The Pillars of Private Pay

As both a traditional and specialty clinician, I choose to work from a private-pay model, as opposed to an insurance-pay model, to allow my patients the most consistent, thorough, and flexible care for their needs – be that to work on a specific challenge, manage an on-going diagnosis, or improve related regulatory skills. 

Naturally, I find myself working closely with private educational institutions like Brightmont Academy. Just as private educational settings can afford for greater customization of the learning experience by focusing on the specific needs of the individual student, it is also the case that therapists like myself, who elect to work exclusively from a private-pay model, have a greater capacity to provide specialized, tailored care to their clients. I intentionally carry a smaller caseload to be able to offer a flexible, accommodating schedule and thorough, present care both in-session and between-sessions.

I was inspired to write this article after reading about the potential wave of public-school closures here in the valley, where collective enrollment has declined by thousands over the last decade. Being a clinician who often works closely with school providers to support my pediatric and adolescent patients, this revelation shocked me. 

We all understand implicitly that public and private investment decisions are challenging and schools operating in this environment are often left spreading funds, staff, and resources far too thin. At a minimum, these dynamics increase teacher and administrator stress and creates uncertainty for students and families, particularly those who count on school resources for continuity of care. At a maximum, the quality of care and instruction suffer which disproportionately impacts those students who rely on services beyond classroom instruction. 

The parallel between a family’s decision to invest in a private education and private-pay therapy services became clear. It has become increasingly challenging to find a therapist in the valley that will accept health insurance, is open to seeing pediatric patients, and does not have a long wait list. When it comes to children, given the rigidity of the academic calendar, often the consequence of waiting multiple months to begin care is simply unacceptable. 

There is no beating around the bush—paying out of pocket for therapy (in addition to what seems like literally everything else these days as well) can be expensive, particularly in relation to the apparent alternative of next-to-nothing  when insurance covers the tab. It may look that way in theory, but speaking for myself and several of my peers who have opted for the private pay route I assure you we did so with intentionality – we take the quality of our care seriously.

The quality of care a provider can offer with an intentionally smaller and more focused caseload has intentional parallels to the tenets expressed in Brightmont’s own 2021 student and parent experience survey: greater success, more confidence, and better engagement.

Greater Success 

Insurance-reimbursement policies enforce a strict cookie-cutter structured approach to treatment and seeks to promote standardization of treatment across patients and sessions. Could you imagine if we providers treated every patient, condition, or need the same? This is a business-problem tail wagging the human-problem dog. One-size-fit-all does not work. The administrative, diagnostic, and practical constraints inhibit providers and patients from making progress together. By electing to remove the third-party business from our equation, your therapeutic team is freer to operate however will be most helpful for you  and your  concerns. This includes, but is not limited to, what can be discussed in session, how often sessions are held, total sessions available to you, and what goals are set at which cadence. With the support of your therapist, you are in control of your care, not a claims adjuster who does not know you.

More Confidence

Often insurance providers limit patients to a certain number of sessions and control the allocation within certain timeline outlined to them in data tables of “averages.” Wildly enough, insurance can even decide to pay or not pay for a session that occurred, based off their interpretation of content recorded in your therapists required clinical note (did I mention they have complete access to notes, diagnoses, and all clinical information?). Session limits, unreliable coverage, and open exposure to your information, are just a few of the common impediments to a productive therapist-patient relationship focused on your goals. Safety and trust within the therapeutic setting and ease of accessing that care are top priorities of mine, though both are at jeopardy when your care is quantified, qualified, and opined on by someone who isn’t the patient, the parent, or the provider. 

Better Engagement

Speaking from experience, patients see greater success with therapeutic services when care is easy to access, predictable, and reliable to them -–a safe and productive environment. For the provider, disintermediating insurance means more time for the patient pre-appointment and post-appointment as well as the ability to carry a smaller, more focused case load. That means more flexible scheduling around your needs, more of that provider’s mindshare in each day, and more time for the provider to prepare for and reflect on the patient’s needs between sessions. The provider and the patient more seamlessly establish respect and trust and more quickly and accurately get on a path to progress. 

These are important attributes of my practice philosophy, and it is the congruency of these beliefs with what Brightmont Academy promotes that attracted me as to them as a partner - an educational institution with an acute focus on high-quality education and the creation of individualizable success for its students. By reducing third-party stressors, Brightmont Academy and my own therapy practice each have a greater capacity to support our students and patients through the challenging experiences of childhood and adolescence.