How Do I Pay for Counseling/Therapy?
The cost of therapy depends on if you will be using your medical insurance or paying out of pocket. There are good and bad reasons for both. The most important factor is which one will allow you to stay engaged, committed, and present during the treatment process.
Therapy normally starts at one time a week for 45 – 60 minutes for several weeks. The length of therapy is dependent on many things, such as, the extent of the issue which you are seeking help, openness to self-exploration, and/or if there is a chronic condition that requires long-term support. Therapy will gain better momentum starting out with frequent contact and then tapering down once treatment progress can be maintained for longer periods of time.
As you can imagine, using your insurance to help cover the cost of therapy will alleviate any financial strain. If affording treatment is a factor for you, this would be the best option. However, you will need to confirm that the therapist you choose is contracted with your insurance company (aka in-network).
Not all plans allow you see providers that are not in your network. Out-of-network benefits are typically very limited. If you want to use these benefits, please contact your insurance company to get the details of your coverage. Our office can provide periodic statements, or Superbills, for you to submit for reimbursement.
YES, the therapist is in your network:
The therapist will be reimbursed as per the agreed upon contracted rate. In most cases, this will be lower than the therapist’s normal cash rate. What your financial responsibility will be depends on several factors: do you have to meet your deductible first; is there a coinsurance percentage or copay; have you had a lot of medical claims and met your Out of Pocket (OOP) Maximum for the year.
Let me illustrate what that would look like:
John has a $500 deductible he must meet before his insurance will cover any cost (he has not had any medical expenses to date). His copay is $20, per session. The contracted rate for an in-network therapist is $100 for the intake (1st) session, and $80 for each subsequent 45-minute session. John will have to pay the first $500, and once that is met, he will pay the $20 copay until the plan renews for the next year and his deductible resets to $0.
*NOTE: some plans will waive the deductible for mental health outpatient, in-office care. That is why it is so important you call your insurance company prior to selecting a therapist.
That is the good news. There is a downside to using your insurance. All insurance companies require the therapist to submit claims with a listed mental health diagnosis (from the DSM5, The Diagnostic Statistical Manual). If the treatment is not short-term, or is more than one time a week, they can and/or will require the therapist show there is medical necessity for this more intense treatment. What that would mean to you, is that the therapist would have to give a diagnosis that demonstrates a more acute or chronic condition. They could also request ALL of your medical records to audit them for medical necessity or they will deny coverage. In essence, they have some control over the frequency and length of your treatment. Their decisions will be based on the mental health diagnosis you are given.
*NOTE: This means that diagnosis will be in your medical record. This information is protected by HIPAA however but it can be accessed under special circumstances by the legal system.
**It is important that you understand a judge can subpoena your entire medical record and the therapist must abide by the request.
* PAYING OUT OF POCKET
Paying for the therapy yourself (commonly called “self-pay) has the opposite risk and benefits of using your insurance. The frequency (e.g., two times a week) and length (e.g., longer than 3 months) of your treatment cannot be dictated by the insurance company. You and your therapist are able to tailor your treatment in the way that best serves your needs. No one will have access to any of your treatment information (e.g. diagnosis). However, your entire medical record can still be subpoenaed by a judge.
In closing, it is ultimately your choice whether to use your insurance or pay out of pocket. As you can see there are many factors to consider, and they might not all apply to you. What is most important, and what to keep in mind when deciding, is which one will allow you to get what you need from therapy and show up ready to do the work.
If you have contacted your insurance company and are still unsure what is the best choice, Healing & Wellness staff can answer any questions to help you decide.