‘And How Does That Make You Feel?’ The Cost of Therapy

Opinions and descriptions of therapy vary as much as the individuals who engage it: It’s medical; it’s personal; it’s a luxury; it’s a necessity; it can be tremendously helpful and beneficial; it can be expensive.

Logan and Martha have discussed how depression affects them (and their money). There’s another money factor involved here: When you want or need to go to therapy, how much is it going to cost you?

Therapy involves trusting someone with your deeply personal thoughts, your secrets and your raw self. Yet therapy is bracketed by commerce—it is a service, and a source of revenue and expenses, with insurance adding another twist in the process. If I quantified the comfort and help I get from therapy, that number would be far higher than what I can afford to spend. Money and value play a tricky game here: I want excellent care and support; I also want to minimize my out-of-pocket costs.

When I decided to see a therapist in New York, I had three options:

• See a therapist who did not accept my insurance
• Pursue a low-cost alternative, like a student training program or referral center
• Find an in-network therapist.

I figured out these options after stumbling into the office of a pricey out-of-network therapist. I met with this therapist based on a recommendation from someone in the field, and I liked her right away. Scratch that, I loved her. She looked like she could be my aunt, she totally got me, and she was going to fix everything! I could feel my problems melting away—right up until she told me she charged $220 per 45-minute session, and did not accept insurance.

It was a rude awakening. I had assumed that insurance would cover my visits, and didn’t think to ask about fees until the end of our first session. I briefly considered if I could make this work, but the thought of spending $900 each month for these sessions practically had me breaking out in hives. For $900, I could buy 100 Chipotle burritos! (Though probably more like 85 burritos with guac—they really get you on the guac.) Still, the ups and downs of eating three burritos a day would be stressful, as would worrying every month about coming up with enough money to pay for therapy. It was hard to walk away from someone I felt could really help me, but practically, I needed a lower cost option.

Other friends had found help through training centers and graduate programs, with costs ranging from $0-60 per session. I researched nearby places, many of them with rave reviews about their services and low costs, and called for intake appointments. However, the variability in their pricing gave me pause. None of them took my insurance in-network, though after intake fees of $30-60, I might be assigned to a therapist who accepted my insurance. There were too many unknowns for me in this scenario. I wasn’t sure if I was eligible for sliding scale fees, and that would not be determined until after the assignment was made. It was impossible to anticipate what this route would cost me.

Additionally, this would be a long process—it could take a month to be seen an intake, then more time for an assignment. Ever the optimist, I inquired about reassignment if I didn’t like my initial therapist. I was assured it was possible, though would make for a longer process. I wanted more certainty about both provider and costs. This might have been the least expensive option, but I couldn’t know until later in the process. I was impatient, and didn’t want to spend any more time wondering about therapy’s affordability.

Looking for someone in-network was appealing, since my in-network deductible was significantly less than my out-of-network one. I spent several hours on Psychology Today’s website looking for providers who would take my insurance and seemed like a good fit (I also used recommendations and my insurance’s doctor directory). I called and emailed a dozen therapists. Many therapists did not take my insurance, were not taking new in-network clients, or did not have suitable time slots available.

Research and follow-ups were a frustrating process that required a hefty time investment. And it was stressful; I often felt hopeless about finding someone I could afford who would be a good fit for me. I worried if the quality of care I would receive from someone in my network would be as good as my $220 therapist-on-a-pedestal. I felt limited by my finances. I wanted to give up. But I didn’t give up.

I started having introductory phone calls and sessions with therapists I hoped would be my match. The parallels to dating here are unavoidable: friends, and even other therapists, trotted out familiar language, like “keep meeting people until one feels right” and “I’m sure you’ll find someone great.” These lines could be in the pages from a book called He’s Just Not That Therapist for You.

But comparison shopping for people is very different from flipping between tabs for Amazon and Target. Shopping around for a therapist feels slimy, like letting a dude at a bar buy you a drink without mentioning your live-in boyfriend. I could tell, sometimes within seconds, that this was not the relationship I wanted. Unlike a bad date, the check I had to write at the end of a bad session was far more than the cost of two gimlets.

This story has a happy ending. Well, sort of. I found someone in my insurance network that I like working with. She charges $80 per session, and after meeting my in-network deductible in the first month, I now pay $10 per session. I feel good about what I’m paying and the quality of care I’m receiving. But the process of seeking therapy has made me realize how cost can be a deterrent to seeking good care. Finding the right therapist required persistence, and I can understand why someone might give up or settle for someone they’re less than satisfied with, particularly in a period of depression or high stress. Fortunately, I didn’t have to deal with psychiatrists and prescriptions, which I imagine add another layer to this sometimes dizzying process.

I have tremendous respect for therapy, and see immense value in doing the work of mental health. It is hard to place this service in a medical context of deductibles and $10 co-pays. Therapy might make me feel much happier, but that feeling does not deposit thousands of dollars in my bank account to cover payment. Maybe there’s psychological heft to paying upwards of $200 per session, but I don’t feel like I’m getting “only” $10 worth of care when I see my therapist. At the same time, I don’t want her to feel that I undervalue the time we spend together because it costs less than a gym membership.

We often associate more money with more worth, though money and value are not the same thing. My least expensive option would have been forgoing therapy altogether—something I never considered. Yes, therapy can be extremely expensive. It can also be very valuable. For me, it’s worth it.

 

Deb Weiss is not a health, insurance, financial or medical professional. She is also not a therapist.

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21 Comments / Post A Comment

I currently don’t have insurance and am paying $125 a session for my therapist. And I got the discounted rate because she’s part of the company that bought out my old psychiatrist’s practice (my new psychiatrist also gave me the discounted rate of $95) and they promised all his patients discounts if they stayed. I go every other week to therapy (I sat it up to match my pay periods) and I’d probably go every week if I could afford it. I try not to think about how much faster I could get out of debt with what I’m paying monthly in therapy, for she’s helping me get control of the habits and emotions that got me in debt in the first place.

mbmargarita (#781)

This post, man. This was my life for a while. Not to mention the fact that I was trying to limit my options to someone I could reach within easy walking distance of my office, so I could try to slip out discreetly, and how stressful it was to try to imagine being able to get out of my office for a weekly standing appointment, when my office really isn’t flexible about that kind of thing and I was a very junior person on the team. It got so dispiriting that my best friend took charge of finding leads for me, and even then everyone would answer the phone and explain that they WEREN’T actually taking new patients, or DIDN’T actually accept my insurance. I ended up getting a recommendation from my mom for an out-of-network therapist who would work with me over the phone, in the evenings, for $60 a pop. There was no insurance coverage but not having to worry about getting out of the office was worth every penny.

PicNic (#3,760)

I found my therapist on Craigslist.

I had just moved to Boston, had really terrible insurance with no mental health coverage, and was desperately in need of someone to talk to. She does sliding scales with the cheapest being $50 for 50 minutes. When I started seeing her I was making $25k a year. My mom helped out at first but when I moved on to my next job making $32k I started paying for it on my own. 5 years later I’m making 53k and she has never raised my cost. I moved from seeing her every week to every other week and was able to do so because of the tools I’ve learned in sessions with her. The moment I met her we instantly clicked, much like the author talks about the first very expensive therapist.

Once I got better insurance with mental health coverage I did check out a few other therapists. I hated them all and by then I’d established such a good rapport with her I decided to keep paying out of pocket. Sometimes I wonder if I’m wasting money by not using my insurance (which has zero deductible and would be $15/copay for eternity), but when I take stock of how much better I feel seeing her, it’s so worth it.

I love hearing about the process different people went through to select their therapists. Best “How We Met” Stories ever :)

Teach it like you preach it, Deb Weiss! I also found my therapist on therapists.psychologytoday.com, very useful and accessible. I have recommended it to people in my life who, like me, felt that being in therapy was a foreign concept from Woody Allen movies and had no idea how to go about finding a cool therapist who would work for them.

CaddyFdot (#2,686)

@Lily Hudson@facebook Me too! I also used it to help my sister find someone, and recommended it to two other friends when they asked/seemed interested. It’s got a good set of search options (including insurance type), a blurb by each provider, and links to their websites, so you can get a sense of their approach.

pterodactylish (#2,321)

Yes, this.

squishycat (#3,000)

I don’t think I’ve ever had a therapist/psychiatrist who accepted insurance – I’ve always had to bill my insurance myself.

PicNic (#3,760)

@squishycat how does this work?? Do you get paid invoices from your therapist and then submit? What kind of insurance do you have? I’d love to be able to submit mine!

rabbitrabbit (#3,404)

@PicNic This is the point I was going to make; I couldn’t tell if the author of this piece understood that just because a doctor doesn’t accept insurance doesn’t mean your insurance can’t cover the treatment. It just means they won’t do the dirty work of filing paperwork and dealing with the insurance company directly, and that you have to get ‘out-of-network’ care. This likely means higher costs, and laying out perhaps thousands of dollars in upfront payments to a doctor while you wait to be reimbursed by your insurance company. But if you can swing this and are willing to put in the time and energy to understand your insurance policy, file all of the right paperwork on time, ensure your insurance company is paying you what they owe – and haggle with them when they inevitably try to screw you over by ‘accidentally’ incorrectly processing your claim (a dozen times in a row) – it can work.

OfficeDrone4 (#4,080)

@squishycat

This is how I do. It can be frustrating, and the new DSM codes led to some fun this calendar year, but I find it worthwhile.

I have a PPO plan and its a $25 co-pay for in-network (and as the author notes, NYC in-network care is very difficult to navigate) or 70% of cost after my $500 deductible (and 100% if I reach my max out-of-pocket limit of $3500).

@PicNic – you get paid invoices from your therapist and then you submit the claim form to your insurer yourself. There is a fairly long lag time (at least with my insurer, I almost always don’t get payment until 30 days after the visit, despite sending in the invoice the day of the visit). After initial hiccups in the first few months, it almost always goes smoothly, and can be a great option.

Ugh. I’m six months in with my therapist, and I’m feeling like it isn’t going anywhere. Starting this process over again is EXHAUSTING.

ragazza (#4,025)

I guess I was lucky–I found my therapist through a referral (actually a referral from the therapist of my boyfriend at the time, who was the impetus for me seeking therapy in the first place), I liked her a lot, and she took my insurance. (Later she stopped taking it, so I had to take the out-of-network hit. Switching therapists is not like switching dentists.) But I hear a lot of stories like Deb’s from friends who have tried to get help, and it makes me sad.

I just stopped going to therapy after 10 years (with my therapist’s blessing) because–well, it worked! I now feel I have the tools to work out my problems and I’ve learned to recognize the patterns in my behavior/reactions and address them more productively. Toward the end I was only going once a month, but over the years it was a hefty investment, even with insurance. I am lucky that I was able to afford it.

workerbee (#638)

I pay $100 / 60 min session 3X month. For couples session, I pay $150 per session 2X month. Hubby pays $100 2X month – so, roughly almost $1,000 /month in therapy. NO insurance, cash money out, baby. No Visa, either – it’s real cold cash.
My husband and I keep saying “we could be in Europe with all we’re spending.” But, we see it as a 1 year investment worth it to reconnect – married for 10 yrs nearly.

dora_nyc (#4,026)

@workerbee Hey, it’s cheaper than a divorce! (Umm, at least that’s what I say when shelling out my hard-earned cash.)

I’ve seen two psychiatrists. In Canada it’s covered by your healthcare so you don’t really ‘shop’ for them in the same way. You first see your family doctor and they make the referral to a psychiatrist in your area. From my experience you just get a spot with whoever is accepting new patients and can see you as soon as possible.

I started seeing my first therapist when I was 17 and I went to him because my mom went to him. So it was more or less out of my control, but it worked out okay. I loved him and saw him until I was 21 and moved out of the province.

The second psychiatrist I saw, when I was 25, was referred to me by my doctor who I simply went to saying I was depressed/suicidal/whatever, and she made the appointment (“Okay, you will go see soandso at this time.”). He was not a good fit for me and after a year he asked me not to come back (really!) and I never saw anyone again after that. So it’s kind of a gamble being referred by your doctor but no more than picking a name out of a directory, I guess.

@Deb of last year@twitter Er, only free if you get a referral from the family doctor you may or may not have. Otherwise, you pay for it like all the other people. At least in Ontario.

notpollyanna (#2,841)

I’ve been seeing therapists and such since I was 17, so my mom handled it for me for a while. Then when I started handling it, I was still seeing the same people. But none of that was helpful. I went through several therapists, for months or years each, before I found one that helped. The others ranged from benignly unhelpful (probably their strategies were helpful for others, just not for me), to psychologically abusive, to creepy. Finding a new therapist was always sort of random. I found my current, best, therapist via recommendation by my dietitian at the time who saw me rapidly descending into a deep depression. I went to current therapist armed with demands, learned from so much bad treatment, asked if she could deal with them, she said yes.

Finding a therapist just sucks. You are usually doing it when you are very vulnerable and not necessarily capable of making good decisions. You are likely to take the first person who seems remotely helpful because you are so desperate. I wish that therapists were better at referring patients to colleagues when they aren’t able to help, so that the process is easier on people.

Dealing with all that while being unsure of how you will pay for it, that sucks more. This last round of therapy I had a lite version of that. I didn’t make enough money to cover rent, etc. so I was living with my parents. I didn’t have the monthly ~$1000 it would have taken to move out, but I did have enough to cover therapy. After my deductible, therapy has been around $20 a session, $145 before that. My therapist isn’t in-network for HMOs, but is for PPOs, which is massively benefical to me.

ladydee (#2,825)

Social worker here — imagine how difficult this system is to navigate if you have schizophrenia, are homeless, and/or have no support systems in place. Most states provide some sort of coverage for the chronically mentally ill but it’s its own arduous, complex, frustrating system. Please do support programs for community mental health when you can!

jenni liles (#4,372)

The system is definitely a mess from both the provider and participant perspective. It is just as confusing and difficult to navigate attempting to get accepted into the various insurances prospective therapy participants are covered under as it is finding a therapist who carries your insurance.

I have also been in the situation of sticking with a therapist I loved after changing insurances. I also consciously keep my rates flexible to accommodate the financial situations of the people in my working class town.

And always, I am working to be listed as a provider on as many insurances as possible.

Dr. L. (#5,249)

As a psychiatrist in NYC, I was struck by the irony: I couldn’t afford to see myself! So, in an effort to provide great care at lower cost, I hired two excellent Psychiatric Nurse Practitioners. So if you need meds management and don’t want to have to give up your psychotherapy or make other sacrifices, call us at (212)868-5550.

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