Private Pay Therapy for Increasing Access

At Diverge Community Services, accessibility isn’t just a value we talk about, it shapes how we run our practice. We know that therapy can feel out of reach, especially for neurodivergent individuals and families navigating complex systems. We have committed ourselves to offering accessible therapy by thoroughly exploring many avenues of payment for services. Knowing that private pay is not always a realistic option for some of the most in need, we believed accepting insurance would greatly increase affordability for our clients without compromising on the quality of our care. The reality has proven to be much more complex.

When a provider decides to accept insurance, they must apply to be contracted with them. When the provider contracts with an insurance company, they agree to that insurer’s terms and reimbursement rates, often pegged to a percentage of Medicare or market averages. Once under contract, providers are obligated to bill the insurer for any client who holds that plan. That means both the provider and the client lose the option to bypass insurance and pay privately, even if it might make more sense financially or clinically. Suddenly, covered services are inaccessible. Let’s break down this accessibility issue further.

1. Insurance Sets Red Tape

Insurers, not clients or providers, hold the power in determining coverage. They decide which diagnoses qualify, how long services are approved, where therapy can take place, and even how progress should be measured. These rules are inconsistent across plans and often conflict with clinical best practices. Clients who want greater autonomy over their care may want the choice to pay privately to avoid these restrictions.

2. Insurance Requires Deductibles

A deductible is the annual fee that has to be paid before insurance will cover services. Some basic preventative services bypass this, but most therapies do not and require you to pay for the service. If you have a low deductible, say $500/year or less, you’ll likely meet that deductible pretty quickly through co-pays and other routine medical care. Once the deductible is met, services will often be covered…at least partially and for a specific period of time. To have a low deductible, however, means you have to pay a higher monthly premium. Most folks will have a sizable deductible (**thousands of dollars**) unless they have excellent health insurance that is subsidized through their employer or elect to pay high monthly rates. In summary, unless you have a low deductible or are super lucky and have a policy that doesn’t require deductibles to be met before therapy is covered, you’ll be responsible to pay for your services at the insurance rate.

3. Contracted Rates vs. Private Pay Rates

Providers typically charge higher rates to insurance than their private pay rates for two primary reasons. One, insurers usually negotiate and pay a discounted percentage of the rate charged. For example…the provider bills $200 and insurance pays $90. Two, billing insurance is costly in expense and effort, often requiring a designated biller (if not an entire team or department). If providers were to bill private pay and insurers the same rates, they would either have inflated, inaccessible private pay rates or unsustainably low reimbursement from insurance. Recall from above: Once under contract, providers are obligated to bill the insurer for any client who holds that plan.

This creates a strange paradox: clients with insurance may end up paying more if their deductible hasn’t been met than they would if the provider simply charged their private pay rate.

Insurance can and does play an important role in healthcare. But when it comes to therapy, “in-network” doesn’t always mean “accessible.” High-quality therapy is costly to provide, and insurance reimbursement rates are at historic lows. Services become inaccessible if providers can’t afford to provide them. By remaining outside of insurance contracts, providers can offer transparent, consistent, private pay rates to all clients and design their own models—like sliding scale fees or pro bono sessions—to protect access for those who need it most.

While Diverge is still contracted with several insurers at the time of this writing (fall 2025), we are frequently reevaluating our best avenue towards truly accessible services.

Rachel Robertson, OTRL

Co-Founder of Diverge