Insurance

Lack of confidentiality: A case manager and billing staff at the insurance company will be aware of your diagnosis and treatment plan; many mental health benefits are also contingent on periodic updates from your therapist; your therapy may become part of your permanent medical record.

Type of treatment: Treatment is crisis-oriented and required to be brief, focused and behavioral only; growth-oriented treatment is not covered.

Limited number of sessions: A case manager at the insurance company will decide how many sessions are covered; longer-term treatment is only allowed if it's "medically necessary" with a more serious diagnosis, and your mental health contract still determines the maximum number of sessions covered.

Possible denial of life insurance: Some life insurance policies have been denied to those using their mental health coverage, which is seen as a risk.

Initial low co-pay: Many mental health plans do offer a low co-pay; however, a large deductible may first need to be paid out-of-pocket and/or the co-pay may increase over time.

Private Pay

Complete confidentiality: Your case record is the property of the center; information would only be released if legally required or you gave your consent.

Type of treatment: Treatment can focus both on specific crises and on changing long-term patterns.

Unlimited number of sessions: You won't need to worry about being denied sessions; because treatment can be growth-oriented, there is no time limit.

Life insurance policies: No medical record will exist that could interfere in gaining other policies.

Payment: Many times, fees can be equal to a co-pay that increases over time; if a pre-tax account is used, you may even pay less than some co-pays (see below).

Medical expenses flex account/Cafeteria Plan: Some employers allow you to set aside annual pre-tax dollars to pay for medical expenses, which can reduce your costs for counseling even more; depending on your tax bracket, you could save approximately 25% of the cost of treatment; check with your employer to see if they offer such a plan, as many require sign up at the beginning of the year.