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Insurance vs Self-pay. What you need to know.

Having quality health benefits can save you a good chunk of change. However, often insurance can be confusing and ever-changing.

Some key points from a provider and consumer point of view:

-Meeting deductibles can cost more in the long run than paying the self-pay rate for services. Comparing your deductible amount with how frequently you would like to engage in services and the clinician's self-pay rate, can give you an idea of which is more cost-effective. Your clinician can give an estimate based on treatment recommendations following your initial session and presenting goals.

-Insurance audits- insurance can go back at any point and 'change their mind' about what they deem covered. This could mean you or your clinician, is responsible for paying back any money they initially paid if services are not deemed medically necessary or do not pass the audit. Talk about unexpected expense!

-New federal laws require clinicians going forward to provide a Good Faith Estimate for any self-pay client (this does not apply to those filing insurance). This estimate is a written amount per session and an estimate of how much you would spend throughout a period of treatment.

-Insurance companies store your treatment information (diagnosis, treatment duration, progress, etc) in a national database. This information can be requested in a variety of life changes for approval (i.e. applying for jobs, life insurance, impact insurance cost, etc).

-If you choose to self-pay, notes are kept by your clinician and are generally only shared if requested by the client or court-ordered by a judge. In this case, clinicians have more flexibility in the best interests of the client.

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