Why I Am a Self-Pay Practice

I do not contract with insurance companies. All services are self-pay.

I began my career in an insurance-based group practice, briefly contracted with two insurance panels in my early years of private practice, and have operated as a fully self-pay practice since 2018. That decision was not made lightly, and I want to be transparent about why.

1. Reimbursement rates do not reflect the actual cost of care.

The conversation around private-pay providers is often framed as therapists being unwilling to take insurance, but the more accurate picture is that insurance companies are unwilling to reimburse at rates that reflect the true cost of quality care. Reimbursement rates in our area fall significantly below the industry average. Beyond the financial reality, the administrative burden of contracting with insurance companies as a solo provider is substantial, including hour-long hold times, poor customer service, and having to justify to a non-clinical reviewer why your therapist believes you need continued care. Accepting insurance would mean diverting a significant portion of my time from clients to unpaid administrative work. That is not a trade-off I am willing to make.

2. Insurance requires a diagnosis, and that diagnosis follows you.

In order to bill your insurance, I am required to assign you a DSM-5 diagnosis and justify medical necessity at every visit. Not everyone who seeks mental health support meets the criteria for a clinical diagnosis, and this is especially true in the context of relationship and family therapy. Beyond that, a mental health diagnosis becomes part of your permanent medical record and can have implications for future employment, life insurance eligibility, or legal proceedings.

3. Your insurance company has the right to review your records.

Insurance companies employ reviewers, not always mental health clinicians, to audit treatment records and determine whether your care meets their definition of medical necessity, whether you have exceeded the number of sessions they deem appropriate for your diagnosis, or whether claims should be denied after sessions have already occurred. This process gives your insurance company access to the details of your treatment.

I believe you have the right to privacy and confidentiality, including from your insurance company. I believe you deserve the autonomy to move through the therapeutic process at a pace that is right for you, without an insurance company determining when that process should end.

As I do not contract (“In Network”) with any insurance companies, I am considered “Out of Network.” This means that your insurance company may still reimburse you a percentage of what you spend when you use an out-of-network provider. If your policy has these benefits, I can provide you with a Superbill or a specific receipt containing all the information you need to submit a claim with your insurance company. This process still requires you to receive a diagnosis.

Most insurances do not cover evaluations, but they may reimburse for some portions of them, such as the first and last appointments.

Family law services are not reimbursable by insurance.

Questions to ask your Insurance Provider:

​1. What are my “out-of-network, outpatient, mental health benefits” when seeing a Licensed Marriage & Family Therapist?

2. Do I need a referral from my primary care provider (PCP) to receive mental health services?

3. Do I have a deductible (amount you have to pay out of pocket before benefits kick in), coinsurance (a percentage you have to pay), or copay (typically a set fee per service type)?

4. Have I met my deductible this year? When does my deductible restart?

5. Does pre-authorization apply? (Meaning: does the insurance company have to approve the treatment before starting therapy?)

6. How do I file out-of-network claims?

Reduced rates are occasionally available based on financial need, current caseload, and the nature of the presenting concerns. If you are interested in inquiring about a reduced rate, please reach out directly before scheduling to confirm availability.

Health Savings Account (HSA) and Flexible Spending Account (FSA) funds may be used to pay for mental health services, allowing you to apply pre-tax income toward the cost of care. Itemized receipts are available upon request for all charges.

Please note that HSA and FSA funds are not appropriate for cancellation or no-show fees. You are encouraged to keep a non-HSA/FSA card on file for any fees of that nature.

Effective January 1, 2022, you have the right to receive a Good Faith Estimate (GFE) explaining the anticipated cost of your care before services begin. Transparency in billing has always been a priority at Vann Counseling & Consulting, and our fee schedule is available both on this website and as part of the onboarding process for all new clients.

Under the No Surprises Act, healthcare providers must provide uninsured clients and those not using their insurance with an estimate of expected costs for medical and mental health services. Please note that receiving a Good Faith Estimate does not alter any billing agreements you have already established with this practice.

Your rights under this law include:

• The right to receive a Good Faith Estimate for the total expected cost of any non-emergency services
• The right to dispute any bill that exceeds your Good Faith Estimate by $400 or more
• The right to retain a copy of your Good Faith Estimate for your records; a copy will be available in your client portal at any time

For questions or more information about the Good Faith Estimate and your rights under the No Surprises Act, visit www.cms.gov/nosurprises or call 1-800-985-3059.