---
title: "Payment Options: Superbills, HSA/FSA, Sliding Scale & Private-Pay Therapy"
description: "How payment works at a private-pay psychology practice: accepted payment methods, superbills for out-of-network reimbursement, HSA/FSA/HRA guidance, single-case agreements, victim compensation and trauma funds, lien therapy, sliding-scale spots, and what to do if none of these fit."
url: https://www.alafiora.com/payment-options
practice: Alafiora LLC
author: Dr. Esther Lapite-Garrett, licensed psychologist
license: https://www.alafiora.com/website-terms-of-use
copyright: © Alafiora 2026
note: >-
  Educational content, not treatment. Reading it establishes no clinical
  relationship. Every personal account on this page is fiction, written by
  Dr. Lapite-Garrett from her own clinical knowledge and expertise; she uses AI
  as a drafting tool and approves every word. No client information of any kind
  was used to make them.
---

**Alafiora · Payment Options · How Investing in This Work Actually Works**

# Payment Options

### A private-pay practice is a deliberate choice, and financial transparency is treated here as a genuine form of respect. This page lays out, in full, how paying for care at Alafiora actually works: every accepted payment method, how out-of-network insurance reimbursement and superbills function, single-case agreements, pre-tax HSA and FSA options, employer and EAP pathways, victim compensation and trauma funds, lien therapy for active litigation, sliding-scale and scholarship spots, and what tax deductibility can and cannot mean. Reading all of it is worth the few minutes it takes; anything still unclear afterward belongs in the consultation, where it can be sorted out directly.

Alafiora operates as a private-pay, direct-pay, self-pay, and fee-for-service practice, a deliberate structural choice built into how the practice is run. Paying directly for care means purchasing something no insurance panel can authorize and no managed-care framework can replicate: complete confidentiality, clinical depth that is never rationed by a utilization reviewer, and a record that belongs entirely to the client. What gets carried into this work does not appear on a benefits statement, inform a future underwriting decision, surface during a life insurance application, or follow anyone into a security clearance review or a custody proceeding. It stays where it belongs.

---

## How to Pay | Accepted Payment Methods at a Private-Pay Psychology Practice

Alafiora accepts a broad, deliberately curated range of payment methods, so paying for care never becomes its own administrative obstacle stacked on top of everything else a client is already carrying. Fees are collected at the close of each session, or charged automatically at the end of each day; retainer fees for the concierge tier are charged separately at the start of each month. A minimum of two payment methods stays on file for every client. If the primary method does not process, the second is used without a separate notice, so nothing about billing arrives as a surprise.

**Personal and standard payments:**
- Debit and credit cards
- Contactless payment, including Apple Pay and Google Pay
- Cash, personal check, cashier's check, or money order
- ACH transfers and bank bill-pay arrangements, available by prior arrangement
- Health Savings Account (HSA) and Flexible Spending Account (FSA) cards
- Health Reimbursement Arrangement (HRA) accounts
- CareCredit health financing cards

**Employer, institutional, and third-party payments:**
- Corporate reimbursement programs and employer-sponsored wellness stipends
- Lifestyle Spending Accounts (LSAs)
- Select Employee Assistance Programs, by prior written agreement
- Union health funds and welfare trusts
- Invoicing for professional, forensic, or organizational engagements

In select cases, family offices, trusts, or corporate entities may arrange direct payment for clinical, concierge, or retainer services. These arrangements require a separate written agreement that protects client confidentiality and confirms the client alone as the clinical client, regardless of who pays. Privacy is not negotiable, and it is never compromised by a third-party billing arrangement. Anyone for whom this applies is welcome to raise it during the initial consultation or the first session.

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## Insurance Reimbursement and Superbills | Out-of-Network Benefits at a Private-Pay Practice

None of the payment methods above involve an insurance company directly, and that absence is intentional. Alafiora operates entirely outside insurance panels, a deliberate and principled structure built into how the practice runs. Insurance can still meaningfully contribute to the cost of care even so. Many PPO and select other plan types include out-of-network mental health benefits that reimburse a meaningful portion of each session once a deductible is met. A detailed monthly superbill is provided with everything an insurer requires to process a claim: [Dr. Lapite-Garrett's](https://www.alafiora.com/meet-the-psychologist-dr-esther) legal name, NPI, and Tax ID, the dates and duration of each session, the CPT code for each session type, the fee paid, and a diagnosis code where one is clinically indicated and the client has given informed consent for its inclusion.

Before a first appointment, calling the member services number on the back of an insurance card is worth the ten minutes it takes. The questions below can be read directly from this page during that call.

**A considered script for an insurer:**
- What are my out-of-network mental health benefits?
- What is my deductible, and how much of it remains this year?
- After my deductible is met, what percentage do you reimburse for out-of-network psychotherapy?
- What are your allowed amounts for CPT codes 90791, 90834, and 90837?
- Do I need prior authorization to see an out-of-network psychologist?
- Are there session limits or any other restrictions I should be aware of?
- How do I submit a claim, and what is the deadline for submission?

"Your insurer alone determines what they will reimburse, and whether they reimburse at all. Your superbill will be accurate, complete, and submission-ready, so you arrive at that process with everything you need and nothing left to chase."

---

## Single-Case Agreements | Requesting a Gap Exception for Out-of-Network Psychotherapy

Where a plan cannot provide timely access to an in-network psychologist with this specialization, a client may be eligible to request a single-case agreement, sometimes called a gap exception: a formal authorization from an insurer to receive out-of-network services at in-network cost-sharing rates, granted because a specific clinical need cannot be adequately met within that insurer's network. When requesting one, this language may be used directly with an insurer:

"I require care from a psychologist specializing in complex sexual trauma and compulsive behavior. No suitable in-network provider is available within a reasonable time or distance. I am requesting authorization for an out-of-network single-case agreement with Dr. Esther Lapite-Garrett."

Not every plan grants these requests, though many do, particularly when the clinical rationale is specific and well-articulated. Supporting documentation is available where it strengthens a client's case.

---

## Pre-Tax Options | HSA, FSA & Health Reimbursement Arrangements for Psychotherapy

For anyone holding a Health Savings Account or a Flexible Spending Account through an employer, psychotherapy with a licensed psychologist is typically an HSA eligible and FSA eligible expense. Paying with pre-tax dollars meaningfully reduces the effective out-of-pocket cost of care, without adding any administrative burden beyond the itemized receipts already provided as a matter of course.

**HSA.** Funds roll over year to year with no use-it-or-lose-it deadline, are available with most high-deductible health plans, and grow tax-free when invested over time.

**FSA.** Typically operates on an annual cycle. In many cases the full year's election is accessible immediately, even before the account is fully funded; plan-specific rules are worth confirming with a benefits administrator.

Itemized receipts, superbills, or any other documentation a plan requires are provided without having to be requested twice. Anyone whose employer offers an HRA alongside a high-deductible plan should confirm with HR whether mental health services qualify as an eligible expense under that specific arrangement.

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## Employer Benefits, EAPs & Wellness Stipends | Institutional Pathways Worth the Inquiry

Employer benefits are worth investigating before being assumed irrelevant to private-pay therapy. Many clients are genuinely surprised by what an employer already offers and had simply never been asked about. The following questions, directed to an HR department or benefits administrator, are a useful place to begin.

**A considered script for HR:**
- "Does our health plan or EAP reimburse out-of-network psychotherapy with a licensed psychologist if I submit a superbill and CPT codes?"
- "Is there a mental health stipend, wellness fund, or Lifestyle Spending Account I can apply toward private therapy?"
- "Does our plan have a network adequacy exception for specialty care that is not available in-network?"

**Additional institutional pathways worth exploring:**
- Employee Assistance Programs that permit out-of-network reimbursement when no in-network provider can meet a specific clinical need
- Lifestyle Spending Accounts that classify mental health care as an eligible category
- University Student Assistance Programs, health-fee-based reimbursements, or bridge funding for students whose mental health care supports academic functioning
- Disability and Accessibility Services offices that subsidize clinically indicated services tied to documented academic need
- VA Community Care referrals for veterans and military families when access standards are unmet or a specialty need cannot be served in-network; a direct conversation with a VA provider about a Community Care referral is the place to start

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## Victim Compensation & Trauma Funds | Survivor-Specific Funding Pathways

Insurance and employer benefits are not the only outside sources that can help cover this work. Survivors of a qualifying crime may find that state victim compensation programs cover the cost of therapy in full or in substantial part. These programs exist precisely so survivors are not left bearing the financial weight of care made necessary by what was done to them. They are underused. Most simply go unmentioned, and few people know to ask.

"Most programs require a timely application and documentation. Some states offer alternative processes for survivors who did not file a police report. I can prepare invoices, superbills, and supporting clinical documentation for a claim. For anyone working with an attorney on a settlement or restitution matter, it is worth discussing whether therapy costs can be formally included, and I will provide whatever documentation that attorney requires."

**Additional pathways for accident and workplace-related care:**
- Auto insurance Med-Pay and Personal Injury Protection policies may cover post-accident therapy; a call to the auto insurer confirms coverage under a specific policy.
- Worker's compensation may cover therapy connected to a qualifying workplace event with a referral from the relevant treating provider.
- For clients with active personal injury litigation, the lien therapy section below applies directly.

**Programs and funds worth searching for by state:**
- Victim of Crime Compensation Assistance Program (VOCA)
- Sexual Assault Assistance Program (SAAP)
- Sexual Assault Counseling Fund
- Sexual Assault Victim Assistance Fund (SAVAF)
- Camaraderie Foundation, for military-connected survivors
- SNAP Network survivor resources, at snapnetwork.org/victims_of_crime
- Faith-based counseling funds and community foundation grants
- EEOC settlement funds, where applicable
- Worker's compensation, for qualifying workplace incidents

---

## Lien Therapy | Deferred Payment for Active Personal Injury Litigation

For clients still in the middle of an active legal case, not yet at settlement, there is a further option beyond the funds and reimbursements above. For a select number of clients with active personal injury cases or ongoing settlements, Alafiora offers therapy on a lien: care begins now, and payment is deferred until the case reaches resolution. Healing should not have to wait for a legal process to conclude, and this model exists because that belief carries operational consequence.

Lien therapy is offered at a rate modestly above the standard fee, reflecting the delay in payment and the administrative responsibilities the arrangement carries. It requires a formal lien agreement, signed by the client and coordinated with the client's attorney, who agrees to protect and honor the lien from the settlement proceeds. Should the settlement fail or fall below what is owed, the attorney assumes responsibility for the outstanding balance as a condition of the agreement.

"Lien therapy is offered selectively and requires a consultation to determine whether it fits a given situation. Mentioning active litigation during the consultation lets us assess the arrangement together before any care begins."

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## Sliding Scale & Scholarship Spots | Considered Access to Full-Fee Specialized Care

Every pathway above assumes the full fee is the starting point and something else helps offset it. For some clients, the fee itself needs to be different from the start. Alafiora holds a small, carefully considered number of reduced-fee spots, reviewed quarterly. This reflects a principled part of how the practice structures its fees: the depth of specialization offered allows a defined portion of capacity to be set aside for clients whose financial circumstances make full-fee care genuinely inaccessible at this time.

Reduced-fee arrangements are discussed privately during the consultation. No proof of income or financial documentation is required; honesty about the actual situation is what matters, and an equally honest answer follows about what is available and what is not. If a scholarship spot is not currently open, that is stated directly, along with help identifying what else might work. There is no shame in this conversation, only practicality and a shared commitment to getting the care that is needed.

"I also hold limited pro bono capacity through vetted partnerships with organizations serving underserved survivors. Anyone currently receiving services through one of these partner organizations, or who believes they may qualify, is welcome to mention it during the consultation."

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## Tax Deductibility | What This Practice Provides for Tax Purposes

Separate from how a session gets paid for is the question of what happens with that cost at tax time. Psychological services may be tax deductible as a medical expense for anyone who itemizes deductions and whose total unreimbursed medical expenses exceed 7.5% of Adjusted Gross Income in a given tax year. Determining exact deductibility is properly a tax professional's or accountant's call. [Dr. Lapite-Garrett](https://www.alafiora.com/meet-the-psychologist-dr-esther) provides a monthly superbill and itemized receipts, giving an accountant or financial advisor everything needed to make that determination with accuracy and confidence. Anyone for whom this is relevant should bring these documents directly to whoever prepares their taxes.

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## Good Faith Estimate | The No Surprises Act and What It Guarantees

Under the No Surprises Act, in effect since January 1, 2022, anyone uninsured or not planning to use insurance for this work has the right to receive a Good Faith Estimate of the expected cost of care before a first appointment. At Alafiora it carries the same transparency and clarity that defines every part of how the practice operates. A Good Faith Estimate lists the services anticipated, the associated fees, and the CPT code for each. Care can still evolve over the course of treatment; the estimate simply ensures that no bill ever arrives that does not match what was already discussed. Full detail on how this works lives on the [Good Faith Estimate page](https://www.alafiora.com/good-faith-estimate-gfe), provided automatically before care begins, with no need to request it.

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## If None of These Options Apply | When the Path Is Less Clear

Most people find something usable somewhere in the pathways above. There are rare, genuinely difficult situations where none of the pathways above are accessible. A few things are worth knowing before concluding that care is out of reach.

- Some nonprofit organizations providing survivor services, including rape crisis centers and RAINN-affiliated programs, can engage outside providers as subcontractors under their grant funding through a Memorandum of Understanding. Anyone connected to a nonprofit offering supportive services may want to ask whether that pathway exists for their situation.
- Some local faith communities, mutual aid groups, and community foundations offer short-term financial assistance for healthcare. Asking for what is sometimes called benevolence or emergency assistance for medical care is a legitimate and honored request in many of these spaces.
- Network deficiency exceptions exist where a health insurance plan lacks adequate in-network providers for a specific specialty. A gap exception or network adequacy exception can be requested directly from an insurer, asking them to authorize out-of-network care at in-network rates due to the absence of qualified providers within their network.

If cost is genuinely the only barrier standing between a prospective client and this work, that is worth naming directly during the consultation. An honest answer follows about what can be offered, and an equally honest one if this practice is not the right financial fit right now; guidance toward accessible care elsewhere is always preferable to someone going without care entirely.

"Please know that payment is never accepted in any context that compromises a client's safety or this practice's clinical independence. Financial arrangements, regardless of their source or structure, never influence the care provided."

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## Common Questions About Payment Options | What Prospective Clients Ask About Cost and Coverage

**Why doesn't Alafiora take insurance if so many payment pathways are described here?**

Staying outside insurance panels is a deliberate choice built into how this practice operates. Staying out-of-network means no diagnosis or treatment plan is shared with an insurance company, no insurer decides how many sessions are medically necessary, and no session is shortened or redirected to satisfy a utilization review. The pathways above exist because insurance, an employer, or a survivor fund can still contribute to the cost even while the practice remains out-of-network.

**What is a superbill, and how do I actually use one?**

A superbill is a detailed monthly statement containing everything an out-of-network insurer needs to process a reimbursement claim: the clinician's legal name, NPI, and Tax ID, session dates and duration, CPT codes, fees paid, and a diagnosis code where clinically indicated and consented to. It is submitted directly to an insurer, following whatever claims process that plan requires; [Dr. Lapite-Garrett](https://www.alafiora.com/meet-the-psychologist-dr-esther) provides one automatically each month.

**Will my insurance actually reimburse me for an out-of-network psychologist?**

Often, though not universally, and the honest answer is that no provider can guarantee an insurer's reimbursement decision. Many PPO plans reimburse a meaningful percentage of out-of-network psychotherapy once a deductible is met; the script in the section above is built specifically to get a plan-specific answer directly from an insurer.

**Is private-pay therapy actually more confidential than insurance-based therapy?**

Yes, in a specific and checkable way: paying privately means no diagnosis or claim is submitted to any insurer, and no employer-visible billing claim is generated, unless a client separately authorizes or requests that release of information themselves. Anything a security clearance, licensing board, or employer might independently require is properly a matter for a client's own legal counsel to address.

**Does a sliding-scale or scholarship spot mean lower-quality care?**

Not at all. A reduced-fee client receives the identical clinical work and the same doctoral-level training as a full-fee client; what changes is only the fee charged, drawn from a small, quarterly-reviewed portion of capacity set aside for exactly this purpose.

**What if I genuinely cannot afford any of these options?**

It depends on the specific circumstances, and this is exactly the situation the "If None of These Options Apply" section above exists for: nonprofit subcontracting arrangements, faith-based or mutual-aid assistance, and network deficiency exceptions are all real, if less commonly known, pathways. Naming the financial barrier directly during a consultation gets an honest answer, including honesty about whether this practice is the right fit financially right now.

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Reading through every payment pathway on this page is not the same as having decided which one applies, and it does not need to be. Many people who eventually reach out here read a page like this one more than once first, often while still sorting out which script to use with an insurer or an HR department. Nothing about reviewing these options commits anyone to a specific arrangement before they are ready to discuss it directly.

**Begin a Confidential Conversation**

For anyone who already knows they are ready to begin, starting directly with a first session is the most direct next step, and payment logistics, from superbills to sliding-scale eligibility to a single-case agreement request, are simply worked through as a normal part of getting started. For anyone who wants questions about cost, coverage, or a specific pathway answered first, a consultation remains the lower-commitment way to do that: a brief conversation, held in confidence within the legal and professional limits of confidentiality any licensed psychologist explains before clinical work begins, where a financial question is never treated as an imposition and the only subject is whatever actually needs sorting out.

[ BEGIN WITH A FIRST SESSION ] [ BEGIN WITH A CONSULTATION ]

For anyone wanting the underlying fee schedule these payment pathways apply to, the [Rates and Fees page](https://www.alafiora.com/rates-and-fees) lists current session formats and pricing directly, and this page can always be bookmarked, or the QR code in the footer scanned, to keep this information close until the timing feels right.

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