Private pay puts you in the driver’s seat when choosing the quality of counseling you desire and the level of privacy you prefer.

Life Edit Therapy is considered out-of-network (OON) with all insurance companies and accepts private pay only. If you desire to use your insurance benefits, mental health services are often eligible for reimbursement of 50%-80% of the allowable amount once their deductible is met.

If you submit your claims to insurance, here are some facts to consider:

• I am required to give you a diagnosis. And, you may not meet the criteria for any diagnosis. If that is the case, insurance will not provide coverage for your therapy sessions.

• If you meet diagnostic criteria, a diagnosis becomes part of your permanent record as well as any treatment notes which they may require before considering payment. For some, this is a concern as others have access to private information and may impact their future such as a career move or application for life insurance.

• Having a documented diagnosis may be considered a “pre-existing” condition and potentially impact your insurance premium should you switch or renew your plans.

• Insurance may dictate what therapy approach I use which may not be the best use of our time together.

• Insurance may also dictate how long our sessions are or how often we meet together.

• Insurance is not necessarily always the enemy and many have successfully used this option when seeking therapy. It may be the most logical and helpful option depending on your situation.

• Most private health insurance plans provide some degree of out-of-network (OON) reimbursement. If your insurance card or plan mentions “POS”, “PPO” or “out-of-network,” then you like will have some level of coverage for OON services. Check with your insurance to be sure.

• Reference the insurance guide I’ve created to set you up for better success in getting accurate information.

• Consider using Mentaya so you may easily submit your claims for out-of-network health insurance reimbursement for a nominal fee. 

What are out-of-network benefits? Here's a breakdown:

If your insurance plan offers out-of-network benefits, it means they will cover a portion of the cost when yo see a therapist who doesn't have a direct contract with your insurance company.

Unlike in-network providers, who bill your insurance company directly, with out-of-network therapists, you typically pay for the session upfront and then submit a claim to your insurance for reimbursement.

Insurance companies often reimburse a percentage of the therapist's fee, usually after you meet an out-of-network deductible. For example, after you meet a $1,000 deductible, your insurance may reimburse 50-80% of the session cost.

Out-of-network benefits give you the flexibility to choose a therapist based on your needs and preferences, not just those in-network.

Considerations if not seeking reimbursement from insurance:

• Use your Health Savings Account (HSA) or Flexible Spending Account (FSA). Most if not all HSAs and FSAs allow funds to be used toward mental health services.

• Evaluate where you can cut back. When paying therapists out of pocket, you can creatively cut back on other expenses which motivates you to be fully invested and often has this way of making your therapy journey even more meaningful.

• Therapy is an investment. A better version of your or your relationships has a ripple effect in every area of your life and has a positive impact on those closest to you. It is hard to put a price tag on that.

Good Faith Estimate Notice:

• Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.  

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. 

• You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment.  

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.  

•  For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit www.cms.gov/nosurprises. 

I have great respect for gifted therapists who accept insurance, possibly as a way to ensure others have access to good care that might otherwise not be able to afford it. Yet for me, my decision to accept private pay only was based on both personal and professional considerations, both of which ultimately benefit those I serve.