Private Pay Therapy and Social Justice Can Coexist
How private pay therapy can protect clients, clinicians, and quality of care
If you would have asked me six years ago what I thought about private pay therapists, I would've had a negative, judgmental opinion. At the time, I was stuck in the conditioned mindset that social work was about helping the “less fortunate,” and that therapists who saw clients for cash weren't truly “in it” for social change, they were in it for the money (as if that’s a bad thing). I might have even said that these therapists weren’t “really” practicing social work.
And now? Here I am. A private pay social work therapist charging an above average rate for my location. Unapologetically.
Before venturing into private practice, I simply didn’t understand the complexities of working with insurance. I also carried the ignorant belief that social workers shouldn’t prioritize financial gain (Thank God for deliverance from that limited thinking).
I once thought becoming paneled with insurance was simple, you apply, get approved, and bill them for sessions. Ha! If only it were that easy.
The truth is, insurance companies take control of the entire therapy process. They dictate how quickly you must diagnose a client, even when it’s clinically unethical to do so. They decide what treatment options are “appropriate” based on the diagnosis submitted, and if you step outside of their rules, you risk not being reimbursed for the services. Payments are unpredictable, you may have to wait months to get paid for services already rendered. And if they complete an audit a year later and question your work, they can evoke clawbacks and retract their past payments. The result? Your business becomes dependent on companies that have little regard for you as a clinician, your clients, or the care you’re providing.
Private pay is different. I charge a rate that allows me to maintain a sustainable caseload, so I’m not forced to overload my schedule just to make ends meet. I have time for professional development and the space to think deeply about complex cases. Clients can pay with cash or use their HSA or FSA accounts. Most importantly, the notes I keep are private between me and my client, no insurance company has access to their information. (A serious consideration when the Department of Health and Human Services is reportedly using insurance data to build an Autism database.)
This shift in thinking has humbled me. It’s one of the many times I’ve learned that what sounds good in theory doesn’t always match the lived experience of doing the work. On paper, in seems obvious: if you care about serving people with the greatest need, you should accept insurance to increase access to care. But there’s more nuance than that.
There are other ways to make therapy more accessible. Ways that don’t require engaging with a broken health insurance system.
