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Affording Therapy

If you've struggled to find a therapist, you are not alone. Psychology Today is one great resource to help, as is Postpartum Support International.

If you've struggled to find a therapist who accepts your insurance, I feel ya'. Many mental health professionals (like me) only participate in one or two insurance networks, and fewer and fewer therapists participate in any insurance networks at all. The reasons therapists give for giving up on insurance are numerous:

  • The amount of paperwork they have to do for insurance companies results in hours of unpaid labor every week;

  • Even after doing all that work, insurance companies fight with them over paying claims, quibbling with everything from diagnoses to whether therapy is "medically necessary"

  • The amount that insurance is willing to pay is significantly less than what therapists need to keep their small businesses afloat

  • Many insurance companies are refusing to accept any new therapists into their networks.

Another issue you may have run into is downloading a list of in-network mental health providers from your insurance company, only to find that either none of the in-network providers are taking new clients, or worse, none of the names or numbers on the list lead to actual providers. Even if these inaccurate lists are simply a mistake or outdated, they're a symptom of a larger issue: finding an in-network therapist has become an impossible task for many people. And paying out of pocket for therapy might be equally impossible depending on your financial circumstances. Single Case Agreement A Single Case Agreement (SCA) is a contract between an insurance company and an out-of-network provider for a specific client, so that the client can see that provider using their in-network benefits (i.e., the patient will only have to pay their routine in-network co-pays for sessions after meeting their in-network deductible (if any)). The fee per session that will be paid by the insurance company is negotiated by the insurance company and the provider as part of the SCA. An SCA has to basically address the unique needs of the client and the cost benefits to the insurance company of the patient seeing you, rather than an in-network provider. The following are some of the conditions that must be met for an SCA to be granted:

  • The provider of your choice has a clinical speciality that is not available with any of the in-network providers (specialty can include cultural competency)

  • Geographical location - in-network providers are not available locally

  • Treatment by the provider of your choice will keep the client out of the hospital, or will reduce the cost of medications

If the client has had no luck finding an adequately skilled in-network therapist, then the client makes the case for an SCA with the out-of-network provider BEFORE commencing treatment.

Out-of-Network Reimbursement If you are hoping to use someone out of network, you can pay up front and appeal to your insurance to get some money back for sessions, as allowed by certain insurance providers, funds and healthcare programs. There are no guarantees. It is the best idea to check with your insurance company first*. You can also ask your provider to provide a "superbill" to assist you. A superbill is an itemized form which details services provided to a client. It is the main data source for creation of a healthcare claim, which a client sends directly to their insurer for consideration for reimbursement of part or all of the session fee. *If you plan to seek reimbursement from your insurance or Employee Assistance Program (EAP) AFTER receiving services, please clarify with your insurance/employer the following BEFORE starting sessions: ‏ • Benefits and scope of coverage ‏ • Annual deductible ‏ • Number of sessions allowed under coverage and process to appeal for more sessions ‏ • Coverage amount per session ‏ • Whether pre-authorization is required and whether referral is necessary to start therapy

Health Savings Plan Health savings accounts (HSAs) are like personal savings accounts, but the money in them is used to pay for health care expenses. You — not your employer or insurance company — own and control the money in your HSA . One benefit of an HSA is that the money you deposit into the account is not taxed. A health savings account (HSA) is a tax-sheltered account designed to allow you to use tax-advantaged money to pay for healthcare expenses, and if you do not need to use it to pay for healthcare expenses, then you can invest that money in the market, and the money will grow tax-deferred. In order to be eligible to use a HSA, you need to be enrolled in a health insurance program that qualifies as a high deductible healthcare plan (HDHP). HSAs are meant to be used to pay for qualified medical expenses in conjunction with a high deductible healthcare plan. Contributions are deductible on your tax return, even if you don’t itemize, and withdrawals for qualified medical expenses are tax free. Employee Assistance Program An Employee Assistance Program (EAP) is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems. EAPs address a broad and complex body of issues affecting mental and emotional well-being, such as alcohol and other substance abuse, stress, grief, family problems, and psychological disorders. If you have an EAP benefit through your employer, you may also qualify for single case agreement, allowing you access to the provider of your choosing, as long as they are approved through the EAP. Sliding Scale Sliding-scale therapy is simply therapy offered for sliding-scale fees based on a person's income. The way therapists set up sliding scales varies. Some assign a specific fee to a set range of incomes. For example, some use a formula to determine their fees, such as [0.001] x [Annual Income]. Public or private non-profit mental health clinics often offer sliding-scale therapy for lower rates than private practice therapists. One reason is that these clinics frequently receive income from sources private practice therapists don't have, like state or federal grants or charitable donations. Most therapists who offer sliding-scale fees mention it on their website or profile page. Many won't list their full fee scale online, as rates may change over time. To find out what fee you'd be assigned to pay per session, you can call or e-mail the therapist to inquire. Some may ask for proof of income, but some won't. Since most sliding-scale fees are tied to income, your rate may change if your income changes significantly. If you lose your job and have to take an interim job that pays less, your therapist may be willing to lower your fees, especially if you both already have a good working relationship.


Some private therapists and community mental health agencies receive donations to provide scholarships to clients in need of therapy, but without the ability to pay full fees. It never hurts to ask the provider of your choice if they have a scholarship fund that clients can access to reduce the financial burden of therapy.

County and Nonprofit Mental Health Services

County and nonprofit mental health agencies receive funding from federal, state, local or private donors to allow them to provide therapy to clients at little to no expense. Just because the services are free doesn't mean they are poor quality, but accessing these services may require you to go through a process of assessing your need before qualifying for services, and some come with waiting lists, so you can't expect to start services right away. The first place to start is googling your county name + "mental health", or by contacting Postpartum Support International, which provides online and telephone support and referrals as well as a list of providers and support groups by locale.


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