How to Get Therapy Without Insurance
The landscape of therapy is ever-changing, and while there are many therapists in network with insurance, others are opting to part ways with many insurance companies and offer their services “self pay”. You may be curious about self-pay options for therapy if you’re uninsured, underinsured, or find it difficult to find an ideal provider in-network. If you’re curious about choosing a self pay option for therapy, read about the advantages below as well as some options for finding affordable self-pay therapy without using insurance.
What does it mean if a therapist is not in network with my insurance?
When a therapist is “OON” or out of network, the therapist is not contracted with your insurance provider. This means that you will be responsible for paying for sessions, and these payments do not go towards your in-network deductible. Many OON therapists can provide you with a superbill i.e. an itemized receipt for sessions. If you have OON benefits, you would submit this to your insurance provider, and it would go towards your out-of-network deductible.
Once you hit your deductible, you’ll still pay your therapist their full fee, but now your insurance provider may reimburse you for sessions. The amount they reimburse you will depend on your specific insurance plan, but on average out-of-network benefits for therapy reimburse an average 70% of the session cost.
The Benefits of Self-Pay
No diagnosis required - Health insurance companies only pay for therapy if they deem it is “medically necessary”, meaning you meet the requirements of at least one mental health diagnosis. For example, a couple seeking therapy for “pre-marital” counseling does not meet the insurance criteria that the counseling is addressing and treating a mental health disorder of one of the individuals through couples sessions. This is why you’ll find a lot of couples therapists offer their services out of network.
Increased privacy - Insurance companies will look through your diagnosis, case and sometimes therapists’ documentation in order to “audit” or make sure that the treatment is medically necessary. This makes the process more difficult for both patients and clinicians, and many clinicians choose to go out of network in order to avoid the risk of “clawbacks”, where insurance demands the money they paid to the provider back. This is more likely to occur for in-network providers, however please be aware that if you still submit your superbills to insurance for OON reimbursement, your insurance company may still be able to see your diagnosis but will not have access to the therapist’s documentation.
No limits on treatment length, frequency, or coverage - Many companies offer EAPs or other mental health benefits, but only offer a limited amount of sessions. This can be a great option for people looking for short-term, solution-focused therapy, but for those who are looking for more freedom in their treatment length and frequency, private pay provides more freedom and flexibility for you and your therapist to meet for longer, or more frequently (e.g. twice a week).
Access to more providers - Due to low reimbursement rates and stringent insurance policies, more and more providers are choosing to leave insurance panels entirely. Choosing to self-pay for therapy usually means you have a larger selection of providers to choose from since you’re not limited to only providers that are in-network. While there may be talented providers in network with your insurance, some people still choose private pay to see a specialist, couples therapist or simply because the therapist they found is a great fit for their therapy goals.
Affordable Options
While most people may see the benefits of self-pay therapy, not everyone is able to afford it. Fortunately, there are low-cost resources available for those who are not able to afford full-fee rates for therapy.
Sliding scale - many therapists offer a sliding scale, meaning you pay a reduced fee based on financial need. If you see a therapist that looks like a great fit but doesn’t take your insurance, ask about sliding scale options.
Open Path Collective - Open Path Collective is a community-based organization that allows members to find therapists at low self-pay cost (ranging from $30 to $70). This option was created for people who are uninsured, underinsured and not able to afford private pay therapy, therefore the requirement to be eligible for open path is having an annual household income that falls below $100,000 per year.
Clinics that offer low-cost therapy - Many therapy clinics offer low cost therapy, sometimes as low as $25 per session. These sessions are often with interns, therapists-in-training or newer clinicians but it is still a great option for those who are uninsured and on a tight budget.
Therapy groups - While groups often serve a different purpose than individual therapy. If you enjoy a community-based approach or want a resource for skill-building, then you may benefit from finding low-cost therapy groups. You can search for groups in your area on Psychology Today.
LASTLY… Don’t forget your HSA! - Many employer-sponsored health insurance plans also contribute to an HSA account, a tax-advantaged account that can only be used for medical expenses. Ask your therapist if they accept HSA cards as a form of payment. You can also contribute to the HSA yourself, for some tax benefits.
If you’re located in NY or NJ and interested in starting therapy, check out my about page to learn more about my approach as a therapist!