6 Reasons to Consider Private Pay Therapy

(Low on time or attention? Skip to the TLDR at the bottom! 💚)

The world is scary right now, and the need for quality mental health support is at an all-time high. But sometimes, it can be daunting to think about how you will find the support you need in a way that fits your life. Every cent matters, and it probably never feels like you have enough money to relax. So why on earth would you choose not to use an insurance benefit for therapy? Isn’t that like throwing money in the trash? 

Not at all! In fact, there are many reasons why my clients choose private-pay over insurance- particularly right now! Allow me to explain: 

1. Privacy and Confidentiality

It’s 2025, and information protection is a top priority for many people. Surrounded by companies that monetize data and macro systems that threaten based on differences, it is important to have someone you can trust when you bare your emotions.

However, many people don't realize that whoever is paying for the service has access to therapy documentation (unless otherwise specifically stated). This means that your insurance company has access to all of your clinical documentation upon request. These are called "audits" and are used to decide whether or not to continue covering you for treatment (another issue! See below). This means you have far less control over who and what has access to your confidential health information.

Therefore, the first benefit of choosing a private pay therapist is: I don’t have to share notes or diagnoses with anyone without your expressed consent! It’s your information; you should get to choose who sees it!

2. No Diagnosis Required

Did you know that insurance coverage requires a diagnosis? It’s true! 

Without a diagnosis in the first session, insurance will not pay for your treatment- full stop. It doesn’t matter if you’re just looking for some support for a specific issue, are doing preventative mental health maintenance, or have a complex presentation that requires more assessment. Insurance companies force us to prove that you’re “sick” enough for treatment. 

And it gets better! //sarcasm

We must prove that you’re “sick” in a way that fits into the Western Medical Model of Mental Illness. This means that your provider has to give you a diagnosis of mental illness out of the DSM-5-TR and ICD-10 (as of the publication of this post), or you won’t be covered. I bet you didn’t even know there are multiple diagnostic manuals and non-westernized ways of thinking about mental health! (That’s on purpose and enough for a whole other blog post.)

Anyway, this presents an issue for anyone who doesn’t want to try to be the best representation of older, white, “neurotypical” European men that they can be. (And my personal opinion is that nobody should try! I guarantee whoever you are now is way more interesting!) 

Therefore, the second benefit of choosing a private pay therapist is: We can explore all intersections of your identity without compromise or pressure. You are not here to make yourself small and your treatment shouldn’t either. At Hannah Smith Counseling, I am committed to helping you find the biggest, most vibrant, most complex, most authentic version of yourself!

3. More Control Over Your Treatment

Are you seeing a theme starting to form? Well, here’s another place where insurance removes client autonomy!

You are the expert on yourself and your experiences, and you hire a therapist to be the expert on how to heal psychic wounds and facilitate movement toward the life you want. When insurance gets involved, they have the power over all parts of the process, from how long you get to remain in treatment to what kinds of treatment you can have- regardless of whether you or your provider agree. 

A great example of this: I am an autistic therapist who loves working with other autistic adults! However, one of the only “approved” treatments for Autism Spectrum Disorder is the widely-hated-by-autistics-treatment of Applied Behavior Analysis (ABA 🤮). This means that providers are incentivized to use treatments on timelines that don’t work and may even be harmful to clients. I refuse to do that and I don’t think you want that either!

Therefore, a third benefit of choosing a private pay therapist is: You and your provider are fully in control of your treatment- including longevity, frequency, and interventions! You hired me to focus on what works for you for as long as you want, not what a big company thinks you “should” do.  

4. Greater Access to Specialized Therapists

For the reasons outlined above and more, you've probably noticed that many of the providers you actually want to see are out of network. This is not to say that good therapists don't take insurance. Still, it is also true that the more specialized one becomes, the less likely they are to deal with the insurance monster. It sucks for you, AND it sucks for us! 

We choose our specialties because we love our work and our clients, not because of money and security. That's part of why so many specialists (myself included) choose not to take insurance: the financial risk of waiting for the perfect client fit is more important than a steady stream of "just alright" fits. I want to love working with people who love working with me—that's how we get phenomenal outcomes!

Therefore, a fourth benefit of choosing a private pay therapist is: Your perfect therapeutic fit isn’t limited to whoever is on your insurance directory. Therapy is an investment no matter what you do. Don’t waste time and money on someone who doesn’t understand you!

5. Transparent Pricing

Believe it or not, I do have experience taking insurance. Let me tell you about the worst part for me and probably for you. 

Weirdly, it is considered normal that insurance takes weeks (sometimes months!) to accept claims and reimburse therapists. By then, clients have had multiple sessions and already have a strong therapeutic bond. Only then to discover that their insurance denied their claims due to some obscure minutiae in their plan. 

I will tell you: one of the absolute worst feelings I have experienced as a therapist is realizing that my client is now stuck with a huge surprise bill that destroys our relationship of trust AND can no longer continue service with me. (This exact thing happened to me a few times even with a very talented insurance claims assistant. That’s how complex verifying coverage can be!)

And that doesn't even touch the common issue clients run into every January: deductibles must be met all over again. We often don't know your session cost until after your first session!

Therefore, a fifth benefit of choosing a private pay therapist is: What we agree sessions will cost is exactly what they will cost. Focus on your healing without surprises! You will never receive a surprise bill from Hannah Smith Counseling and I will never allow your balance to accrue without your knowledge and consent. You know your financial needs best and should always have timely information to manage them!

6. Long-Term Investment in Yourself

When the cost of everything is so high, paying more than you absolutely have to for only the most basic necessities can feel unthinkable. I get it; I am often the same way. When things feel scarce, it's difficult to remember why long-term investments are important—and may save you from even more costs in the future. 

The fact is that many people don’t invest in themselves, particularly if the need is not clearly “visible,” like a broken leg. All too often, mental health is a forgotten need until one finds themselves in crisis. Then you’re scraping around trying to find whatever therapist has availability the soonest, regardless of fit, just to find whatever relief you can get. You don’t have to wait until your relationships/ job/ health/ identity are in jeopardy to seek support. In fact, it’s often easier to see better results with fewer sessions when we’re not having to do a bunch of clean-up work!  

Therefore, a sixth benefit of choosing a private pay therapist is: It’s an opportunity to invest in your long-term health to save time and resources in the future! Stop paying ADHD tax sooner! Get support in advocating for accommodations for your Autism before you lose your job again! Don’t pay for an avoidable and costly divorce because you and your partner were just waiting for communication and sex to get better on their own. (Trust me, they won’t without work!)

Conclusion

If you've made it this far, let's acknowledge that self-pay is not an option for everyone. As I say to all my clients, "Time and finances are a thing," and we must work with reality. There is no "right" choice for everyone, only the right choice for YOU. So I will provide some structure to help you discern what you need.

Ask yourself: 

• Is it essential that my therapist understand me and my individual needs to provide customized care?

• Are my therapist’s personal identity and specializations important?

• Are the risks of unexpected bills unacceptable to me?

• Do I want complete autonomy and control over my treatment process and information?

• Am I willing and able to invest in myself and my health?

  
  

If you answered “yes” to any of these questions, private pay therapy may be right for you! There are many websites to seek specialized, private pay therapy- simply look up “therapists for (whatever identity or concern is important to you) near me”. I guarantee your perfect fit is out there and is trying hard to find you! 

And speaking of perfect fit, if you’re any mix of neurodivergent, queer, kinky, non-monogamous, complex person looking for support on your sex life, relationships, trauma, identity exploration, or anything else you might need- Come see me at HannahSmithCounseling.com!

I can’t wait to meet you and get started on your best life! 

TLDR: Reasons why you might choose a private-pay therapist

1. Privacy and Confidentiality: I don’t have to share notes or diagnoses with anyone without your expressed consent!

2. No Diagnosis Required: You're more complex than any diagnostic manual. We can explore all intersections of your identity without interference or pressure.

3. More Control Over Your Treatment: You and your provider fully control your treatment- including longevity, frequency, and interventions!

4. Greater Access to Specialized Therapists: Your perfect therapeutic fit isn’t limited to whoever is on your insurance directory.

5. Transparent Pricing: What we agree sessions will cost is exactly what they will cost. Focus on your healing without surprises!

6. Long-Term Investment in Yourself: You are worth it! Invest in your long-term health to save time and resources in the future!

If you want more information, get your free consultation at HannahSmithCounseling.com!