When it comes to paying for health-related expenses, like going to the doctor or seeing a psychologist, most people just assume that using health insurance is their best option.
But what if that’s not always the case?
To be clear: we’re not saying you should get rid of your health insurance or anything like that. Insurance can be critically important, especially if you get hit with a huge and unexpected medical bill.
But there are some situations when it might make a lot more sense to pay out-of-pocket for the care you NEED, rather than filing a claim for the care you qualify for.
There’s a lot to unpack there, so let’s dig into some of the specific reasons why it may be better to pay privately for health care rather than using health insurance.
First: Some of the Problems with Health Insurance
As we said, health insurance is important. We’re not saying to cancel your coverage by any means. But there are certainly issues with the healthcare system in the United States.
There’s a lot to say here, but we’ve come up with 3 main issues that happen when using health insurance:
Privacy concerns. When you go through insurance, your records are accessible to the insurance agency. This can be particularly concerning when seeking mental health care because there are certain fields—such as aviation, the army, politics, and so on—where having that kind of sensitive information on your record could come back to harm your career.
Insurance companies dictate your care. When using insurance, your care isn’t dictated by your doctor—it’s dictated by the insurance company. This applies to the doctors you can see, the procedures you qualify for (only diagnosable conditions are covered), and even your length of care and how many sessions you’re able to have per week. All of which means you aren’t always necessarily getting the most appropriate care.
Overworked clinicians. Don’t get us wrong: we believe all doctors, clinicians, and therapists are doing the best they can. That said, clinicians who take insurance see 2.5x more patients than private pay clinicians—which means they have a tendency to be overworked. Anyone in the healthcare field can tell you that working with insurance companies is extremely time-consuming and tedious. This tends to lead to burnout in clinics that accept insurance, which means they often have less mental bandwidth to deal with your care (compared to private pay clinicians).
Plus, there’s one more issue with health insurance that may come as a shock to many people…
Believe It Or Not, Using Health Insurance Could Be More Expensive Than Paying Out-of-Pocket
Depending on the type of care you’re seeking, you may actually save money by paying out-of-pocket.
How could that be true?
Consider the fact that these days, many plans have high deductibles of $5,000 or more. Usually, your benefits kick in after you’ve hit that deductible. But that means that if the procedure or care you’re seeking costs less than $5,000, then your health insurance essentially provides zero benefit.
Here at The Psychology Group, for instance, we are frequently able to help our clients reach their goals for less than the cost of their deductible.
Also: consider the fact that many healthcare providers charge higher prices for people using health insurance. That may sound shocking, but it’s true. KTVB7 even ran a special report on this phenomenon. Here’s what they had to say:
Due to how expensive healthcare costs are, people are turning to a little-known payment method that could save patients hundreds of dollars if they know their options…
We discovered some health care providers’ cash or self-pay discounts are cheaper than what you’d pay using your insurance. People with high deductibles are finding it’s better to pay their bills with cash or card than let billing departments send it to their insurance.
So basically, using health insurance means that you’ll have to pay a higher price that won’t even be covered until you hit a sky-high deductible.
Not sounding like such a great deal, is it?
The Benefits of Using a Private Pay Therapists
Now let’s take a look at the flipside of the coin: what are some of the reasons it might be better to use a private pay provider? (Particularly for mental health care, like we provide here at The Psychology Group.)
Get the Care You Actually Need
With private pay, you won’t be limited in your care. Choose any therapist you want, and get the care you need regardless of whether or not you have a diagnosable condition.
Because let’s face it: mental health exists on a wide spectrum, and there are millions of people who may not qualify for something like Major Depressive Disorder or Generalized Anxiety Disorder, but who still need support.
Get as Many Sessions as You Need
When it comes to psychology, insurance often limits the number of appointments you’re able to have in a year—usually, this number is around 5 or 6. But we find that for most people, reaching your mental wellness goals takes 12-20 appointments on average.
Get Fully Focused Care
Remember that private pay clinicians almost always have fewer patients than those who take insurance—which means they have more mental bandwidth and can provide fully focused, thoughtfully individualized care (without having to constantly jump through hoops for the insurance company).
Medical Director/Chief Surgeon David Richardson, M.D. put it this way:
Preferred Providers do not serve you. They serve your insurance company. And that is the sad truth. One cannot have two masters.
We don’t mean to criticize any of our fellow healthcare providers; we know everyone is doing the best they can. It’s simply our belief that by not taking insurance, we gain additional freedom that allows us to provide better care.
Private Pay Therapy Can Be Surprisingly Affordable
Here at The Psychology Group, we are private pay—so we don’t have any of the limitations associated with health insurance. That gives us the ability to be 100% focused on what’s best for you, without having to cater to insurance regulations.
But just because we’re private pay doesn’t mean we’re more expensive.
We don’t include any of the “up-charging” that often occurs for insurance patients. In addition, we are frequently able to provide the care you need for less than the cost of your insurance deductible.
Plus, you can still take advantage of your HSA account and/or out-of-network benefits to help cover our costs.
HSAs (Health Savings Accounts or Flexible Spending Accounts) provide a convenient way to pay for health care with pre-tax dollars, which means you save on your tax bill.
Out-of-network benefits, often included with PPO plans, allow you to see any therapist regardless of whether they’re in-network. In this case, you’ll still need to pay for the appointment up-front and provide a medical reason for seeing a therapist, but the insurance company will then reimburse you for some of your out-of-pocket expenses. Usually, this comes to 60-90% of the total costs, after meeting your deductible. When you add it all up and factor in the deductibles, out-of-network benefits often cost you the same out-of-pocket as using in-network benefits.
If you need any help figuring out how to take advantage of these cost-saving opportunities, get in touch with us here and we’ll be happy to help.
Your Mental Health Is So, So Important
At the end of the day, the absolute most important thing in life is your health. Because without that, nothing else matters. And mental health is an incredibly crucial part of your overall health and well-being.
So if you’re struggling with issues of mental health, please do yourself a favor and seek out the help you need.
Maybe you have trouble with depression, grief, or trauma. Or maybe not—maybe you’re just feeling unfulfilled in your life. Maybe you’re not feeling like yourself. Maybe you’re experiencing overwhelming anxiety. Or maybe you’re just feeling unhappy or “blah,” and you want some help to find a place of greater fulfillment and joy in your life.
No matter what you’re feeling, we can help.
Here at The Psychology Group, we pride ourselves on our unique concierge therapy. It’s a combination of evidence-based psychotherapy along with first-class hospitality. We employ incredibly talented clinicians who tailor their therapy to your unique needs.
Evidence-based practice means that the methods we use are proven—through rigorous studies—to work.
And first-class hospitality means that from the moment you walk through our doors, we’ll treat you right. From being greeted with free beverages to having your therapy sessions in a beautiful room with giant windows, everything in our office is designed to put you at ease and help make sure you’re in the right frame of mind to make positive changes in your life.
We also make it easy to find the specific service you need. In addition to therapy for conditions such as depression, anxiety, eating disorder, PTSD, and more, we also provide popular services such as…
In short, we know how fragile and important our mental health is. And that’s why we take every step possible to make you feel comfortable and help you overcome your problems.
If you’d like to talk with someone to learn more about how we can help, contact us here. We would be honored to help you get more perspective and a better understanding of how you feel, along with help and guidance on the tough decisions in your life.
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