Frequently Asked Questions (FAQs) About Insurance vs. Cash Pay for Therapy

As of the beginning of 2025, the Founder, Owner, and Lead Therapist of Conversations Therapy will be accepting some insurance plans. The preference for our practice is still direct pay patients and providing a superbill for possible out-of-network benefits. If you plan to utilize insurance, it will need to be verified prior to the first appointment. You will then be notified of what your coverage is. A list of accepted insurances will be added to this page of the website. Stay tuned for updates.

This is a complex, yet straightforward, subject. Many private practice therapist (and physicians) no longer accept insurance, and here are some of the key reasons.

• Privacy & Confidentiality: Although the Health Insurance Portability and Accountability Act (HIPAA) of 1996 protects much of a person's Protected Health Information (PHI) from being released without their specific permissions, insurance companies are usually outside of these guidelines. They have very specific requirements for documentation from providers and can request to review treatment plans, notes, and require a diagnosis for treatment to continue. This means individuals (non-clinicians) can have access to an individual's extremely personal information, as well as use it to determine whether or not that person is allowed to remain in therapy (despite the recommendation of the provider).
• Future Impact: While I am a firm and strong believer in dismantling the stigma and division between healthcare and mental healthcare, currently some of this information can be used in adverse ways in the lives of the people it is meant to serve. For example, when a young person later goes to acquire their own health insurance and already has a diagnosis listed in their history, it can be used to determine their future insurance premiums.
• Insurance Fraud: If I were to include an inaccurate diagnosis on paperwork submitted to an insurance company - for the sake of protecting my client(s) from the impact of these privacy issues or future impact possibilities - it would mean that I was essentially committing insurance fraud. The cost for this could be my professional licensure.
• Impact on the Therapist: The qualifications, training, and expertise of any provider is not a consideration for insurance companies when determining their negotiated reimbursements. While most individuals stay long-term in careers striving for advancement through promotions and salary increases, insurance companies have consistently lowered their reimbursement rates for providers annually. This has pushed many therapists (and professional providers from numerous backgrounds) to discontinue accepting insurance in order to maintain a salary level that competes with the escalating cost of living. Can you imagine working harder every year, gaining expertise and knowledge, only to be told that your salary was being decreased by an estimated 8-10% annually?
• Administrative Impact: In addition to losing income through the decreasing reimbursement rates, there has been a significant increase in the required documentation that must accompany insurance submissions. A therapist can easily anticipate between 30-45 minutes of paperwork for each client's session to be ready for submission to an insurance company. Even with this, claims can be rejected and returned for many reasons. Additionally, a therapist can receive their agreed upon compensation only to have that claim denied months later and restitution made to the insurance company. 
• Others Who Explain It Well: There is an article that was published recently through ProPublica, in combination with NPR, that explains well what it's like for solo therapists to accept insurance these days. It's definitely worth taking a look at, especially before you rule out Conversations Therapy as a viable candidate for your provider: https://projects.propublica.org/why-i-left-the-network/

If you choose will not be using insurance, Conversations, is happy to provide you a monthly statement (a "superbill") of your payments that can be provided to your insurance company for reimbursement of "out-of-network" benefits. If you have a deductible to meet before your benefits become effective for therapy, you can also utilize this superbillto keep your insurance apprised of how much you have paid out-of-pocket. 

For cash pay clients, any reimbursement you receive from your insurance provider will be less than what your full coverage would be, but it is a recuperation of a portion of your investment in therapy. Not all insurance companies offer this out-of-network coverage, so it is important to inquire about your benefits ahead of time, if you plan on using this method. 

Insurance companies also require a diagnosis on the superbill, so be sure to discuss this with both your insurance company and therapist. Additionally, some insurance companies will only pay out this reimbursement to the therapist. Conversations is happy to let them pay the check to us, so that we can then sign it over to you. (Please let us know if this is the case, so that we can be watching for your reimbursement in our mailbox.)