Why We Chose to Stay Private Pay — And Why It May Cost You Less Than You Think

Every year, it seems more and more of us are wrestling with insurance — both providers and patients alike.

As a mom, a wife, and a patient myself, I understand the frustration. We pay hundreds (sometimes thousands) of dollars each month for insurance, only to be met with high deductibles, co-pays, and confusing coverage rules. Many times, our family has chosen private pay providers and used our HSA card instead — and we’ve often found the cost comparable, sometimes even less, with far better quality of care.

When I started Flourish Speech Therapy, my original goal was to slowly credential with insurance panels, beginning with Blue Cross and expanding from there. I completed the application. It was filled out and ready to sign.

But I had a bad feeling.

Something didn’t sit right.

So I didn’t sign.

Instead, I continued forward as a private pay clinic, offering superbills for families who wished to submit to their insurance companies for possible reimbursement.

And do you know what happened?

Several families were surprised — even shocked — to find they were paying the same or sometimes less per week than they had been paying at insurance-based clinics.

Here are two common reasons why:

1. Multiple Billing Codes Per Session

Some clinics bill two treatment codes per session — for example, a feeding code and an articulation code. While this may be clinically appropriate in certain situations, it can also increase the cost of the session and the reimbursement rate.

Even with insurance, some families were paying $75–$80 per session after co-insurance and deductible adjustments.

2. Frequency of Sessions

Some families were attending therapy twice per week with a $35–$40 co-pay each visit — totaling $70–$80 weekly — yet reporting minimal progress.

When these same children transitioned to our clinic, we often reduced sessions to once per week and implemented intentional parent coaching and structured home practice. With this model, many began making significant progress — sometimes faster than before.

In addition, many of our families who submit their superbills receive reimbursement checks from their insurance company, further reducing their out-of-pocket cost.

Private Pay vs. Insurance-Based Clinics

Choosing an insurance-based clinic is not wrong. Many wonderful clinics operate within insurance networks.

But private pay clinics can be beautiful, personalized, and surprisingly comparable in cost.

Without the administrative burden of insurance approvals, documentation demands, and reimbursement limitations, private clinics often have the freedom to:

• Spend more time with families

• Individualize treatment without billing constraints

• Choose assessment tools freely

• Focus on clinical growth and excellence

• Prioritize quality over volume

My therapists and I truly feel a sense of freedom not being bound to an insurance company. It allows us greater autonomy in our testing and treatment decisions, more flexibility in documentation, and more time to grow clinically.

And that freedom directly benefits our families.

If you are considering a private pay or cash-based clinic, know this:

You will be well cared for.
You will receive intentional, individualized therapy.
And financially, you may come out very close — sometimes even ahead — compared to an insurance-based clinic.

Insurance can be helpful.
But it is not the only path to high-quality care.

At Flourish, our goal has always been simple:
Care first. Progress first. Families first.

-Rebecca Fonseca M.S. CCC-SLP