Thank you for this perspective.

What are some of the concerns re: reduced confidentiality?

We tried a therapist a few years ago for ODS and were very underwhelmed (three visits, nothing more than "getting to know" him and once, a brief meeting with us, and she seemed to forget everything from one visit to the next). From time-to-time we think about trying again. I hadn't considered not using insurance and perhaps using HSA funds until now.