the right way of thinking. The way out was through.
This is not to say that diagnoses aren’t useful. The DSM is built upon categorizing people’s symptoms into labels based on similar experiences, and it is — sometimes — a profoundly useful instrument of the trade. It is also constantly being worked on and compared to the ICD, which offers a slightly different view on many symptoms. The DSM has yet to include complex PTSD and is undergoing a revision to its section on personality disorders, which will likely have huge implications for American psychotherapy.
A diagnosis can help a clinician know what else to examine and how to treat particular issues. Scientific research would not be possible without the concept. At the same time, a diagnosis doesn’t mean that you have every symptom. It doesn’t connote a lifelong affliction. It really doesn’t mean that anything about your life is different than before you were diagnosed.
Language is imperfect. I use idioms and metaphor often, partly because they help simplify complex ideas and partly because they can mean many different things. We think more creatively about something before we have a word for it. The word itself constrains our thought process — which can make it more efficient, but can also lead us astray from the reality of the situation.
This article is for informational and educational purposes and is not a substitute for mental health therapy. Reading it does not establish a therapist–client relationship. If you are in crisis, call or text 988 or call 911.
