Private Pay vs. Insurance — What You Should Know

If you’ve ever tried to start therapy and felt overwhelmed by all the “private pay” vs. “insurance” talk, you’re not alone. It can feel like one more confusing step when you’re already dealing with enough. This post will break it down—no jargon, no guilt—just the information you actually need to make the best choice for your healing journey.

1. What is Private Pay?

Private pay simply means you pay your therapist directly—without going through insurance.

Pros:

• Freedom to choose the therapist that fits you best (not just the ones in-network).

• No diagnosis required for insurance approval.

• You decide how often you meet—no insurance company telling you what’s “medically necessary.”

• Your records stay private between you and your therapist.

Cons:

• You cover the full cost yourself.

• Can feel like a big investment upfront.

2. What is Insurance-Covered Therapy?

Insurance-covered therapy means your sessions are billed to your insurance provider.

Pros:

• Lower out-of-pocket cost (sometimes just a copay).

• More accessible financially for some people.

Cons:

• Must receive a mental health diagnosis to qualify for coverage.

• Insurance decides how many sessions you “need.”

• Limits on types of therapy or providers you can see.

• Your diagnosis and some treatment notes become part of your medical record.

3. Questions to Ask Yourself Before Deciding

• Do I want complete privacy with my therapy records?

• Am I okay with having a mental health diagnosis on my insurance file?

• Is the therapist I want to see in-network?

• Can I afford private pay, or do I need insurance coverage to make therapy possible?

4. A Middle-Ground Option: Superbills

Some therapists (including me) offer superbills—itemized receipts you can submit to your insurance for possible reimbursement. This gives you more choice in who you see while still using your benefits in a flexible way.

5. My Take as a Therapist

Your healing is too important to be dictated by a billing system. I’ve seen clients thrive with both private pay and insurance-covered therapy—it all comes down to what helps you feel supported, safe, and in control of your healing process.

If you’re considering therapy and unsure which route is best, let’s talk about your options.