Paying for Therapy: To Use Insurance or to Not Use Insurance?

Therapy can feel expensive as rates for psychotherapy can vary between $100-$300 per session.  For many, it is a relief that insurance tends to cover therapy sessions, which can make it more affordable.  What makes using insurance different than paying out of pocket?

  1.  For insurance to cover the cost of a session, the client must be seen as having an issue that is considered to be “medically necessary.”  How is this determined?  By the clinician providing a diagnosis.  Otherwise, insurance companies do not see you as having a concern that needs medically necessary treatment.  When receiving therapy without using insurance, the clinician is not required to provide you with a mental health diagnosis from the DSM-V.  For example, if you are receiving treatment for a relationship, the diagnosis can be relationship issues rather than depression or anxiety as a result of the relationship problems.
  2.  Insurance companies can conduct an audit to make sure the clinician is providing appropriate treatment and that you are working on goals designed to treat the illness that is diagnosed and ideally reduce the amount of time you will need to be in therapy.  This limits confidentiality in that the insurance company can have access to your records, which you agree to when signing the informed consent at the beginning of treatment.  Many times, this can be several people at the insurance company reviewing your records, including your diagnosis, and not all of those people have a clinical background. When not using insurance, you can keep your treatment private, between yourself and the therapist (unless there is a subpoena for records due to court involvement).
  3. Many companies change insurance companies.  Some therapists may only work with a limited number of insurance companies.  If that happens, you may by faced with a decision of whether to remain with your therapist without using insurance or switching to a brand new therapist who is covered under your new insurance.  This would never be an issue when paying out of pocket for your treatment.
  4. Most insurance companies do not cover couples or family counseling.  Many times, one of the partners or family members is the “identified patient” and is the one given a diagnoses, with the collateral attending sessions with you.   When not using insurance, the clinician can focus treatment on the relationship issues rather than how the relationship issues are impacting the identified patient’s medically necessary diagnosis.

There are pros to using insurance to help make therapy more affordable.  However, it’s important to be aware of the differences so you can make an informed decision on whether to use insurance.   Although therapy may feel expensive, remember, at the end of the day it is an investment in you!


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