There are both advantages and drawbacks to out-of-pocket private payment and to using insurance. Obviously, the biggest drawback of out-of-pocket private pay is that it is an immediate out-of-pocket expense. However, there are several advantages of private pay that may make the expense worthwhile.
You pick your provider.
Perhaps most importantly, when you pay privately you are able to choose your provider based on “best fit” for you.
In order for insurance to pay, you must be diagnosed.
This is important to consider before you decide to utilize insurance. Since health insurance is part of the medical model, you as a patient must be diagnosed with a condition if you utilize insurance. This stipulation is important to understand up front, since any subsequent diagnosis will become part of your permanent medical record – possibly affecting your future insurance coverage, employment, etc.
Your privacy is protected.
When you pay privately, you share an agreement with your clinician – and no one else. With the exception of special cases (e.g., issuance of a court order, or in situations where someone’s life or safety is threatened), your records will never be released without your written authorization. Cash sessions are entirely confidential. Conversely, insurance companies can and do audit clinicians – meaning patient’s records must be made available to the insurance company and, quite possibly, various other “third party entities” (such as government agencies). Even if your clinician is not audited, he/she is still required to submit certain information about you to your insurance company.
Only you and your clinician determine scope of care.
When you pay privately, your clinician will work with you to formulate goals and intervention based upon your unique circumstances. These plans can be modified, continued, or concluded based on the decisions you make together – in confidence. On the other hand, insurance companies require clinicians to submit client treatment plans – which their claims departments will then decide to approve or deny. When you choose to utilize insurance, the type of assessment, results and diagnoses, and recommended treatment must be submitted to your insurance company. Their claims department will then determine whether the outcomes and recommendations of your sessions fit the insurance company’s decision-making matrix.
You have more options.
When you pay privately, your clinician can utilize any assessment tools that he/she believes will be most helpful and appropriate for yielding a clear and comprehensive profile. He/she is not constrained by what your insurance company will or will not pay for.
No hidden costs.
Private-pay typically involves “flat fee” rates. All agreed upon services will be provided for that price. There are no “extra” or “hidden” costs. You will not receive any “surprise” follow-up bills.
Often less expensive than insurance.
In the long run, the cost of a treatment may end up being less when you private-pay. One reason is “deductibles.” Insurance companies typically require you to pay a certain amount before they will cover additional costs. If this amount (i.e., your deductible) is greater than the cost of the evaluation, your insurance policy will not pay. Keep in mind that, just because you have received an initial quote for reimbursement, this does not guarantee you will actually be reimbursed (as mentioned above, claims may still be denied). Furthermore, since insurance companies direct scope of care, they may agree to cover only a limited-scope assessment. And in all cases, the insurance company will require a diagnosis. But what if no diagnosis is warranted? And what if further testing is appropriate? When all is said and done, you may be left with more questions than answers, and the total cost of the assessment process will increase substantially.