One of the first questions people ask when they contact Heal.online is whether we take their insurance. It is a completely reasonable question. Counseling is an investment, and most of us have been trained to assume that health care runs through an insurance card. So when the answer is no, it can feel like a door closing before the conversation has even started. We want to explain the reasoning behind that decision plainly, because it was not made to keep anyone out. It was made to protect the kind of care we believe our clients deserve.
How Insurance Actually Pays for Therapy
Most people never see the mechanics of an insurance-billed therapy session, so it helps to walk through them. For an insurer to reimburse a session, the therapist must submit a formal mental health diagnosis, a diagnostic code that justifies the treatment as medically necessary. That diagnosis becomes part of the client’s health record with the insurer. The insurer may then review treatment plans, request progress notes, limit the number of sessions it will cover, or decide that continued treatment is no longer necessary, regardless of what the client and therapist believe.
Federal privacy law permits this. Under HIPAA, health information can be shared for payment purposes without a separate signed authorization from the patient, which is what allows insurers to see the diagnostic and treatment details they need to process a claim (U.S. Department of Health and Human Services, n.d.). But many people beginning counseling have never been told that using insurance means a third party gains a measure of access to, and influence over, their care.
Why So Many Therapists Have Stepped Out of Networks
Anyone who has tried to find an in-network counselor knows how difficult it can be. That experience is not imaginary. Researchers Tara Bishop, Matthew Press, Salomeh Keyhani, and Harold Pincus examined national data on physician practices and found that psychiatrists accepted private insurance at markedly lower rates than physicians in other specialties (Bishop, Press, Keyhani, & Pincus, 2014). An actuarial analysis by Milliman found a similar pattern on the patient side: behavioral health office visits were far more likely to take place out of network than primary care or medical specialty visits, and reimbursement rates for behavioral health providers lagged behind those for comparable medical care (Melek, Davenport, & Gray, 2019).
Low reimbursement and administrative burden have pushed many experienced clinicians toward private-pay practice. Heal.online made that same choice for specific reasons.
What Private Pay Allows Us to Protect
Client privacy. Without an insurance claim, no diagnosis has to be submitted to a third party simply so that a session can be paid for. The clinical record stays between client and therapist, governed by professional confidentiality and the limits of law that apply to every licensed clinician.
The treatment plan. The length of counseling, how often sessions occur, and what the work focuses on are decided by the client and therapist, not by a reviewer who has never met the client. Some clients need six sessions. Some need a year. Neither should be cut short or stretched to fit a policy.
Room for the whole person. Insurance reimburses the treatment of a diagnosable disorder. But many people come to us with struggles that matter deeply without fitting neatly into a diagnostic category: a marriage that has grown distant, a crisis of faith, grief that has lingered, a season of spiritual dryness. Private pay allows us to address what each person is actually carrying, including the spiritual dimension, without needing to frame it as a disorder first.
What This Means for a Family Budget
We do not want to minimize the cost question. Paying out of pocket is a real financial commitment, and it deserves careful thought. Our current self-pay session fee is $175 for pay as you go or a subscription of 4 sessions billed at $600, and sessions run 50-60 minutes. When clinically indicated, we also allow 30 minute extensions or sessions, billed at half of the rate that applies (as you go or subscription).
Clients whose plans include out-of-network benefits may be able to request partial reimbursement on their own. 4KIDS is happy to provide superbills or statements on request. Submitting for reimbursement does mean a diagnosis will be shared with the insurer, so the privacy trade-off is worth weighing first. Many clients are also able to use a health savings account (HSA) or flexible spending account (FSA) for counseling, which plan administrators can confirm.
It can also help to compare the cost of counseling against what a person is already paying for the problem itself, in lost sleep, strained relationships, missed work, or simply carrying something heavy alone for too long. Counseling is rarely the cheapest option in the short term, but it is often among the most valuable in the longer term.
Counting the Cost Wisely
Jesus spoke directly about the wisdom of weighing a commitment before making it: “Suppose one of you wants to build a tower. Won’t you first sit down and estimate the cost to see if you have enough money to complete it?” (Luke 14:28, NIV). That is exactly what we encourage. Looking at the fee honestly, praying about it, and talking it through with a spouse or family members who share the budget all make for a wiser decision. We would rather people start well informed than start and then stop because the commitment was never realistic.
Thoughtful planning, rather than a rushed decision in either direction, tends to produce the best outcome. And Jesus’s observation that “where your treasure is, there your heart will be also” (Matthew 6:21, NIV) is a gentle reminder that what we invest in reflects what we value. Investing in personal healing, or the healing of a marriage or family, is not selfish. It is stewardship our souls and relationships.
Common Questions About Paying for Counseling at Heal.online
Does Heal.online ever bill insurance directly? No. Heal.online operates as a private-pay practice. We are happy to provide superbills or statements on request.
Is private-pay therapy less regulated than in-network therapy? No. Every Heal.online therapist holds an active clinical license and is bound by the same professional, ethical, and legal standards as any licensed clinician, whether or not insurance is involved.
What if someone simply cannot afford counseling right now? We want to hear about it. Please reach out to us at info@heal.online. If we are not the right fit financially, we would rather help a person find low-cost care elsewhere than have them go without support. In a crisis, no one should wait on a financial decision; call or text 988 or call 911 right away.
Does paying privately mean there is no record of counseling? Heal.online therapists keep a clinical record, as every licensed clinician is required to do. What private pay avoids is sending a diagnosis and treatment details to an insurance company as a condition of payment.
A Closing Word
Choosing not to take insurance was not a business shortcut for us. It was a decision about what kind of care we want to offer: private, unhurried, shaped around each client rather than around a claim form, and free to include faith as fully as the client wants it included. For anyone whose main hesitation is cost, we would still be glad to talk it through honestly and help them decide what is wise for their situation.
Tim Putman, LMHC-QS, MAMFC, MARE
Scripture quotations taken from The Holy Bible, New International Version®, NIV®. Copyright © 1973, 1978, 1984, 2011 by Biblica, Inc.™ Used by permission. All rights reserved worldwide.
Sources cited:
Bishop, T. F., Press, M. J., Keyhani, S., & Pincus, H. A. (2014). Acceptance of insurance by psychiatrists and the implications for access to mental health care. JAMA Psychiatry.
Melek, S., Davenport, S., & Gray, T. J. (2019). Addiction and Mental Health vs. Physical Health: Widening Disparities in Network Use and Provider Reimbursement. Milliman.
U.S. Department of Health and Human Services. (n.d.). Uses and Disclosures for Treatment, Payment, and Health Care Operations.
