This article will define the terms used when therapists don’t take insurance, what it means to not take insurance for clients and who should or should not work with a therapist who does not take insurance.

What are Out of Network Benefits or Private Pay?

If a therapist says they do not take insurance it likely means they accept out of network benefits (OON) or they are private pay. This means the therapist does not have a relationship with the insurance company and all session fees will likely be paid by the client at the time of the session. 

Out of Network

If the therapist says they are out of network, they will often provide the client with a “superbill” which is a receipt of all the sessions the client has had and the amount they have paid for those sessions. If their insurance has out of network benefits for mental health, then they will be reimbursed by their insurance company directly. Insurance companies will reimburse anywhere from 0%- 80% of the cost of sessions after you have hit your deductible. To find out your unique OON benefits, you will need to contact your insurance company.

Private Pay

Private pay means that the individual is choosing to pay for sessions out of pocket without any intention of getting reimbursed through their insurance company. 

What are the Benefits of Private Pay or OON?

Privacy

If you choose private pay, then you have more control over confidentiality. Since you are not going through your insurance company, they do not have access to your diagnosis or notes related to your services. If you use OON benefits you will need to provide the diagnosis for reimbursement and they can audit your notes, so the added privacy only applies to private pay.

Individualized Care

When you are private pay or using OON, your insurance company cannot dictate the number of sessions nor the interventions used. When you use in network insurance, the insurance company will tell you how many sessions you can have and what interventions can be used. This affects your treatment and is not always created by a therapist nor is it based on the individual needs. With OON or private pay, your therapist can create a therapeutic plan that truly aligns with your needs. 

No “Label” / Diagnosis

Your therapist does not need to assign you a diagnosis if you are private pay. Diagnoses are a necessity when using in-network-insurance or if you use OON benefits. The reason insurance requires a diagnosis is because therapy is reimbursed based on the “medical model” of illness vs. wellness. Some people do not want to be labeled with a diagnosis and it is not always in the client’s best interest.

Better Quality Care

In addition, therapists are able to set their own fees for sessions, which can lead to better quality care than therapists who take insurance. Therapists who are OON or private pay might be able to have a lower caseload than in network therapists. This might mean they are both available to families more urgently—often being able to accommodate schedule changes or last minute appointments and they are able to think about their clients and put time into preparing for sessions. At Spencer’s Therapy Practice LLC we prioritize quality client care and this is one of the biggest factors that led us to be OON/private pay.

Who Should Consider Seeing a Therapist using OON Benefits or Private Pay?

Financial Consideration & Well-being

If you find the payment you are being asked to pay after insurance reimbursement, will not put you in a financially precarious situation and it seems like a good investment, then you might be a good candidate for meeting with someone who does not take insurance. Often times we spend money on things such as a child’s sports team, their individual music lesson or tutoring on a weekly basis. These activities are often meant to help a child or young adult achieve success in their future. Therapy is another way to helping people achieve their goals through mental wellness. Mental wellness can be predictive of success for many individuals and is therefore worth the investment if it is within your budget.

Looking for Specialized Care

If you are looking for something specific it may be the case that the only provider that can support you is OON or private pay because of the added expense of what you are looking for. These are some things that may make choosing OON a good option:

-Clients who move across states often, possibly due to college being in a different state than your home state.

-Needing evening hours or after school hours.

-Someone who specializes in children.

-Someone trained in EMDR or trauma specific work.

-In-person sessions.

-Immediate availability (no wait-list).

-Individualized attention/ability to respond quickly to your concerns.

The reason the above list may be more likely to be OON is because of the cost associated with the above scenarios. For example, if you are in college and you live in one state during the summer and the winter session but you live in a different state in the school year, then your therapist would need to be licensed in two states because they need to be licensed in the state you are physically located in when providing therapy. This means another fee for the therapist and the administrative work of keeping track of another license. It is possible to find someone in network with these qualifications/specializations too-but may take more time searching to find.

Who Should Not Use Out of Network Benefits or Private Pay?

Financial Reasons

If you find that the payment, after insurance reimbursement, will put you into a financially precarious situation OR it does not allow you to save or keep an emergency fund/goals for your future financial success then you should NOT see an OON benefits or private pay therapist. 

If you feel uncomfortable financially doing OON benefits don’t do it. Please be wary of anyone who tries to convince you that it will “pay off” or tells you to take out credit cards or go into debt to be able to afford therapy. I’ve only heard of coaches—who are not legal therapists—doing this but the idea applies for both. A therapist who truly cares about her/his clients will never ask them to spend money they don’t have. 

Fee Does Not Equal Qualifications

Do not assume that because someone does not take insurance or their fee for service is higher than others, that they are therefore more skilled or more knowledgeable. Although we hope this would be true, the reality is therapists set their own fees and there is no structure that dictates what one person’s fee is over another. I have personally worked in settings where my services were free to the families participating and at the same time worked for a private pay/OON private practice where my services were not free.

Final Thoughts

It is a personal decision whether to choose an OON/private pay provider or to get an in network provider. It is important to consider your own financial situation, special circumstances, and to weight some of the pros and cons with getting an out of network provider.