What Is Private Pay Therapy, and Is It Worth It?

With private pay, you and your therapist agree on a session fee up front, and you pay it at each session, much like any other professional service. There's no insurance company in the middle, so there are no pre-authorizations or plan rules about how many sessions you can have.

Private pay doesn't always mean your insurance can't help. Many PPO plans include out-of-network mental health benefits. In that case your therapist can give you a superbill, an itemized receipt you submit to your insurer, and your plan may reimburse part of what you paid. Many people can also use HSA or FSA funds for therapy.

• Privacy: to pay for therapy, insurance companies usually need a mental health diagnosis on file, and that information becomes part of your insurance record. When you pay privately, what you share stays between you and your therapist, within the normal legal limits of confidentiality.
• Care shaped around you, not a plan: without plan rules on session length or number of sessions, you and your therapist decide together how often to meet and when you're ready to finish.
• Couples work: many plans only cover treatment for one person's diagnosed condition, so couples therapy is often not covered at all. Private pay lets couples come in for the relationship itself.

Private pay usually costs more out of pocket per session than an in-network copay, at least until any out-of-network reimbursement comes back. Reimbursement isn't guaranteed: it depends on your plan, your deductible and what your insurer decides.

If cost is the deciding factor for you right now, an in-network therapist, a community clinic or a sliding-scale practice may be a better fit, and that's a completely valid choice. The best therapy is the one you can keep going to.

Call the member services number on your insurance card and ask:

• Do I have out-of-network mental health benefits?
• What's my out-of-network deductible, and how much of it have I met?
• What percentage do you reimburse for outpatient therapy?
• Do you accept superbills, and how do I submit one?

Couples sessions are $350 and individual sessions are $175, both private pay and held online for clients anywhere in North Carolina. A superbill is available on request if you'd like to check out-of-network reimbursement with your insurer.

Whatever practice you're considering, ask for its session fee, cancellation policy and payment methods. Under the No Surprises Act, if you're not using insurance you also have the right to a Good Faith Estimate of expected costs. More answers are on our FAQ page.

It depends on what matters most to you. If privacy, flexibility and working with a specific therapist who fits your needs are high on your list, many people find private pay worth the investment. If budget is tight, it may make more sense to start with your in-network options.

Either way, one of the most important parts of therapy is the relationship with your therapist. A free consultation is a no-pressure way to ask about fees, superbills and scheduling, and to see whether working together feels right.