In a world of insurance, self-pay can seem scary. Most people believe their budget won't allow for self-pay. That may be true for some but we believe it's a more available option than you may expect.
What is ‘self-pay’?
Self-pay is a fixed rate determined by your therapist for a specific service. These rates are usually determined based on years of experience, additional training, and certifications as well as market research for your area. Self-pay visits are not billed through insurance.
Self-pay rates are not applied to a deductible and no insurance claims are filed. This means that if you have a deductible to meet, the self-pay rate will not go towards helping you meet your deductible.
Self-pay Rates Can Be Cheaper
If you have a high deductible plan or are filing out of network it may cost less to self-pay. The rate you pay toward your deductible is a negotiated rate set by your insurance carrier, some providers offer a slightly lower self-pay rate.
For example: if an individual has a $5,000 deductible, the contracted rate could be $121.38 this is the amount per session applied to the deductible. The providers self-pay rate may be $90, this rate will not be applied to the deductible. For individuals who do not usually meet their deductible or do not have many medical expenses, it will ultimately save them money choosing the self-pay rate.
When a claim is filed with the insurance company your therapist must submit a diagnosis for that visit. This information may become part of your medical record and be accessed by other medical providers. Some individuals prefer to keep diagnostic information confidential. By paying a self-pay rate, no diagnosis is submitted to insurance or accessible by other medical providers without a signed release
At Clarity we know that a diagnosis is not a bad thing. A diagnosis is a cluster of symptoms, an imperfect tool, and a way for medical professionals to communicate to ensure clients receive the best care. We know it is absolutely not an individuals identity.
When filing with insurance companies, you’re always aware of the limits of what you can provide (and expect to get paid for). Insurance companies dictate almost everything about treatment: the location of a session, the length of sessions, how many people are in a session, and whether they will pay depends on your diagnosis.
Self pay affords your therapist hte following freedoms.
- Location. For example, You can have phone/video sessions when necessary without concern of insurance denial.
- TIme. Therapists are not bound to the same time constraints as those who file with insurance and can spend more time than the standard 52 minutes.
- Parents, spouses and significant others can join sessions as needed without concern for insurance denial.
- They do not have to diagnose you. If they do they do they are able to keep it completely confidential.
- They can utilize the type of treatment they think is best without restriction.
- They can see you for as many sessions as you need. Not the number determined by insurance companies.
When seeking therapist I think everyone wants to work with a therapist who is an expert in treating the specific issues they are experiencing. The BEST choice for them. Often, these providers choose to only take self pay clients. Insurance companies limit how specalized a provider can become.
In my observations, providers with self-pay practices are able to see who they want, the way they want, and create a more valuable experience for the client. Fewer Clients = Higher Quality. These therapists often have spent extensive time becoming experts in their fields. They dedicate time and money continuing their education and mastering skills essential to being the BEST choice for someone. They may set their rates higher than insurance rates to compensate for their additional skills and experience.