What is the Cost of Therapy? 11 Ways to Manage It
Published By Justin Baksh, LMHC, MCAP
August 28, 2023
Mental health care is key to living a happy, fulfilling life, and a major part of it can include seeking assistance from therapists. As trained professionals capable of providing valuable support and guidance, therapists perform an important role for those who need it. However, the cost of therapy can make it difficult to navigate finding an affordable one.
The Importance of Mental Health Care
Mental health care is crucial for numerous reasons:
Why Seek Therapy?
- Promotes positive mental well-being: Seeking adequate mental health care can help individuals combat stress, anxiety, and depression.
- Fosters healthy relationships: Good mental health enables people to build strong bonds with family members, colleagues, friends, and romantic partners.
- Boosts productivity. Adequate mental health support allows for increased focus and memory retention, leading to higher overall performance at work or school.
- Benefits physical health: Proper mental health care can lead to improved physical wellbeing by reducing the risk of chronic diseases associated with stress.
The Role of Therapists in Providing Mental Health Support
Therapists play a critical role in mental health care.
How Therapists Help
- Offering a safe environment: Therapists provide a judgment-free zone for clients to express their thoughts and feelings openly.
- Guiding personal growth: By setting goals and tracking progress, therapists help their clients develop effective coping mechanisms and improve self-esteem.
- Uncovering patterns. They assist clients in understanding how past experiences may be affecting their current emotions or behaviors.
- Developing tailored treatment plans: Through various therapeutic techniques such as cognitive behavioral therapy (CBT) or psychodynamic therapy, therapists create customized treatments addressing each client’s unique needs.
Average Cost of Therapy
The average cost of therapy hasn’t changed much in the past few years. It still ranges from $100 to $200 per therapy session, a statistic first identified in a 2019 SimplePractice report.
These rates depend on several factors, including location, experience, and specialty.
1. Experience: Therapists with more years of experience may charge higher rates due to their extensive knowledge and expertise. However, therapists who are just starting their practice may offer rates on the lower end of the spectrum to attract clients.
2. Location: The cost of living and demand for therapy services can influence self-pay rates. In urban areas or highly sought-after regions, therapists may charge more compared to rural areas.
3. Specialty: Therapists specializing in certain areas such as trauma, addiction recovery, or couples therapy may offer higher rates due to their specialized training and skills.
Addressing Cost Barriers to Therapy
Unfortunately, cost is often a significant barrier preventing individuals from seeking the mental health care they need. The best (and most utilized) way to pay for therapy is with health insurance. Fortunately, it is more available than ever before, thanks to the Healthcare.gov marketplace.
Types of Insurance Plans that Typically Cover Therapy
Therapy can be an important and beneficial form of treatment for mental health concerns. However, the cost of therapy sessions can often be a deterrent for individuals seeking help. Fortunately, mental health services are now covered by many insurance plans.
Let’s take a look at the various types of insurance plans that typically cover therapy and how to navigate them.
1. Health Maintenance Organizations (HMOs): HMOs are insurance plans that require patients to choose a primary care physician (PCP) who oversees their healthcare. When it comes to therapy, HMOs typically provide coverage only if the therapy is recommended and referred by the PCP. This means that you may need a referral from your PCP to see a therapist and your coverage may be limited to therapists within the HMO network.
2. Preferred Provider Organizations (PPOs): PPOs are another type of insurance plan that offers coverage for therapy. Unlike HMOs, PPOs allow individuals to see any therapist of their choice, both within and outside the network. However, seeing an in-network therapist will usually result in lower out-of-pocket costs, while out-of-network therapists may require higher deductibles or co-pays.
3. Exclusive Provider Organizations (EPOs): EPOs are similar to HMOs in that they require individuals to have a primary care physician. However, EPOs do not require referrals for therapy services. However, these plans exclude coverage for any out-of-network care, except for emergencies.
In-Network vs. Out-of-Network Therapists
When you are evaluating your therapy coverage, it’s vital to understand the difference between in-network and out-of-network providers. In-network therapists have contracts with insurance companies and often have negotiated rates for their services. This means that if you choose an in-network therapist, your insurance plan may cover a larger portion of the cost, resulting in lower out-of-pocket expenses. On the other hand, out-of-network therapists do not have agreements with insurance companies, which may result in higher out-of-pocket costs.
Checking your Insurance Plan for Therapy Coverage
To determine whether therapy is covered under your insurance plan, there are a few steps you can take: – Contact your insurance provider: Call the phone number provided on your insurance card and inquire about the specifics of your mental health coverage.
– Review your plan documents: Check your insurance plan documents or handbook for information regarding therapy coverage, including any restrictions or limitations.
– Look for mental health benefits: Identify specific benefits related to mental health services, including therapy coverage, copayments, deductibles, and maximum coverage limits.
Deductibles and Out-of-Pocket Limits
Deductibles and out-of-Pocket Limits can have a significant impact on the cost of therapy and managing expenses related to them is essential.
A deductible refers to the sum of money that an individual must personally pay for covered medical services before their insurance coverage becomes effective. It usually starts over on the first day of each new calendar year. For example, if your insurance plan has a $1,000 deductible, you would need to pay the first $1,000 of your therapy expenses before your insurance coverage kicks in.
Out-of-pocket limits, on the other hand, represent the maximum amount you have to pay for covered medical services during a specific period. Once you reach the out-of-pocket limit, your insurance will generally cover 100% of the remaining costs for covered services. This limit can include deductibles, copayments, and coinsurance. It ensures that an individual’s healthcare expenses are limited, preventing excessively high costs.
When it comes to therapy expenses, deductibles and out-of-pocket limits can play a significant role. If you have a high deductible, you may need to pay a larger portion of your therapy costs until you reach it. However, once the deductible is met, your insurance will start covering a larger portion of the expenses.
How to Afford Therapy
To manage expenses related to deductibles and out-of-pocket limits for therapy, here are some tips:
11 Ways to Manage the Cost of Therapy
- Understand your insurance plan: Review your insurance policy and become familiar with the deductible amount, out-of-pocket limit, and coverage details for therapy. This will help you better plan and anticipate your expenses.
- Opt for in-network providers: Choosing therapists who are in-network will help you maximize your insurance coverage and potentially lower your out-of-pocket costs.
- Sliding scale fees: Some therapists offer sliding scale fees, adjusting their rates based on a client’s ability to pay.
- Negotiate therapy fees: Reach out to therapists and discuss the possibility of reducing fees or setting up a payment plan if you anticipate difficulties in meeting your deductible or out-of-pocket limit or need to self-pay for therapy.
- Use health savings accounts (HSAs): If available, contribute to an HSA, which allows you to save pre-tax dollars specifically for medical expenses, including therapy costs.
- Credit Cards/Care Credit: You can also put the cost of therapy on your own credit card or look into starting a Care Credit account, which is accepted at many therapy and medical providers as well.
- Budget for therapy costs: Take into account the deductible and out-of-pocket limit when budgeting for therapy expenses. Consider setting aside money to cover these costs at the beginning of the year; perhaps with a federal tax refund, if you qualify for one.
- Community mental health centers: Some communities offer affordable or no-cost mental health services to residents through public clinics or nonprofit organizations.
- Frequency of Sessions: In some cases you may be able to lower the frequency of therapy sessions and still obtain a clinical benefit. Instead of going to a therapist once a week, you may be able to go once every other week. This can save you up to 50 percent on the cost of therapy.
- Keep track of expenses: Keep records of all therapy-related expenses, including session fees, prescriptions, and other out-of-pocket costs. This will help you keep an accurate account of how much you have spent towards your deductibles and out-of-pocket limits.
- Speak with your insurance provider: If you have specific questions or concerns about deductibles, out-of-pocket limits, or coverage for therapy. If you have specific questions or concerns about deductibles, out-of-pocket limits, or coverage for therapy, each out to your insurance providers customer service center for a clear explanation on this.
Understanding deductibles and out-of-pocket limits, asking for a self-pay discount, along with implementing other strategies to manage therapy expenses can help you navigate the financial aspect of therapy. Exploring all avenues can ensure that you receive the care you need, without undue financial burden.