I paid out of pocket for my therapy for most of the 10+ years I saw L. We negotiated a discounted rate for a while, and then for another while I did half-sessions for half her normal rate. I did use my HSA sometimes, but mostly I paid cash. She doesn't take insurance, and my out of network deductible is so stupid-high I would never meet it anyway, so I didn't bother with insurance. Wait that's not completely true now that I'm thinking about it. During the first year, I worked at a different company and they covered out of network under the same deductible as in-network, so I submitted receipts for reimbursement after I'd met my deductible. They only reimbursed like 30% for out of network if i remember correctly. that was a long time ago now. I cannot believe it's been almost a year since I stopped seeing her! Yeesh how time flies.