07/22/2025
💡Why Some Clients Choose to Pay Out of Pocket for Therapy
I often get asked why some clients opt not to use insurance when coming to therapy. This post, written by my colleague, Alicia Rippy at Wild Strength Therapy, does a fantastic job breaking down the reasons in a clear and compassionate way.
With her permission, I'm sharing my shortened version of it here because it might answer questions you've had about how therapy works—and help you decide what’s best for you. If this resonates and you're thinking about starting or returning to therapy, I’d love to connect.
Message me or go to my website www.dsrcounseling.com to schedule a session or learn more about what working together could look like. Here's the post:
A Guide for Therapy Clients Navigating Insurance
Did you know that in order to use insurance for mental health services, you must receive a formal diagnosis from a licensed provider such as a therapist, counselor, psychologist, psychiatrist, or physician? This requirement exists because insurance companies need to establish that treatment is medically necessary in order to approve and reimburse claims.
However, it’s important to recognize that not everyone who seeks therapy meets the criteria for a clinical diagnosis. Many individuals benefit from therapy simply by having a supportive, nonjudgmental space to explore their thoughts, process experiences, and co-regulate emotionally—regardless of whether their situation constitutes a mental health disorder under diagnostic guidelines.
The Complexities of Insurance
Mental health diagnosis can be nuanced and complex. I often use the CPT (Current Procedural Terminology) code for “Adjustment Disorder” when working with clients navigating life transitions or stressors that don’t meet the threshold for a more severe diagnosis. This code allows us to meet insurance criteria while still honoring the client's lived experience.
That said, an Adjustment Disorder diagnosis is only valid for up to six months. After that, insurance companies typically require a reassessment and, in many cases, a more "serious" diagnosis to continue coverage. This puts clinicians in a difficult position—balancing ethical care and confidentiality with the rigid standards of insurance providers.
I made the decision to step away from direct insurance billing and adopt a private-pay model. This allows me to center my time, energy, and attention on providing high-quality, personalized care. For clients who still want to use their insurance, I now offer superbills.
What Is a Superbill?
A superbill is a detailed invoice that includes all the necessary information for a client to submit an out-of-network reimbursement claim to their insurance company. It typically includes:
Provider name and credentials
Client’s name and date of birth
Date and duration of sessions
Diagnosis code (ICD-10)
Procedure code (CPT)
Total session fee paid
Provider's NPI (National Provider Identifier) and tax ID
While submitting a superbill doesn't guarantee reimbursement, many clients receive partial refunds—especially if they have a PPO plan with out-of-network benefits.
Thanks to Alicia for the clear and empowering explanation. Regardless of how you ultimately pay for therapy, it's helpful to know what the options are so that you can step confidently into receiving the support you deserve, whether you pay fully out of pocket or are able to be partially reimbursed. And while I'm giving credit to those who support efforts to provide resources, credit for the cute graphic goes to Jen Stocksmith, whose talent I borrow on a frequent basis!
