1. There is a line in your insurance contract that clearly states by using your insurance you are allowing your insurance company access to your chart and your mental health information. Did you know that? Your information is not really confidential between you and the therapist. As much as your therapist will want to keep the insurance company out of the treatment room, he/she will have no choice in the matter if you are using your insurance. If we don’t allow the insurance company access to your information when they contact us then they can “claw back” or recoup all of the payments they made on your behalf, leaving you with a big bill owed to the counseling office for services rendered. More insurance companies than ever are auditing charts regularly in their effort to keep their costs down. So, it becomes “us” (the therapists) fighting against “them” (big insurance companies) on your behalf. We put up good fights but seldom win.

2. Once your information is accessible to an insurance company it may be accessible to other entities like disability, some employment (normally high security jobs), and life insurance. You may be denied opportunities in the future due to what was shared with the insurance company from your counseling record.

3. Just because you have insurance does not mean it will pay for your services. Crazy but true. For insurance to pay you must meet what is called, “medical necessity.” In the world of mental health this means you MUST qualify for a mental health diagnosis and that diagnosis MUST create barriers to your getting through your daily life. If you are simply looking to engage in counseling to explore things in your life or increase your overall well-being your insurance will not pay. Secondarily, if you do begin counseling by meeting medical necessity, but your symptoms improve during the counseling process (which we aim for), the insurance company can stop paying while you are in middle of your process.
*This is especially important if you plan to use insurance for your first appointment. If at the end of your appointment we cannot assign medical necessity then we are not allowed to bill your insurance for the appointment. To do so would be committing insurance fraud.

4. If the insurance company chooses to audit your chart at any time and deems that you didn’t really meet medical necessity during your counseling process (which is subjective to them, we could say you did but they could disagree), they can “claw back” any money they paid on your behalf, thus leaving you with a big bill owed to the counseling office.

5. Many insurance companies will only reimburse for certain types of therapy delivered. This means that if you will best be served by a type of therapy that they don’t pay for then you won’t receive it when using your insurance. Note that insurance companies also don’t pay for couple’s counseling at all, and many don’t pay for family therapy.

6. Insurance companies make it extremely difficult for mental health providers to get paid. For this reason, many providers no longer take insurance. It is time consuming and costly to fight to get paid and the attention therapists end up giving to billing takes us away from focusing on what we do best-therapy. Don’t be surprised if you find that few therapy offices accept insurance when you contact them for all of the reasons listed here. There are some of us that do still try to take insurance, in an effort to make therapy accessible to folks who otherwise could not access it, but again there is no guarantee of payment.

1. If you have a PPO type of insurance plan that is not accepted at a therapy office, you can request a super-bill. This is an invoice you can submit to your insurance company for partial reimbursement for therapy services. You pay your therapist in full at the time of the appointment and they give you a super-bill to submit to your insurance company. This only works for plans with which they are not contracted. When you operate this way, the therapist is not required to jump through any insurance hoops for you to receive the services you desire.

2. You can opt out of using your insurance altogether so you can be in charge of your care. You inform your therapist that you won’t be using insurance and you can pay cash for services. Most therapy offices have set prices for a session, but some will negotiate with you for the rate if you are experiencing a financial hardship. For example, at CLCC a 50-minute session with Dr. Cearfoss is $140. However, for those experiencing financial difficulties Dr. Cearfoss will often offer a sliding scale fee of $20 to $30 off of the weekly appointments. CLCC also employs Associates. Their rates are significantly lower than other private practice offices. You are not compromising quality, however! The Associates are working on their licenses so they are in learning mode at all times and this translates to great care for you. Our neighboring therapy offices, for example, charge between $180 and $250 for a 50-minute session. The Associates at CLCC offer quality care for only $100 per meeting, and all Associates are under the direct weekly supervision of Dr. Cearfoss, who has 25 years of experience in the world of mental health.

3. Find a therapist that is affordable to you. Therapy prices range dramatically given location, length of time in practice and specialties practiced. If someone is out of your price range call around until you find what is affordable to you. Starting rates for a 50-minute session can go as low as $90 and some agencies will even offer a pro-bono slot or two for clients. CLCC is not currently in the position to offer pro-bono services but our rates are some of the most competitive around.

1. So there is no fear of insurance auditing your chart.

2. There is no chance insurance will claim their payments back and you will be billed at a later date. In other words, no surprises.

3. Confidentiality and privacy. Paying for your services independently leaves your therapy in your hands. You decide the frequency and the end of your process. You can also receive the type of therapy best suited to you!

4. You don’t need to have a mental health diagnosis. Insurance requires one. If you pay cash for services you don’t get a diagnosis.