Talk may be cheap—but talk therapy certainly isn’t.
Here in the United States, at least, mental health therapy is often a luxury that only the privileged few can afford, a truth made particularly lousy when you consider how life-changing it can be whether you’re untangling complex emotions or dealing with a mental health diagnosis.
In big cities like New York where demand is high, many therapists don’t take insurance. Instead, patients pay out of pocket for their sessions—with bills that can easily total $200 or more per hour.
Even if a therapist does accept your insurance, they may not have room for you. This was my experience, and it’s a common one: About a year after COVID hit, I was feeling increasingly anxious about parenting a young child during a pandemic and decided to seek out therapy. I spent hours searching my insurance company’s website for in-network providers.
I landed on a list of 12 that sounded promising, then called and emailed each of them—and heard nothing. So I followed up. Only two of them got back to me: One told me she wasn’t taking new patients, and the other offered to add me to his six-month-long waiting list. (Not-so-fun fact: A few years ago, researchers staged this scenario for a study. Posing as patients, they called 360 psychiatrists listed as being in-network with Blue Cross Blue Shield—and were only able to book appointments with 26 percent of them.)
I was living in Boston at the time. If you’re in a more remote area, you may not be able to find any therapists within driving distance who take your insurance and have availability. In fact, 37 percent of Americans live in what’s called a “mental health desert,” areas where there aren’t enough pros for the population. (According to data from The Health Resources and Services Administration, it would take over 6,000 more mental health providers to fix this.)
It all sounds rather, well, depressing. But we’re here to help. We did a little digging for unexpected tactics that’ll help you score a great therapist—at an affordable price that allows you to have your daily Starbucks (and drink it, too).
Why Is Therapy So Expensive (and Affordable Therapy So Rare)?
It’s hard not to think, dude, these people be greedy. And therapists are well aware it can appear that way when they charge hundreds a session and don’t take insurance. But the full story is more complex. “We share your frustration,” says Amanda Craig, Ph.D., LMFT, a therapist with offices in Darien, Connecticut, and New York City. “It makes me so mad—it shouldn’t be so difficult to access mental health care.”
When setting their rates, therapists have to factor in a lot of behind-the-scenes expenses, like student loan debt. If they work for a group practice, that organization gets a cut of their earnings (usually around 30 percent). And if they’re in private practice, things like rent, taxes, and time off come into play, explains Michael Fulwiler, marketing lead at Heard, a company that handles accounting for therapists.
The reason many therapists don’t take insurance is equally thorny (every rose has its thorns, indeed). There are so-called parity laws in place that are supposed to ensure that insurance coverage for mental health care is comparable to other medical treatments. Yet reimbursement rates for therapy remain frustratingly low. “In some states, a therapist’s cash rate could be something like $100-150 per session, and they’ll only get half of that from insurance,” explains Fulwiler.
And, of course, taking insurance as a provider is about as annoying as navigating insurance as a patient—but on steroids, with piles of paperwork and reams of red tape. “First of all, you have to apply to be an in-network provider, and it can take months to be accepted,” says Fulwiler. ” And then, in order to bill insurance, you have to write up notes for the session and submit them. You also have to include a diagnosis code—and if there isn’t a clear-cut diagnosis, the therapist is forced into one, which can be ethically murky.”
There’s also something called a clawback, which basically means that the insurer can review a therapist’s records, decide that past sessions didn’t qualify, and take back the money that they paid, notes Fulwiler. “It can be thousands of dollars, months or even years later. It’s the kind of thing that could put someone out of business,” he says.
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7 Ways to Find Affordable Therapy
Sounds like it’s time for a health insurance redo. Until that time, use these pro tactics for finding, and affording, therapy when you need it.
Ask about a sliding scale. How to tell you therapist you can’t afford it? Haggling over healthcare can feel awkward if you’ve never done it before, but it’s totally okay to approach a therapist and say, I want to work with you, but I can’t afford your rate—is there anything we can do? Most therapists set aside slots in their practice for lower-cost sessions, because “as part of our ethical code, there’s an expectation that we give back to the community,” Dr. Craig says. It might seem counterintuitive at first, but therapists who don’t accept insurance actually have more flexibility to offer a sliding scale, Fulwiler says.
GOTTA READ: How to Tell a Loved One You Need Therapy
Hit up your local community services department. You may be able to get free or low-cost therapy via your local health department or human services center, Dr. Craig says. “Sometimes it’s only short-term, but you can at least get in quickly and get started, and they’ll often help you find ongoing care from there,” she says.
Get a referral. Maybe you’ve heard great things about a local therapist, but their rates are Gucci-level. Don’t be shy about reaching out to see if they know of an up-and-coming therapist to recommend. “I took two calls like that this week,” says Dr. Craig, who regularly mentors therapists working toward their licenses. “Some people may be turned off by the idea of a junior therapist, but in my experience they’re often super enthusiastic, creative, and totally up-to-date on the latest approaches.”
Work with a clinical intern. To elaborate on what Craig said above: If you live near a university with a master of social work program, you may be able to get free or deeply discounted therapy with an intern working on their required hours for licensing.
Check your insurance’s out-of-network coverage. Therapists who don’t take insurance can provide you with something called a superbill to submit to your insurance. I’ll use myself as an example here: I’m lucky enough to have a good PPO plan through my husband’s employer. After my out-of-network deductible is met, my insurance reimburses me for about 20 percent of what I pay out of pocket for therapy. It’s not making me dance happy jigs, but it’s better than nothing.
Consider telehealth. “You can only see a therapist who is licensed in your state,” says Fulwiler, “but opting for online sessions definitely opens up more options for you beyond where you can travel.” And, per a study conducted by Reed Consulting, telehealth is typically far less costly than in-person appointments. If you have Medicare, this tool can help you find providers that do the telehealth thing—they’ll have a little checkmark indicating the option.
Try a service like Open Path Collective. Open Path is a nonprofit aimed at people with an annual household income below $100,000. You pay a one-time membership fee of $65 and get connected to a collective of therapists who offer in-person or virtual sessions ranging from $40 to $70.
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