Private Pay Benefits

• Financial transparency: with private pay, the fees listed are what you get. For insurance, approximately 20%-30% of claims are denied because clients and clinicians are short on time and are often confused by the “insurance world” protocols and jargon. Moreover, insurance agencies often do Clawbacks. Clawbacks are “the recovery of money” after a claim has already been accepted and approved by the insurance carrier. The responsibility of the Clawback (which can sometimes be thousands of dollars at a time) then falls onto either the clinician OR the client.

• No required diagnosis: this reduces over-diagnosing and prevents any stigmatized labels from being entered into your permanent electronic health record.

• No ethical or moral dilemma: only “F codes” are reimbursed by insurance agencies. For example, bereavement (loss of a loved one) is not an F code. Therefore, in order for the client to receive services and be reimbursed, the clinician would have to diagnose either an inaccurate or more severe diagnosis that the client may not actually meet the criteria for in order to obtain services. Otherwise, the client will be denied care.

• Client control: Frequency and form of treatment are decided by both client and therapist instead of having imposed limitations placed by the third party. Insurance agencies often dictate which types of treatments are accepted/reimbursed in addition to how often a client can be seen.

• More privacy and confidentiality of services: The insurance agency will have access to records and client’s private health information. This includes diagnoses, treatment goals/modalities, progress notes of what was discussed during session, and payment information.