Private Pay Therapy: How It Works and Who It's For
Private pay therapy (also called self-pay or out-of-pocket therapy) means paying for sessions directly, without billing your insurance company. No diagnosis required. No insurance company reviewing your records. No limit on the approach your therapist can take.
At The Relationship Institute Utah in Spanish Fork, private pay is available for every service we offer, from individual therapy for anxiety and depression to premarital, couples, family, and teen sessions. Insurance is also accepted for individual therapy.
What Is Private Pay Therapy?
Private pay therapy is a payment arrangement where clients cover the cost of sessions directly, either at the time of service or through an HSA or FSA account, instead of submitting claims to an insurance company. The term appears under several names: self-pay therapy, out-of-pocket therapy, or simply paying without insurance. They all mean the same thing. No insurance company is involved in your care.
Here is why that matters
When you use insurance for therapy, your insurer has a financial stake in your treatment. They require a billable psychiatric diagnosis to authorize sessions. They set limits on session counts. They can request records during claims review.
With private pay, none of that applies. Your therapist can focus on what you actually need rather than on what a plan will approve.
Who Is Private Pay Therapy For?
Private pay works for any client who wants therapy without the constraints of an insurance billing framework. At The Relationship Institute, private pay is chosen by clients across every kind of work we do.
Individual Therapy
Clients working through anxiety, depression, grief and loss, codependency, faith and spirituality questions, life transitions, or personal growth. Some choose private pay to keep the work off their insurance record. Others prefer the flexibility of an open scope. Individual therapy is also available with most major insurance plans if that fits better.
Family therapy sessions, including parent-teen and multi-generational work, are always private pay for the same reasons as couples therapy. When the goal is to change how a family functions, filtering everything through one person's diagnosis gets in the way of the actual work.
Couples preparing for marriage typically do not carry a psychiatric diagnosis and cannot be billed to insurance for this work. Premarital counseling is always private pay.
Every couples therapy session at The Relationship Institute is private pay, including high-conflict couples work, betrayal recovery, and roommate-syndrome disconnection. This is not a policy choice; it is a clinical one.
Why Couples and Family Therapy Is Always Private Pay
Most insurance plans do not actually cover marriage counseling or family therapy, even when they say they do. Here is why.
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For insurance to pay for couples or family therapy, one person has to be designated as the identified patient and assigned a billable psychiatric diagnosis. That diagnosis becomes a permanent part of that person's medical record. It follows them to future insurance applications, life insurance underwriting, and employment screenings that check medical history.
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Insurance then requires the therapist to prove medical necessity for the other partner's or family members' presence during treatment. The entire course of therapy has to be framed around treating the identified patient's diagnosis, not around the relationship or the family. Sessions cannot focus on communication, trust, conflict patterns, or emotional disconnection as their primary goal. The relationship becomes a backdrop to a medical treatment plan.
Our approach starts with the relationship or the family, not with a diagnosis. The work done here, grounded in Relational Life Therapy and Structural Family Therapy, cannot happen the way it needs to under an insurance billing framework. That is why couples, family, and premarital sessions are always offered as private pay.
What About a Super Bill?
If you have out-of-network mental health benefits, you may be able to submit a Super Bill for partial reimbursement on any private-pay service, including couples and family. A Super Bill is an itemized receipt with session codes and provider credentials that you submit directly to your insurer. Some plans apply it toward your out-of-network deductible. We provide Super Bills on request.
1
Attend Your Session
Pay for your session directly at the time of service.
2
Request a Super Bill
We provide an itemized statement with session date, CPT code, provider NPI, and amount paid.
3
Submit to Your Insurer
File it as an out-of-network claim. Whether you receive reimbursement depends on your plan's benefits.
Important: Call your insurer first and ask specifically about out-of-network mental health benefits before counting on reimbursement.
Affordability: What Treatment Actually Costs
Private pay therapy often costs less than people expect. Once you factor in how long treatment actually takes and what insurance copays add up to over the same period, the gap shrinks.
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Session Length and Pace
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Most therapists who bill insurance offer 50-minute sessions because that is what insurance reimburses. Couples sessions at The Relationship Institute run 75 minutes, which allows time for deep work rather than just warming up. Individual sessions run 50 minutes.
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Total Course of Treatment
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Because we use an accelerated, skills-based model, most couples achieve their relationship goals in 6 to 10 total sessions. Sessions are typically weekly for the first month, then every other week for the remaining months. That structure keeps momentum while giving couples time to practice what they are learning.
Individual therapy varies more by concern and goal, but focused work often completes in a similar range.
The Actual Math
6–10 sessions × $215 = $1,290 – $2,150
Full course of couples treatment, typically completed in 3–5 months
Insurance for Individual Therapy
Individual therapy at The Relationship Institute accepts most major insurance plans, including:
Select Health
Cigna
BCBS
EMI Health
United Healthcare
Aetna
Anthem
UMR
Most other commercial plans
Some Medicaid plans are accepted depending on the specific plan. Medicare is not accepted.
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For clients who prefer private pay for individual therapy, the session rate is $145 for a 50-minute session. To verify your benefits before booking, contact us, and we will confirm your coverage directly.
What Does Private Pay Therapy Cost?
Rates at The Relationship Institute are straightforward:
​Individual
$145
per 50-minute session
Insurance also accepted. Private pay available for those who prefer it.
Couples
$215
per 75-minute session
Accelerated model: most couples finish in 6–10 sessions ($1,290–$2,150 total)
Family
$215
per 75-minute session
Parent-teen and multi-generational work. Always private pay.
Premarital counseling is billed at the couples therapy rate. Teen sessions are billed at the individual rate. There are no hidden fees. For scheduling and payment options, visit the Rates and Booking page.
How to Pay
For all private pay sessions, the following payment methods are accepted:
Cash
Personal Check
Credit / Debit Card
HSA
FSA
EAP Benefits
Open Path
Bishop Pay
HSA and FSA payments let you use pre-tax dollars for private pay sessions without any insurance involvement.
Why Many Clients Choose Private Pay
Beyond the situations where insurance simply does not work, private pay changes the experience of therapy itself. Nothing about your sessions gets shaped around insurance documentation, diagnosis requirements, or approval processes.
The practical differences show up in three places. Your records stay private, because nothing from your sessions creates a paper trail in the insurance system that might affect future coverage, employment screenings, or life insurance underwriting. Your therapist and you decide the pace, the focus, and how progress gets measured, without session caps or claim denials. And the work can include reasons for therapy that insurance never covers, like premarital preparation, relationship maintenance, faith questions, and other growth work that no clinical diagnosis fits.
What Our Clients Say
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