Updated: Aug 17
Further, it seems that anytime you find a skilled practitioner, they’re not in-network with insurance; thus, making it even more difficult to have access and receive quality care!
Specifically in the mental health industry, psychiatrists are typically booked up weeks to months in advance making it more challenging to receive help when you need it now. Sometimes, your life could literally depend on it!
I hear you…it’s frustrating!
I am going to tell you exactly why this is and provide specific steps on how to get the help that you need.
I will review the reasons for the cost of therapy, the role that insurance plays in determining the quality and access of mental health services, the benefits of working with an out-of-network therapist who knows their worth, and tell you exactly where your funds are going when you pay your therapist.
BONUS: While interviewing a therapist to determine if they are right for you, ask this one question and it will tell you everything you need to know –
“What is your self-care routine and how are your rates a reflection of you and your standard of care?”
See #5 below to learn more about this.
Is therapy covered by insurance?
Your health insurance provider will tell you whether they cover therapy and under what conditions they will cover it. The law doesn’t require them to pay for the total cost of therapy, if it’s covered at all. They may cover a portion of the payments.
Using your mental health in-network benefits
When a mental health provider is considered an in-network mental health clinician, this means that the mental health provider has entered into a contract with the insurance panel and is able to provide treatment to members who have mental health benefits that are covered under their plan.
This contract sets the rate that the mental health therapist is paid, dictates which treatment models (i.e. such as CBT) can be used, and mandates the following:
1) A mental health diagnosis
Note: Whether a mental health diagnosis exists or not, a diagnosis is still REQUIRED in order to be approved to cover services. Read that statement again.
Not only is this unethical but it is profoundly immoral to label a person with a mental health disorder when their behavior, in fact, does not fit criteria. I always ask clients to evaluate the potential impact this could have on their future.
A few limitations of having a mental health disorder diagnosis are:
a) Preventing you from participating in the armed forces – if you have a mental health diagnosis and/or take at least one psychotropic medication, you will not be permitted to join the armed forces. While exceptions can be made, they are rare.
b) Preventing you from getting a job if you have given written consent for any healthcare practitioner to share your health history (not just a mental health provider, primary care physicians can issue mental health diagnoses as well). It is important to note that this is not common practice but it can and has negatively affected clients.
c) It can stigmatize you and cause you to believe that the condition is worse than it actually is – if you have been issued a diagnosis of Borderline Personality Disorder but do not fully understand what is meant by the diagnosis you may research on your own and run into copious amounts of misinformation; thus, deepening feelings of shame and guilt. This can, in fact, make the situation much worse.
Always be sure to be clear on the diagnosis your mental health practitioner has issued.
2) Access to your complete treatment record
This includes, but is not limited to, mental health treatment notes, mental health assessments, intake documents, discharge documents, health history information provided by other healthcare practitioners, disability requests, letters of recommendation, etc.
Note: whenever you begin services with an in-network provider, you have already provided written consent for this information to be shared at the time that you signed up to receive benefits. Your insurance company can contact your mental health provider and request any of the aforementioned information without informing you at the time of the request as you already provided consent when you signed the contract to receive benefits.
3) The type of mental health care you receive
The only types of treatment that are permitted for the practitioner to use must be approved by the insurance company. Insurance companies limit the treatment models to those that are strictly evidence-based. For the most part, this is not such a bad thing; however, for those who are interested in receiving complementary and alternative treatment modalities, such as Reiki, massage, naturopathy, reflexology, spiritual guidance, etc) the insurance company will not cover these services.
In other words, they get to decide the definition of health and how it is achieved and/or maintained by limiting the access of healthcare services to treatment models with which they deem to be effective. This disregards a wide array of services that more and more individuals are interested in receiving because the agreed upon options do not work for them.
Using your out-of-network mental health benefits
A mental health provider is considered out-of-network when a mental health clinician provides a service that the insurance company covers but the mental health practitioner does not currently have a contract with them.
Under these circumstances, the member is required to pay the mental health practitioner’s full service fee but is permitted to submit claims to the insurance company for reimbursement. These payments are applied to the member’s out-of-network deductible.
The good news is that while coverage varies from plan-to-plan, insurance can reimburse you around 60% of what you paid out-of-pocket to your therapist upon submitting claims to your insurance company.
How much does therapy cost and why does therapy cost so much?
The price of therapy. as well as the reasons for the disparity from one mental health practitioner to the next, are vast and extend beyond the scope of this blog.
However, some important factors to consider that might influence the therapist’s rate are:
1) How competitive the area is for therapists
The more therapists in the area, the more likely the rate will be less while fewer therapists could mean the price is higher.
2) Living in a rural area versus an urban area
See explanation for number 1.
3) The experience of the therapist
Some therapists will base their rate on how long they have been in practice while others do not use this as a determining factor at all.
4) The cost of running a mental health private practice
Whether or not the therapist has a staff, is a solo or group practitioner, cost of overhead, cost of business expenses, etc are all factors that can determine the cost of therapy.
If you are seeing a therapist who is a solo practitioner, there is a good bet that the rate he/she is charging is not only to cover the 50 minute session he/she is providing but also to the following expenses:
Phone and fax
Accounting and practice software
Accountant and Lawyer Consultations
Mandatory continuing education courses to maintain licensure
Professional organization memberships
Additionally, the solo practitioner is oftentimes completing many or all of these tasks all on his/her own.
The rate you are paying is not just for your therapy, it is also to compensate for hours spent to run the business, business expenses, as well as personal compensation.
5) The value that the therapist attributes to themselves and the services they provide
Oftentimes when a therapist is providing a low price, this can be a reflection of how they value themselves and how they run their business.
Those who are committed and motivated to continuously pursue self-improvement tend to hold themselves in higher regard, value themselves more, and this will show up in their work, regardless of the industry.
Their price will reflect this.
Our therapists at Blue Sage Counseling and Wellness are committed, life-long learners and if we are not in session, we are reading, collaborating, and furthering our skill set through a multitude of modalities to ensure that you get the absolute very best top-notch care
Our therapists participate in weekly coaching, supervision, and our own therapy to prevent burnout, to take care of ourselves to ensure our work is effective, and because we are in it for the long haul.
Practitioners who work for group practices or agencies often have overwhelming caseloads, are drowning in paperwork, are drastically underpaid, work very long hours, often travel long distances to see clients, and are vastly underappreciated.
This is why your past therapy has not been very effective or your therapist seems tuned out.
At BSCW, we keep our caseloads at a manageable number, work/life balance is mandatory, practice healthy boundaries, and engage in continuing education on a weekly basis so that we have the physical and emotional resources to make you feel valued and get you the results that you need.
This is our promise to you and this is how you definitely get what you pay for.
6) Countless hours are spent on the phone verifying insurance benefits and chasing down payments from insurance companies that can last for weeks or months
Denial of insurance reimbursement can, and oftentimes does, result from errors that range from minor to being the fault of the insurance company getting it wrong.
There was a time period in which I waited three months to get reimbursed by an insurance company because they claimed that I had made an error when in actuality it was an error on their end!
Conclusion: Is therapy worth the cost?
Naturally, the answer to this question is it depends on the individual. With therapy, you are going to get out of it what you put it into it. Every time.
If you are questioning whether or not therapy is right for you, ask yourself the following questions:
1) Am I ready to get serious about my life, face the problems I’ve had for a long time (and have likely been avoiding), and finally get some answers?
2) If therapy is too expensive for me, in what other areas of my life am I willing to make arrangements in order to make myself a priority?
3) How do I find a good therapist? Ask friends, family, doctors, perform Google searches, ask other practitioners in a similar field, check out the therapist’s website. A therapist’s website is like their store front. In today’s modern technology age, you should be able to decide whether or not a therapist is worth reaching out to based on the quality and content of their website.
4) How do I define value? Is it money? Experiences? Time? People? On what do I spend my money already that I find valuable? On what do I spend money that I do out of habit but no longer find valuable? Could therapy be valuable to me?
5) Am I ready? Sometimes embarking on a journey of self-discovery can be too much for some people. They have simply been living an existence that is comfortable for too long and feel that therapy would or is opening areas of themselves at a faster rate than which they are comfortable.
The purpose of therapy, to me, is about getting out of that comfort zone because getting out of it is where substantial change happens.
If you are not ready to be encouraged in this way, there is no shame in that but don’t give up.
Therapy can be expensive and yet it is valuable. While it can be more affordable by using your insurance benefits to cover this expense, there are risks involved in this option as well.
Regardless of whichever path you choose, the point is about getting the help that you need and pursuing the path that works best for you.
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