Choosing an Out of Network Therapist
1.Accessibility
The first advantage to seeing a therapist outside of insurance is accessibility. Private pay therapists tend to have more availability and greater flexibility in scheduling new clients. You’ll be treated sooner.
Here’s why:
Therapists who take insurance often have very large caseloads.
While a therapist who works outside of insurance might see 20 clients in a week, a therapist who takes insurance can see 40.
For this reason, people seeking therapists within their insurance often find that it is difficult to get in contact or that the therapist has a long waiting-list. Additionally, even as an established client, it can be difficult to reach the therapist outside of sessions or to schedule an appointment in a timely manner.
Because therapists who do not work with insurance often have smaller caseloads, they tend to be more accessible. They usually have the availability to respond to calls and emails more quickly, to accommodate new clients, and to schedule appointments without long wait times.
2. Specialized Treatment
While many therapists can treat common mental health conditions, such an anxiety or depression, if you are interested in working with a specialist to treat specific issues or longstanding issues, for instance, a trauma informed psychotherapist, you’ll want to consider going out-of-network.
Private pay therapists generally have more specialized practices, along with additional training, expertise, experience, and skill sets to address challenges, such as trauma, not typically found in-network.
3. Confidentiality
If you don’t want your insurance company to have access to any information about your mental health, choose an out-of-network therapist.
A significant advantage to seeing an out-of-network therapist is confidentiality.
Insurance might seem like a way to get one’s mental health care paid for, but it comes with many caveats.
This is because insurance companies do not simply pay for mental health care.
Instead, they consistently monitor clients and decide if they should receive or continue to receive mental health services. To do this, several people at the insurance company have to review client files and these files must be detailed, meaning people at the insurance company will be reading about the intimate details of your sessions.
Most people are unaware of this and bristle at the idea when they find out. In therapy, people want what they say to stay between them, and the therapist then find that when they use insurance, many strangers are reading about their personal thoughts, feelings, and experiences. An easy way to make sure this never happens is to see an out-of-network therapist.
 4. Quality of Care
With an out-of-network therapist, the kind of treatment, length of treatment, number of sessions is based upon what your therapist determines is best for you. Not what your insurance company decides they are willing to pay for.
For insurance companies to pay for your sessions, they require the therapist to give you a diagnosis of mental illness. Many people who come to therapy are there for personal growth and do not meet criteria for a mental health diagnosis but when going through insurance, the therapist must put some diagnosis on record in order to get paid. That means having a diagnosis of mental illness on your medical record. Additionally, as in the portion on confidentiality, many people might have to review the diagnosis to continue payment.
Many clients do not feel comfortable getting a diagnosis, or having one on record even when they do have a diagnosis. They worry this will affect their insurance rates or the care they receive from other medical providers.
When seeing an out-of-network provider, you do not need to be diagnosed. If you do have a diagnosis, it can stay between you and the therapist and does not have to get documented on insurance records. Furthermore, when seeing a therapist that takes insurance, the company decides how many sessions you are allowed to attend and how often.
People who would like to attend more sessions than they are allowed by their insurance find themselves getting cut off from payment and having to pay out-of-pocket anyway. When seeing a therapist outside of insurance, you as the client get to decide how many times and how often you will attend.
Finding the right therapist and the right treatment can also be a challenge within insurance. You might find you click very well with a therapist but feel you cannot see them because they do not take your insurance. In this case, you will have to choose from a limited list of therapists your insurance provides rather than the one you felt you could connect to. Research has shown we make a lot more progress in therapy when we have a good therapeutic relationship with our therapist.
Finally, as insurance companies mandate the length of care, they can also dictate the type of treatment a person receives. Insurance companies seek to pay the least that they have to, in order to be a functioning business model. Therefore, they often insist clients go through manualized or short-term treatment programs, rather than allowing the client to choose. When seeking therapy outside of insurance, the client and therapist are free to plan treatment that is personally tailored to the individual client.
5. You found a great match
For your therapy to be successful, your relationship with your therapist is one of the most important aspects of the healing process.
If you only consider in-network therapists, you might eliminate therapists who would be a really good fit for you and help you feel better faster.
Choosing an in-network therapist who doesn’t make you feel comfortable or specialize in the areas you’re struggling with solely because they’re in-network is a waste of your time, effort, and money. Prioritize the personality fit and you’ll find a great match.
5. You have a high deductible plan
A deductible is the amount you have to pay upfront before your insurance coverage kicks in.
For instance, If you have a $6,000 deductible and you haven’t had any other medical expenses yet in the year, you are responsible for paying up to $6,000 in therapy session fees out-of-pocket before your standard copay applies.
 6.You have good out-of-network benefits
If you have good out-of-network benefits, your insurance company may reimburse you as much as 80% of each session fee, depending on your plan and the therapist’s rate.
This means that in many situations, using your out-of-network benefits can actually be more affordable or comparable to your standard copay to see an in-network therapist.
7. Overall Cost
While paying a co-pay that is much less than a full session fee can seem financially prudent at first, the issues previously outlined point to more time and more money spent long-term. Many factors add up in how much we spend for therapy. Research has shown that many people get worse while waiting on long waiting-lists. This can lead to needing more extensive therapy, ultimately incurring a larger cost. Not being able to freely choose your own therapist can also cost more in the long run.
Having to bounce around from one therapist to the other to find the right fit can end up using up the number of sessions insurance will cover, leaving clients having to start over, and sometimes choosing an out-of-network therapist anyway, where they could have saved the time and money by starting with the right therapist. While there are many talented therapists who accept insurance, that does not always mean clients can access them, or even get the services they need from them.
Insurance creates many roadblocks to mental health care that make quality care less accessible. It might seem more costly at first, but your mental health care is one of the most important investments you can make. It is something that can help you achieve your highest potential. Finding that can be a lot more difficult, time-consuming, and costly when using insurance.
Summary:
Using an out-of-network therapist allows you to be more in control of the care you receive; thereby allowing you to select the therapist you want to see based upon their specialty, ability to provide excellent treatment, create an individualized treatment plan, and other critical factors like confidentiality.