Written by: Claire Marino MHC-LP & Sarah Nunes LCSW

More and more, therapists and providers are making the shift toward not accepting insurance. This has sparked a nuanced discussion in the field of mental health, highlighting points about access to quality of care, equity, insurance reimbursement, sustainability, and medical debt.

At Brick City Therapy, we recognize that insurance can play an important role in helping many people access mental health services. At the same time, we’ve intentionally chosen a private-pay model that aligns with our approach to individualized, relationship-centered therapy.

We believe it’s important to be transparent about why we’ve made this choice, what it means for the care we provide, and what potential benefits a self-pay model may offer. Our intention isn’t to suggest that one approach to therapy is right for everyone, but to help you understand our philosophy and make an informed decision about the kind of care that best meets your needs.

In order to bill insurance, clinicals need to document a qualifying mental health diagnosis that supports the medical necessity of clinical treatment. While diagnoses can be helpful in understanding symptoms or help inform the direction of therapy, it often doesn’t capture the full complexity of a person’s lived experience.

Life is messy. Relationships are complicated.Here we believe that you are more than a collection of symptoms or diagnostic labels.Your experience has context. Care that is focused on reducing symptoms of a diagnosis can lead to a medicalized, surface-level approach to therapy, leaving you feeling unseen and misunderstood. Often these diagnoses follow a person for life and we are aware of the stigma that may create and how this may impact certain careers and security clearances.

Insurance can make it extremely difficult for clients to know what’s what. I’m sure you have had the experience where you visited a doctor’s office and expected insurance to cover the appointment but in actuality you received a large bill that you weren’t expectating. Deductibles, copayments, coinsurance, and coverage decisions complicate the process. At Brick City Therapy, we value transparency which is why you know what our fees and policies are up front.

The length and frequency of therapy should reflect your needs, goals, and what’s happening in your life, not an arbitrary schedule. Insurance companies (people who have no clinical background or training) dictate how often sessions occur and for how long, often pushing clinicians to terminate care prematurely. What this looks like in practice, if you are in crisis and need to come in twice a week for a period of time

Healing takes time and is rarely linear. Many clients want to take therapy at their own pace and adjust session frequency as life unfolds. Whether coping with grief, job loss, family crises, or just a tough week, we know you appreciate the ability to schedule additional sessions (e.g. twice in one week), which is something that insurance often restricts.

For clients exploring longstanding relationship patterns, processing trauma, or developing a deeper understanding of themselves, therapy may involve layers of work that unfold over time. We believe these decisions deserve thoughtful consideration and ongoing conversation between the client and therapist.

We don’t believe therapy should continue indefinitely, nor do we believe progress must happen within a predetermined number of sessions. Our goal is to work collaboratively toward the change you want to see happen, regularly evaluate progress, and adjust the approach as your needs evolve.

We’ve intentionally chosen a practice model that supports individualized clinical care and the flexibility to meet you where you are starting. We believe therapy isn’t a one-size-fits all process. Each person brings their own unique history, experiences, pain, and goals to work on. Our private-pay model reflects our commitment to providing specialized relational-centered care. It allows us to structure our entire practice around the approach we believe best serves you.

We believe meaningful therapy requires more than just time your therapist spends in session. It requires specialized knowledge, ongoing learning, clinical curiosity, and a willingness to look beyond the surface. Our practice aligns with the philosophy of scholar clinicians, we invest in specialized training, ongoing consultation because we care about the work.

We also value consultation and continued professional development as essential parts of responsible clinical practice. Thoughtful collaboration helps clinicians reflect on their work, consider different perspectives, and remain intentional about therapy.

Your privacy is an important part of therapy. We want you to understand how your information is being handled and who may have access to it. I’m sure you have seen the recent news about Headway (who is owned by a parent company of Blue Cross Blue Shield) attempting to get therapists to sign away their image, likeness of their voice, and the ability to snoop on your sessions for their profit and goodness knows what else (although we have some theories). Insurance companies require therapists to share client information, including diagnoses and progress notes, directly with administrators. This sensitive information gets stored in insurance company databases, making them a target for data breaches and hacking. When you choose self-pay therapy, your information stays securely between you and your therapist.

Here at Brick City Therapy we take your confidentiality seriously. We aren’t going to play games with your confidential information like Headway might. We are a relationally and trauma focused practice and know that coming to do this work needs a softer and safer place for you to land. If you want to learn more about all drama with Headway, check out a dear friend and colleague’s (Jessica Good) take on all of this. You can find out more here.

Running an insurance-based practice often involves significant administrative work, from submitting claims and navigating denials to managing authorizations and communicating with insurance companies. While these processes are part of how many practices operate, they also require time and attention outside the therapy room.

At Brick City Therapy, we’ve chosen a private-pay model that allows us to devote more of our professional energy to the work we believe matters most: providing thoughtful, informed, and intentional care.

Although Brick City Therapy is a private-pay practice and does not bill insurance directly, we can provide superbills for clients who wish to seek potential out-of-network reimbursement through their insurance plans.

A superbill is an itemized document that includes information about your therapy sessions, such as the dates of service, fees paid, provider information, and applicable diagnosis and billing codes. Unlike a traditional insurance claim, a superbill is provided to you so that you can submit it to your insurance company for consideration of reimbursement.

If your insurance plan includes out-of-network mental health benefits, you may be eligible to receive reimbursement for a portion of your therapy costs. You would pay Brick City Therapy directly for your sessions and then submit your superbill to your insurance company according to its requirements.

Reimbursement depends on your individual plan, deductible, coinsurance, and out-of-network benefits. Submitting a superbill does not guarantee that your insurance company will reimburse you.

We encourage you to contact your insurance company before beginning therapy to ask about your out-of-network mental health benefits. You may want to ask:

• Do I have out-of-network outpatient mental health benefits?
• Have I met my out-of-network deductible?
• What percentage of the allowed amount will my plan reimburse?
• Is a mental health diagnosis required for reimbursement?
• Are there any session limits or other requirements?
• How do I submit a superbill, and what documentation is needed?

It’s also important to understand that superbills may contain sensitive information, including diagnostic and billing codes. Submitting one to your insurance company means sharing that information with the insurer as part of its review.

At Brick City Therapy, we want you to have the information you need to make an informed decision about your care and its financial implications. We’re happy to explain how superbills work so you can explore whether out-of-network reimbursement is an option for you.

If you want to learn more about us connect with us at [email protected]