Payment Plans


Over the years I have noticed that a lot of people don’t get the mental health help they need because of cost. Although many people believe that using their insurance is the best way to access therapy services, that’s not necessarily true. Allow me to share a few secrets with you. But first, a request: I know this may be a long post but please hang in there and read the entire post before X-ing out of this screen and assuming therapy is outside of your price range. You may be surprised at what you learn.


Ok so deciding to start therapy is a huge life-changing decision, and in my opinion, is as important as getting married or starting a new job. Seriously, what could be more important than committing to work on becoming the best you?

That’s why it’s so important that the therapist you choose has the training, experience, and expertise to help you get to the next level in life, whether you’re working on anxiety, depression, self-exploration, relationships, career goals or all of the above.


Now that they’ve decided to take that first step, one of the things most people consider is whether that therapist accepts their insurance. As a matter of fact, this is often THE deciding factor for many people when choosing a therapist. After all, you have insurance AND pay a monthly premium so why not use it? Not to mention the fact that you use your insurance for all other doctors so why not for therapy too, right?

Unfortunately, many people soon discover that it can be quite difficult to find a therapist that accepts their insurance. But wait, why are so many therapists not accepting insurance? Many people are unaware that there are several drawbacks, for both clients and therapists, when they use their insurance to pay for therapy. Read on as I explain this a bit more.


When you use your insurance to pay for therapy, the Insurance company dictates which therapist you can see, how often the therapist can see you, where the therapist can meet with you, and the types of treatments or assessments your therapist can utilize. Choosing to see a therapist is hard enough, so when you finally make that decision you should be able to have more control over who you work with. You should also be able to meet with your therapist in the way that suits your needs at that moment whether it is in their office, or from your office or your living room, etc. If you are in a moment of crisis, you should also be able to connect with your therapist as soon as possible; not wait weeks for an appointment.


Now that you’ve found a therapist you finally feel free to share some of your most intimate life events because after all, what happens in therapy stays in therapy, right? Nope! When insurance companies pay for therapy, your therapist is required to provide your diagnosis and session notes to your insurance company in order to get paid. The insurance company’s employees will read what you and your therapist talked about in your therapist’s session notes for several reasons including determining whether your issue is “a medical necessity” or you’re overusing your insurance coverage. This undermines the basic premise of confidentiality and also gives a lot more people access to private health information about you. If this is news to you, you’re not alone. It’s all written into the HIPAA document you get when you start therapy (or go to any doctor’s office) the problem is most people don’t read all the fine print.

After reading the session notes, the insurance company may refuse to authorize additional sessions because you’re not progressing fast enough; our work in psychotherapy does not qualify as “a medical necessity”; or because the insurance company doesn't recognize my treatment approach as an “evidence-based treatment” (code for short-term, as in 6-12 sessions). I believe that you should have the liberty to progress through treatment at a pace that’s best for you – one that allows you sufficient time to take everything that you’re experiencing and that process is different for each person.


Even if you’re okay with your information being shared with your insurance company, you probably do not realize that sharing this information can have unintended consequences in the future.

Insurance companies require a certain diagnosis to establish that you have “a medical necessity” before they will pay for your sessions. But what if you don’t have a mental illness? After all, many people seek therapy for personal growth and exploration, not because they are depressed or anxious or have a serious mental illness. In the eyes of your insurance company, these are not valid reasons for seeking therapy on their dime. As a matter of fact, most insurance companies don’t consider relationship issues, marital issues, existential issues, life transitions, personal development, or self-improvement as “a medical necessity”. Therefore, your therapist would have to assign you a diagnosis or your insurance will not pay for your work together. And even then, there are some diagnoses that insurance companies don’t consider serious enough to pay for. Therefore, your therapist would have to label you with a more severe diagnosis they will pay for, but one that may not really reflect your situation.

This puts your therapist in an awkward and ethically challenging position. If you don’t meet criteria for a mental illness, He or she has to:

1. Assign a diagnosis that your insurance company will pay for even if you don’t meet criteria for that diagnosis.
2. Discontinue therapy which can lead to ethical violations (ex-abandonment).
3. Continue to work with you without assigning a diagnosis but often is not paid for the work.

Hopefully, you are starting to better understand why so many therapists don’t accept insurance.

As I mentioned above, your therapist must provide your insurance company with your session notes and diagnosis to get paid. Now, you may be asking yourself “what’s wrong with that, that doesn’t bother me.” Actually, it can harm both of you.


I feel that people should be able to get the help they need without stigma, or fear of repercussions for prioritizing their mental health and personal growth. However when you use your insurance to pay for therapy a diagnosis becomes part of your permanent medical record and can impact future events such as: applying for life insurance, seeking employment requiring regularly handling firearms, seeking employment in the financial sector managing other’s assets or any sector in which your decision-making might be called into question due to your emotional state!


Ok, so you might be wondering how this all relates to increased premiums for you.

Well let’s say your therapist assigns you a diagnosis, whether or not you meet criteria, so that your insurance company will pay for your sessions. Now you have a diagnosis on record with your insurance company, and this “pre-existing condition” can cause your premiums to increase when it’s time to renew your insurance or you switch plans.


If your therapist assigns you a diagnosis that is not truly reflective of your situation, he or she would technically be committing insurance fraud. Now I know some providers are willing to take this risk, but I am not. For me, the penalties and professional consequences of insurance fraud are huge, and frankly, not worth it. Plus, I’d rather enjoy the peace of mind that comes with integrity, than have a few extra dollars in my bank account.


Did you know that insurance companies often ask therapists to pay them back money for services they pre-approved and the therapist completed? Just think for one minute, how you would feel a former employer sent you a letter requesting that you repay income you’d earned 3 years ago for work you had already completed and they had approved. Would that seem fair to you? I didn’t think so. Well, insurance companies do that quite often. They’ll audit your claims and paperwork for several years back. If they find any mistakes or inconsistencies in the therapist’s paperwork (including grammar, punctuation, margins, etc.) they missed when they originally approved the therapist’s claim, the insurance company will request that the therapist return the fee she/he was paid. This practice can amount to thousands of dollars that can bankrupt a small business like a private practice. Although I remain dedicated to providing the best care for people in need, I cannot help anyone if I’m out of business.


Many people believe that therapists earn the big bucks but that’s not true.

Here’s the reality, many providers that accept insurance overbook their schedules in order to earn a modest profit (equivalent to teachers’ salary) after they pay for rent, utilities, malpractice, and other expenses. This increases the number of clients they treat in a day. When they’re not seeing clients, they’re drowning in insurance paperwork and billing claims in order to get paid, or spending hours on the phone contesting unpaid claims. Of course, they could pay a medical billing company to take care of this, but then that just increases their expenses and cuts into that modest profit. Then they will need to see even more clients and the destructive cycle just continues. And of course, there’s no sick or vacation time to be had either.

That’s a recipe for a tired, overworked, and stressed out the therapist.

I should know. I started to experience the symptoms of burnout after several years of insurance-based practice and noticed it in the other therapists I worked with too. And that’s when I realized, “OMG! We are all doing the things we tell our clients not to do!” Talk about hypocrisy! So, I changed my business model for the sake of our well-being, and to preserve the quality of care we provide to each and to every one of our clients.


Remain Your True Self – You don’t have to worry about having an unnecessary or inaccurate diagnosis on your medical record.

Confidentiality & Privacy – Only you and your therapist will know you’re in therapy. Your session notes and intimate details won’t be available to prying eyes and you get to choose who you disclose this information to.

Your Therapy-Your Choice – You get to choose the therapist that you are most comfortable with and whose training and background will best help you to achieve your goals. You and your therapist are the only ones involved in deciding when to meet, where to meet and how often to meet. No need to depend on someone who is totally unfamiliar with you to approve whether or not you can continue to pursue your personal growth.

Concierge Care & Attention You Deserve – You’ll get to work with a psychotherapist that is not bogged down by paperwork or tied up on the phone fighting for approval to care for you. Instead, your therapist can actually use his/her expertise and time to provide you with the support and techniques that can lead to goal achievement. And because she or he is not tired and overextended you’ll able to call and actually speak to her/him if you need support between sessions.

Now I know you might be thinking that these are just my opinions about insurance companies. But don’t take my word for it. The fact that so many therapists don’t accept insurance and that number is increasing daily speaks for itself. Still don’t believe me? Check out these articles on insurance if you have a minute!

How much does a counselor in private practice make
Can't find a psychologist who accepts insurance

Comprehensive Psychological & Assessment Services (CPAS) is a private practice located in Central Florida. Our team of experienced, effective therapists utilizes a professional approach to provide individual and couples effective tools for positive change. Our therapists help you to develop positive new habits that help you to form healthy relationships, manage depression and anxiety and achieve personal and professional goals. Our passion is helping others achieve happy, fulfilling, lives that make your world a better place. Each therapist has their own areas of expertise. Not sure who you’d like to work with? Click here to schedule a free 30-minute phone consult to help you decide.

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