Pro tip: Ask if your therapist offers a sliding payment scale.
If you’ve been thinking about therapy but are deterred by the fees, you’re not alone.
Thirty-three percent of Americans say that the cost of therapy is the biggest roadblock they face in getting the mental health care they need, according to an online survey conducted in 2020 by SingleCare, a prescription savings service that partners with pharmacies to offer consumers lower medication costs.
The poll (of 1,000 Americans; sex and age were census-balanced to match that of the U.S. population) also found that 43 percent of respondents skipped an appointment to save money.
Other data (collected as part of the National Health Interview Survey in 2019) suggests 46 percent of Americans who sought therapy chose their mental health practitioner on the basis of affordability and their insurance coverage, which trumped important factors like expertise, years of experience, and even finding a therapist with a similar background.
“The cost of therapy will range significantly depending on the expert you’re seeing, whether you are from an urban or less-populated area, and whether your insurance provides coverage,” says Lynn Bufka, PhD , a licensed clinical psychologist and the associate chief of practice transformation at the American Psychological Association (APA), where she works on healthcare policy issues and improving mental health care delivery. Price can definitely be a barrier for individuals, she adds.
How Much Does Therapy Cost?
There are no hard-and-fast rules for how much therapists may charge you. Organizations like the American Psychological Association (APA), the American Counseling Association, and the National Alliance on Mental Illness (NAMI) do not provide patients with estimates for the cost of therapy because there are too many moving parts involved, from where therapists are located to their years of experience and areas of specialization.
The therapist directory GoodTherapy suggests that an hourlong session can range from $65 to more than $250 for Americans without insurance, with most patients paying between $100 and $200.
The variations in cost will depend in part on these factors:
Location Anticipate paying higher fees if your therapist is practicing in a city with higher living costs, such as San Francisco, Los Angeles, or New York, rather than a smaller town or less-expensive region, according to Liz Morrison, LCSW , a New York City–based psychotherapist and the owner of Liz Morrison Therapy. Her New York City clinic, which specializes in cognitive behavioral therapy (CBT), charges $225 per session. On the other hand, Lynn Linde, EdD, the chief knowledge officer at the American Counseling Association , charges $125 per session in Baltimore, where she practices.
Type of practitioner and their expertise Count on therapists with extensive training or niche areas of specialization to charge more than their counterparts who are establishing their practice and building up their clientele. Dr. Bufka notes that the type of practitioner you work with will also affect the cost — counselors and social workers may charge less than psychologists and psychiatrists. Typically, providers with more advanced degrees or education will be the ones charging more. According to the life insurance provider Northwestern Mutual, some psychiatrists, who are medical doctors and can diagnose mental disorders and prescribe medication, charge as much as $300 to $500 for an initial assessment.
Online versus in-person therapy Subscription services like BetterHelp or Talkspace may be more affordable than in-person therapy with a provider. BetterHelp charges a $60 to $90 weekly subscription fee, which includes a real-time therapy session done via videoconferencing and the ability to message your therapist anytime.
Setting Group therapy will usually be far cheaper than one-on-one sessions. Morrison says a single session of group therapy can start as low as $50 to $75. Dr. Linde says not to assume you’re getting lower-quality or less-effective care if you opt for group therapy. “You’re in a microcosm of individuals with similar kinds of issues supporting each other and finding ways of changing behaviors together,” she explains.
Does Insurance Cover the Cost of Therapy?
It depends. Some therapists submit claims to insurance companies the way other doctors and clinicians do, and they may work only with certain plans. Other therapists will ask you to pay for services up front and then submit the claim to your insurance company yourself to get reimbursed for all or part of the service.
Whether your insurance plan covers part or all of the cost of therapy for mental health depends on your provider and your specific plan.
Mental Health Parity Laws Require Insurance Reimbursement for Treatment of Mental Illness, but Not All Mental Health Care
Many insurance plans help cover some of the costs of therapy for mental health, according to NAMI.
And legally, many plans are required to provide equivalent coverage for any care related to the treatment of a mental health diagnosis, as the plan would pay for physical health issues.
Under the Mental Health Parity and Addiction Equity Act, passed in 2008, insurance companies cannot charge higher copays or deductibles for treatment related to diagnosed mental health disorders. This law applies to most employer-provided health insurance and individual plans purchased through state and federal health insurance, according to the APA.
NAMI provides resources for individuals who suspect their insurance provider is not following these regulations.
But note that this mental health parity legislation requires coverage only for clinically diagnosed mental health disorders. That means that if you’re seeking therapy for mental or emotional health without a diagnosis, your insurance isn’t legally required to pay for it, Bufka says.
“Health insurance is predicated on treating a health condition, so when you’re billing your insurance provider, it must show what the diagnosis is and what service was provided,” Bufka says. Some insurance providers and plans may still cover preventive mental services (or therapy without a clinical diagnosis), but the only way to know is to check your specific plan and policy details.
It’s worth noting that an additional barrier to effective mental health care coverage by insurance companies is inadequate provider networks. If there’s a shortage of mental health providers who are “in network” (providers your insurance company will reimburse you for seeing), it’s going to be challenging for you to get good mental health care.
NAMI research suggests that mental health office visits are five times more likely to be out-of-network than primary care doctor’s appointments. Its 2016 report found that Americans have a harder time finding in-network providers for mental health care than for general and specialty medical care.
This problem is assumed to have been exacerbated by rising demand for therapy and mental health services since the pandemic. A 2021 poll from the APA suggests that psychologists have been dealing with increased workloads, longer patient waiting lists, and low capacity for new patients.
How Do I Find Out if My Insurance Covers Therapy?
To find out if your insurance provider will cover the therapy and practitioner you’re interested in, you’ll likely need to do some research before your first appointment. You can:
Contact your insurance provider. For starters, pick up the phone and call your insurance company to ask for detailed information on what’s covered, a list of approved therapists or mental health services in your neighborhood, and how you can make a claim, Bufka says. Your provider’s website may have an online portal where you can see what services are on offer and connect with therapists who are in network.
Contact your therapist. Check your therapist’s website or contact them directly to see which insurance plans they accept and if they’ll submit claims directly to your insurance company (or if you need to do it after your appointment), Morrison says. You may learn at this step that the therapist you were hoping to work with is not in network and doesn’t accept insurance at all. Note: That doesn’t necessarily mean your insurance company won’t cover some or all of the costs of your care, but if the provider doesn’t work directly with insurance companies, you may be on the hook for paying for service up front and then sending the necessary paperwork to your insurance company (if your insurer will reimburse you), Morrison says.
Consider contacting your employer’s human resources department. If your health insurance is provided by your employer, you may be able to get started by contacting your HR department. In some cases, they may have an employee assistance program to connect you with the resources you need. But remember, whether or not you choose to disclose to your employer (or your HR department) that you are seeking therapy for mental health is up to you. And know that you are never legally required to disclose a psychiatric issue to an employer (unless you are requesting a job accommodation).
7 Tips for Finding More-Affordable Therapy for Mental Health
Whether you have insurance or not, there are ways to make the help and counseling you need more affordable.
Know what your insurance plan covers and what it doesn’t. Many insurance companies provide some mental health care coverage. Start by researching the details of your plan and options in your area to have some of the costs of your mental health care covered by your insurance plan. If you get insurance through your employer, many companies provide benefits, such as a flexible spending account, which is an annual lump sum of cash you can use for health, fitness, and wellness. This funding could be applied toward a few therapy sessions. Some companies also offer employee assistance programs, which include third-party counseling when you need it. Many colleges and universities have guidance counselors on staff who can provide either free or low-cost therapy as well.
Ask about a sliding scale. If your therapist doesn’t accept insurance, he or she may provide a sliding scale, which is a reduced fee for clients who can’t afford to pay for their full rate. If this isn’t on offer, you can ask about a payment plan instead, so you aren’t footing the full fee up front, Linde says.
Join a support group. Online or in-person support groups can be more affordable than one-on-one therapy and can offer big mental health benefits.
In some cases, these groups are free of charge, such as Alcoholics Anonymous, and provide you with group counseling, mentorship, and a sense of community for people with shared experiences.
Research low-cost or free therapy services. NAMI suggests looking into federally funded health centers that help underserved areas or populations, or provide a sliding scale fee. NAMI keeps a lengthy list of free clinics and nonprofits that focus on providing affordable counseling to low-income Americans.
Use databases that filter according to price. Make use of databases like the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Locator or Medicare provider list to filter therapists according to cost of treatment and insurance coverage.
Get care from a trainee. You may live near an academic medical center where psychology and psychiatry residents are practicing under the supervision of licensed therapists. This can be a great option to receive affordable care, Bufka says.
Try a subscription service. Therapy that’s provided over the phone and via videoconferencing from companies like BetterHelp start at just $60 to $90 per session — or $240 a month, which can be the cost of a single in-person session in some cases.
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