Why I Chose Private-Pay Therapy: What Going Out-of-Network Really Means

A little confession: In addition to my work as a school counselor, homeschooling mama, and teacher, I spent over two years working at a chiropractor’s office (which I loved). I learned a lot.

I learned how to closely look at EOBs (explanation of benefits) and examine different billing codes. I’ve checked enough insurance plans and fought through enough rejected claims with my son’s medical needs to know that “Yes, you have insurance,” and “Yes, your insurance will actually pay for this” are two very different sentences.

I have spent more time than I’d like deciphering benefits, tracking down authorizations, appealing decisions, and trying to figure out exactly what was (and what wasn’t) covered.

When I started Estuary Wellness & Counseling, I made a decision early on: I would offer private-pay therapy rather than bill insurance directly.

I know this may not be the right fit for everyone. (Let’s chat if this is you.) I have just seen firsthand how complicated the system can become, and how easily the focus can shift from “What does this person need?” to “What will the plan cover?”

Here’s what private pay actually means:

• You don’t need a diagnosis to talk to me.

  Insurance generally requires a mental health diagnosis in order to reimburse therapy. But sometimes what’s actually going on is not enough to warrant a true diagnosis. Sometimes we just need someone to just be in the trenches with us. To listen. To try to understand.

  You shouldn’t need to squeeze your experience into a clinical label to get support. And if you do need a diagnosis, we can cross that bridge on our terms.

• Confidentiality.

  Period. Because I don’t bill insurance directly, your sessions aren’t being submitted to an insurance company. That means you have more privacy and control over how your care is handled.

  Of course, therapy still has the same legal and ethical confidentiality requirements that apply to mental health counseling.

• We decide the pace - not a claims department.

  No insurance authorization determining whether you’ve “had enough this year.” You set the pace.

• No surprise bills.

  Ever.

  You know the cost upfront. No trying to decipher an explanation of benefits while sitting on hold with a customer service representative.

• And yes, I know private pay isn’t right for every budget.

  I won’t pretend it is.

  If cost is a real concern, let’s talk about it. I have a small number of reduced-fee slots that I reserve for needs that arise. I also can provide you with a superbill, so if your insurance plan offers out-of-network mental health benefits, you may be able to receive some reimbursement for our sessions.

I recommend checking with your insurance company before beginning therapy to understand your specific out-of-network benefits, deductible, reimbursement rate, and any other requirements.

Ultimately, I chose private pay because I wanted to build a practice where therapy is actually built around you.

I would love the opportunity to connect. Schedule your free consultation to see if we’d be a good fit!

With care,

Kim