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Psychiatric Self Pay vs. Insurance Coverage Advantage

There are three main advantages to psychiatric self-pay over health insurance coverage to pay for psychiatric evaluation, treatment and follow up. While many feel managed care reduces out of pocket expenses, this decision comes with a price. With so much variation between insurance companies including the types of policies they offer, it is not feasible to discuss all the differences between individual plans or work supplied group coverage. Today use of “networks,” “managed care,” or “HMO’s” may help cut costs for the patient as well as the insurance company; however, these types of policies typically place restrictions on who you can see, what you may pay “out of network,” as well as provide incentives to mental health providers to provide less treatment overall to their patients.

Insurance Plans Interfere with Process of Therapy

There is a growing trend among mental health professionals to provide services on a self-pay basis. The U.S. mental health system has serious coverage gaps, where psychiatric service is generally slated for limited payments and encounters. Very often group insurance plans require the patient to start with telephone-based counseling through an employee assistance program, or require first starting with a limited number of mental health practitioners including social workers or a family counselors, before authorizing an evaluation and treatment by a network or plan psychiatrist. Even if the plan allows partial payment for an out of network practitioner, the paperwork,  appeals for denied treatment, wait time for additional authorizations or restrictions to time or number of days, directly impact and interfere with the process of therapy and developing a therapeutic working bond.

Psychiatric Self Pay vs. Insurance Coverage

The Therapist Directory  categorizes the three main differences as  1.  Payment,   2.  Choice of Therapist,  3.  Choice of Length / Type of Treatment

Here are some of the other differences:

Privacy

  • Self Payment: Info strictly confidential; therapists unable to share information about treatment without prior patient written consent, except in cases of danger to self or others.
  • Insurance: Info required to justify treatment. Therapist must provide a diagnosis, treatment plan and progress notes. Info put in database where others may access it.

Choice

  • Self Payment: Freedom to pick a therapist, get a second opinion, or change therapists.
  • Insurance: Some plans limit choice of therapist, require treatment through a psychiatrist in their network, or provide no reimbursement for out-of-pocket care

Duration & Type of Treatment

  • Self Payment: Patients active participants in their care. Treatment sessions continue as long as necessary without interference or restriction.
  • Insurance: Plan determines session length, type of treatment, maximum dollar payout, or visit frequency

Atlanta Psychiatric Self Pay Treatment

Dr. Darvin Hege, a leading area self pay psychiatrist for over 30 years does not subscribe to insurance company restrictions or third party privacy invasions, but rather works with you to provide a successful mental health treatment plan that is unique to your needs. Call us today.