Should I pay out-of-pocket or use my insurance benefits?

Amanda accepts private pay, Blue Cross Blue Shield and Aetna.  There are both advantages and disadvantages to using your insurance benefits, as well as choosing to pay out-of-pocket:

PRIVATE PAY

  • Pros
    • Heightened confidentiality between you and your therapist, as third-party payers are eliminated.
    • It is not necessary that a diagnosis be given.  You can receive therapy for a multitude of issues that do not necessarily indicate a psychiatric diagnosis.
    • You and your therapist will determine the course of treatment, frequency and number of sessions, and treatment modalities that are used.
  • Cons
    • Paying out-of-pocket is sometimes more expensive than utilizing your insurance benefits and could be cost-prohibitive.

INSURANCE

  • Pros
    • If you have coverage to see the provider you choose, using your insurance may be the most cost-effective option for you.  It is important to know your deductible, copay, and coinsurance for outpatient therapy in order to gauge whether or not this is the most economical choice.
    • Whether you are self-employed or receive insurance through your provider, you are already paying a lot for your healthcare benefits, and it may make the most sense to use those available benefits.
  • Cons
    • There may be circumstances where you want to keep the fact that you are seeing a therapist, as well as any information about that treatment, completely confidential.  In order to qualify for and use your insurance benefits, you must give up a degree of confidentiality to your insurance company that would otherwise be contained to you and your therapist
    • Treatment must be deemed medically necessary which means you will receive a psychiatric diagnosis that remains on your permanent medical record in order for your sessions to be covered.  This is important to know, as with any medical diagnosis, it is important to know that this diagnosis will be accessible in certain circumstances, i.e. applying for life insurance or disability insurance
    • Medical insurance will not cover therapy centered around personal growth, grief and loss, adjustments to life situations that do not meet criteria for a diagnosis, some marital and family issues, and career counseling
    • Some insurance plans may limit who you can see for therapy, how many sessions you are allowed, and the type of therapy received. 
    • Sometimes companies switch insurance providers to save money.  This can be frustrating if you form a strong therapeutic bond with your therapist, only to find he or she is not a provider with your new insurance plan.