Out-of-Pocket vs. Using Medical Insurance to Pay

Additional considerations regarding out-of pocket payments vs. using medical insurance to pay for your sessions with us in our Fuquay-Varina office.

Out-of-pocket payment

Using Medical Insurance

You determine if therapy services are necessary.

Insurance company decides if therapy services are “medically” necessary.
You determine how many sessions are needed and how often you meet.

Insurance company decides how many sessions they will pay for and caps the number of sessions.

Diagnosis of a mental disorder is not required in order to receive services. In many circumstances, (for example, relationship difficulties, family developmental transitions, major life decisions, family crisis) a diagnosis of a mental disorder is not appropriate or necessary.

Typically, insurance companies require a diagnosis of a mental disorder before they will pay for services (In other words, they won’t pay unless you’re diagnosed). The Diagnostic and Statistical Manual of Mental Disorders (referred to as the DSM), published by the American Psychiatric Association, lists and provides criteria for diagnosis.

Greater confidentiality. The information you share with your therapist stays between you and your therapist.

Decreased confidentiality due to the large number of persons handling medical insurance claims. Potential company (mis)control of information when claims are processed. Insurance companies have access to your therapy/counseling records.

Therapy services are tailored to meet your unique needs.

Insurance companies may require that services follow standardized models.

You (along with your therapist) are in the driver’s seat in regards to the services you receive. Your goals and needs are the top priority.

You are only one out of millions of people for whom the insurance company makes healthcare decisions. The top priority is managing health care costs and delivery (this is why it is called “managed” care).

**used with permission and adapted from considerations on insurance by Dr. Jeff Krepps***