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Why Pay Out of Pocket for Your Counselling and Psychotherapy Rather Than Using Medicare, Private Health Insurance or Employee Assistance Programs?

This article has been adapted from 'Why Self Pay?' with permission from the American Mental Health Alliance.

You want privacy: Whenever Medicare or Private Health Insurance is used, your private information, psychiatric diagnosis, presenting issues, treatment plan and progress reports, are available to the insurance company and, at times, to employers. Medicare, Private Health Insurance and Employee Assistance Programs often ask for detailed personal information about clients in order to make payment decisions. This review can undermine your sense of privacy and confidentiality necessary for effective counselling and psychotherapy. Once you have a ‘Mental Health Plan’ diagnosis, it becomes part of your health records. When clients pay for psychotherapy out of pocket, there is no loss of privacy to third party companies.  

You want to choose your own therapist: Many insurance companies limit the choice of therapists. Some  "preferred providers" offer good treatment, keep their clients' interests foremost, and try to keep treatment brief without sacrificing quality. At times, however, the insurance company asks preferred providers to divide their loyalty between the client and the insurance company. Many clients prefer to choose their psychotherapist personally and avoid seeing a therapist with a potential conflict of interest. Other clients may want to work with a therapist who was highly recommended but may not be on the company or preferred provider list.

You want to choose the length of your treatment: Medicare, Private Health Companies and Employer Assistance Programs often limit the choice in therapist that you are able to use. They also limit the length of treatment and the type of therapy. Most companies provide only ultra-brief therapy (3, 6 or 12 sessions). Most people require many more sessions than this to provide long lasting change. Self-paying for therapy may be necessary in order to receive the type and length of treatment required to suit your needs.

You don't want Medicare, Private Health Insurance Companies or Employee Assistance Programs making choices for you. When a third party is responsible for payment, they have the power to influence your treatment. A company employee evaluates your motivation, the severity of your problem, your progress, and makes treatment recommendations. The therapist must take the company's recommendations into consideration or risk losing a contract to work with the company altogether. Many clients prefer paying for their own treatment to eliminate this outside influence.

You don't want to be labelled sick: Whenever insurance is used for counselling or psychotherapy, the treatment must be "medically necessary," which means that your therapist must label you with a mental illness or psychiatric diagnosis. When you pay directly, you may seek consultation from a therapist for any reason you choose. People use therapy for emotional, psychological and spiritual growth, for help coping with stressful life situations, and for marriage and family difficulties, as well as for chronic and serious psychological problems. Having a psychiatric diagnosis on your health records can can restrict your ability to qualify for future health and life insurance coverage as well as when applying for future employment.

© 2010 Jodie Gale