Why This Practice Is Private Pay First (and What That Actually Means for You)

When you start looking for a therapist, one of the first questions you probably ask is whether they take insurance. It’s a practical question, and a fair one, so hearing “private pay only” can feel like a dead end or a luxury you can’t justify. Destany’s practice is private pay first, with one meaningful exception, and understanding why can change how you think about the question entirely.

This isn’t about avoiding paperwork or maximizing income. It’s a structural decision about what happens in the room between you and your therapist, and who else gets a say in your care. If you’re weighing whether this practice is a fit for you, here’s what private pay actually means, how the one exception works, and how a superbill can help you recover some of that cost through your own out-of-network benefits.

Why We’re Private Pay First (And the One Exception: Sendero Health)

Many people ask why do therapists not take insurance at all, given how expensive care can be without it. The honest answer is that insurance panels come with strings attached: reduced reimbursement rates, required diagnosis codes, and utilization reviews that can shape treatment decisions from outside the room. Destany made a deliberate choice to stay off most insurance panels so those decisions stay between the two of you. The one exception is Sendero Health, a Texas plan she accepts in-network, so if that’s your coverage, insurance can be part of the conversation from the start.

Choosing to work outside most insurance networks isn’t about limiting who gets care, it’s about protecting what care looks like once you’re in it.

What “Private Pay” Actually Buys You: No Diagnosis Codes, No Session Caps, No Insurance Company in the Room

When an insurance company is billed for therapy, it usually requires a clinical diagnosis to justify the claim, even if what brought you in is more nuanced than a diagnosis (a life transition, a relationship strain, day-to-day anxiety that doesn’t rise to a disorder). Insurers can also cap the number of sessions they’ll cover or ask for progress updates to keep approving more. Private pay removes both. There’s no requirement to attach a permanent diagnosis to your record if your situation doesn’t call for one, and no outside party deciding when you’re “done.”

You and Destany decide together what your care needs, not a plan administrator reading a chart from the outside. That’s especially relevant if you’re doing slower, body-based nervous system work, the kind explored in this piece on anxiety as a nervous system problem, which doesn’t always fit neatly into insurer timelines.

How a Superbill Works: Getting Reimbursed by Your Out-of-Network Benefits

If you have a PPO or other out-of-network benefit, a superbill can bring some of that cost back. A superbill for therapy is simply an itemized receipt, session dates, service provided, Destany’s license and NPI number, and the fee paid, that you submit to your insurance company yourself. The practice doesn’t submit it for you, which is part of what keeps your file out of the insurance company’s system.

To use one: pay for your session as usual, request a superbill (monthly is common), check your plan’s out-of-network mental health benefits, then submit it through your insurer’s member portal or by mail. Many PPO plans reimburse a meaningful portion of out-of-network therapy costs, even though the exact amount depends entirely on your specific plan. A quick call to your insurer before you book is worth it.

Do Therapists Take Insurance? Why So Many Don’t, and What It Means for Care Quality

You may have noticed that many therapists, not just this practice, don’t take insurance or take only a couple of plans. It’s a pattern many people find while searching, for a real reason. Reimbursement rates from insurers are often set well below the cost of a private-pay session, so therapists who stay on panels frequently need larger caseloads to sustain a practice, which can mean shorter sessions and less capacity for the kind of deeper somatic work trauma and anxiety often require.

A therapist choosing to work outside insurance panels is often choosing to protect the time and attention available to you, not withholding access to care. It’s a tradeoff, and this practice wants you to understand it clearly before you commit to it.

Is Private Pay Therapy Right for You? What to Ask Before You Book

Before you book, it can help to ask yourself a few questions. Do you have out-of-network benefits you could use through a superbill? Does a diagnosis-free, insurer-free treatment plan matter to you? Is Sendero Health your coverage, in which case in-network billing is already available? And logistically: sessions are offered primarily via telehealth, opening access to this practice anywhere in Texas or Washington State, with a smaller number of in-person appointments in Austin for those who prefer to meet in person.

There’s no wrong answer here, only the setup that actually fits your life and your budget. If you’re still weighing it, a short, no-pressure consultation call is often more useful than trying to decide from the outside.