To bill insurance, a therapist has to give you a diagnosis, attach it to a treatment plan, and prove, on paper, to someone who's never met you, that your symptoms are severe enough to require ongoing care. That model works for some things. It isn't built for what we actually do here.
Every session has to be justified by "medical necessity," which means the system is set up to keep you sick enough to stay covered, not to help you get somewhere where therapy is about growth instead of crisis management. The diagnosis itself becomes a permanent part of your claims record. It doesn't expire, and it doesn't stay as private as you'd think; it can resurface in life insurance applications, custody proceedings, certain security clearances, occasionally professional licensing questions, depending on your field.
And at any point, an insurance company can audit your file, meaning a reviewer who's never sat across from you can request notes about what we've actually talked about and decide whether you still "qualify" for care. None of that has anything to do with whether the work is helping.
Working privately means the two of us decide what this looks like, not a claims adjuster. We're not constrained to whichever diagnosis fits a billing code, or a treatment plan written to satisfy a reviewer instead of reflecting what's actually going on with you. We can take the time we need to build trust before going near the harder material. We can keep going after your symptoms technically "resolve," because the deeper attachment and relational work is often just getting started at that point.
And what we talk about stays between us: no claims file, no third-party review, no record that outlives whatever it was created for. It also means continuity. If you change jobs, your insurance changes, or your plan drops out of network, none of that has to interrupt the work, because the work was never tied to a network to begin with.
Insurance companies typically only reimburse sessions up to 45 to 53 minutes, regardless of where you are in the work that day. In my experience, that's often right around when things actually start to open up, around the 30 to 45 minute mark, just as something real is getting going. I offer 60-minute, 90-minute, and two-hour sessions, so we're not stopping right when it starts to matter.
If you're able to invest in this directly, private pay generally means faster access, more flexibility in how we work, and a relationship that isn't shaped around what an insurer will or won't approve. I provide superbills for clients who want to seek out-of-network reimbursement through their own insurance, on their own terms, without it shaping the treatment itself.
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