Fees &
Insurance
RTX is a private pay practice, meaning at this time we are an Out of Network provider for major medical insurance plans. However, upon request, we can provide you with documentation that you may submit to your insurance company. Depending upon the specifics of your policy, you may be partially reimbursed for some of the services we provide. It is important to know that because insurance requires information related to diagnoses and procedure codes, the "superbill" (as it is termed in the insurance world) will contain potentially sensitive information that will become part of your record with the insurance company.
To provide affordable care options in our community, we are in the credentialing process to accept Medicare, Medicaid, and Texas CHIPS.
When seeking therapy, one of the most important decisions you’ll make is how to pay for your sessions. While insurance is often the first option people consider, private pay (paying out of pocket) offers several unique benefits that might make it the better choice for your mental health journey. Understanding the differences between insurance-based therapy and private pay therapy can help you make an informed decision that aligns with your goals, privacy concerns, and long-term well-being.
Let’s explore why some therapists choose not to accept insurance, the key benefits of private pay for clients, how out-of-network reimbursement works, and financial options that can make therapy more accessible.
Why Some Providers Don’t Take Insurance
Many highly qualified therapists opt for a private pay model to offer clients the highest quality of care without the constraints imposed by insurance companies. Here’s why:
1. Flexibility in Treatment
Insurance companies require therapists to assign a DSM-5 mental health diagnosis for reimbursement. However, not all therapy clients seek treatment for a clinical disorder. Many individuals pursue therapy for personal growth, stress management, life transitions, or relationship counseling, which may not meet insurance criteria. For example, educational assessment, couples therapy, and career coaching are often not covered by insurance (due to lack of diagnosis), despite their immense benefits.
2. Greater Confidentiality & Privacy Protection
When you use insurance for therapy, your mental health diagnosis becomes part of your permanent medical record. This information could potentially impact future employment opportunities, security clearances, or life insurance rates. Private pay therapy ensures that your records remain confidential between you and your therapist, offering you full control over your personal information.
3. Short-Term Diagnoses & Insurance Limitations
Certain diagnoses, such as Adjustment Disorder (F43.2), are only valid for six months according to insurance regulations. This creates challenges for individuals who require long-term care but don’t meet the criteria for chronic mental health conditions. With private pay therapy, treatment duration is based on the client's needs rather than arbitrary timelines set by insurance providers.
4. Freedom from Insurance Restrictions
Insurance companies often dictate:
•The number of sessions covered per year
•The type of therapy modalities allowed
•The length of sessions
•The necessity of pre-authorization for ongoing treatment
Private pay therapy eliminates these restrictions, allowing therapists to design personalized treatment plans that best support client goals without interference.
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The Benefits of Private Pay Therapy for Clients
Although private pay therapy is an investment, it comes with a range of advantages that can significantly improve the quality and effectiveness of your mental health care.
1. Customized & Comprehensive Care
Private pay allows you to receive truly individualized therapy without the limitations of insurance. This means that you and your therapist can focus on what matters most to you, whether that’s overcoming anxiety, improving emotional intelligence, processing trauma, or enhancing personal growth. Therapists are also able to integrate multiple therapeutic approaches without being constrained by insurance guidelines.
2. No Diagnosis Required
If you don’t meet the criteria for a mental health disorder but still want support, private pay allows you to seek therapy without needing a formal diagnosis. Many times, parents seek privacy for their child's mental health services, and private pay affords them this right. Private pay is especially beneficial for high-functioning professionals, entrepreneurs, couples, and individuals working on self-improvement.
3. Increased Privacy & Security
Since no information is submitted to an insurance company, private pay therapy ensures that your records remain confidential. This is particularly crucial for executives, healthcare professionals, first responders, or individuals in high-profile careers who value discretion.
4. No Session Limits
Insurance-based therapy often limits the number of covered sessions per year. This can lead to rushed treatment or premature termination. With private pay, therapy is tailored to your pace and progress, ensuring lasting change and deeper healing.
5. Access to High-Quality Specialists
Many highly sought-after therapists operate on a private pay basis due to the extensive training and expertise they offer. This gives you access to top-tier professionals without being limited to providers in an insurance network.
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Utilizing Out-of-Network Benefits for Therapy
Even if your therapist doesn’t accept insurance, you may still be able to reduce your out-of-pocket costs using out-of-network benefits.
1. Submitting a Superbill for Reimbursement
A superbill is a detailed invoice that includes session details and diagnosis codes. Many PPO insurance plans offer partial reimbursement for out-of-network therapy. Many therapists also offer collaboration with companies (like Mentaya) where you can check your coverage and easily submit for reimbursements of services, rather than hassling with the insurance companies themselves. Check your policy to see if your plan provides coverage for mental health services outside its network.
2. Verifying Your Out-of-Network Coverage
Contact your insurance provider to ask:
•What percentage of out-of-network mental health services is covered?
•Is there a deductible you need to meet first?
•How do you submit a claim for reimbursement?
3. Seeking Guidance from Your Therapist
Many therapists are experienced in helping clients navigate the superbill submission process. At Rural Texas Psychoeducational Services, PLLC, we provide superbills upon request for easy reimbursement submission and guide clients in understanding how to maximize their insurance benefits.
Check your Out-Of-Network Benefits Today!
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Financing & Payment Plan Options
Therapy is an investment, but it should also be accessible. At Rural Texas Psychoeducational Services, PLLC, we offer various payment solutions to help clients prioritize their mental health:
1. Monthly Payment Plans
Some clients opt for structured payment plans that allow them to spread the cost of therapy over several months if they are purchasing larger packages like Therapy packages or Comprehensive Assessments.
2. HSA/FSA Accounts
Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) can often be used to cover therapy costs, providing a tax-advantaged way to pay for services.
3. Third-Party Financing
We partner with CareCredit to offer payment options for mental health services, making evaluations and therapy more budget-friendly.
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What to Expect When Choosing Private Pay Therapy
When opting for private pay therapy, you will sign an acknowledgment or opt-out form stating that you have chosen to pay out-of-pocket for services rather than using insurance. If you decide to submit a superbill for reimbursement, the process will be between you and your insurance provider. At Rural Texas Psychoeducational Services, PLLC, we ensure transparency by clearly outlining payment policies, providing documentation, and helping clients navigate their payment options.
Good Faith Estimates & No Surprises Act
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost. Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy/counseling services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
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Invest in Mental Health Today
Choosing private pay therapy is an investment into well-being, personal growth, and future success. With the flexibility to receive customized care, increased privacy, and access to expert therapists, private pay can be one of the best decisions you make for accessible mental health services.
If you’re ready to explore how therapy can support your journey toward greater emotional resilience, improved relationships, and personal fulfillment, we invite you to schedule a consultation at Rural Texas Psychoeducational Services, PLLC.
Mental health is worth prioritizing, and we’re here to help you every step of the way.