Ah, we’ve arrived at my least favorite topic in the world: insurance. I. Hate. Insurance. But I love my therapist, and I want you to get a chance to love yours too. The truth is, it’s pretty difficult to get therapy without insurance, because it can be expensive. Most therapists charge somewhere between $75 and $100 per visit, although there are outliers on either end. For instance, university psychological services are the best. For four years, I paid $60 per semester to see my therapist as often as I wanted, plus psychiatry visits once every few months. Now, one individual session costs me $60. If you’re in college and you’re considering therapy, I urge you to go. It will never be this affordable again, take advantage!
Unfortunately, most universities don’t accept non-students, but if you can’t afford $60/session or if you don’t have insurance, that doesn’t mean you should give up on therapy! It just means your options might be more limited. Some therapists charge based on a sliding scale, so you may be able to afford them out-of-pocket, and most cities also have clinics that only accept clients without insurance or clients with Medicare or Medicaid.
I’ve been very lucky to have health insurance my whole life, but even with insurance, paying for therapy can be frustrating. Especially if, like me, you aren’t 100% sure how insurance even works. It took several months, countless phone calls, and many, many breakdowns, but I think I’ve finally got the gist of it:
Insurance is meant to secure a fair price for your care (theoretically). The provider (dentist, therapist, hospital, etc.) charges a certain amount for services and sends that number to the insurance company. The insurance people look at that number and decide how much of it the provider should really be allowed to charge you, and they send that new number back. Then the provider sends you a bill. What happens after that point really depends on what kind of insurance plan you have, so I can’t go into too much more detail, but that’s the idea. Usually.
Of course mental health care is different. Because we’re not already mentally exhausted enough. In many cases, you will find that your health care plan has a whole separate system for mental health care. Different people to call, different co-pays, different everything. One of the most surprising and irritating differences I’ve discovered is that most mental health care providers expect payment on the day that you see them. If you’re used to having co-pays or getting a bill later or anything like that, it typically doesn’t matter. They still expect to be paid in full at the end of your appointment.
So what happens if they charge more than your insurance would have allowed them to charge? Unfortunately, in most cases you have to contact the provider, send them proof that your insurance only approved them to charge part of what you paid, and hopefully they’ll send some of your money back. This is an unnecessarily confusing, terrible process that puts you in an awful position. I want to say that it’s because health care is inherently confusing and difficult to navigate from all sides, which is true, but the reality is that we’re easy to extort.
If you are mentally ill or struggling, and you seek help for those issues, providers know you may have a hard time making all the phone calls or keeping track of all the paperwork necessary to pay a fair price. So they charge too much and make you pay right away because they know many of their clients won’t be able to do much about it. Pretty messed up, right? It makes me want to avoid the industry as a whole, but maintaining my daily life and general wellbeing depends on going to these appointments. Which they know. *sigh*
Just to clarify, it isn’t usually your therapist doing these conniving things. Many therapists are part of a group or office or something like that, and they simply work there. Sort of like how a doctor isn’t responsible for your hospital bill. Still, there are definitely therapists out there who want to take your money. We’ll talk more about that next week in Part 3: Good Signs and Red Flags.
Lastly, I just want to say that even though it’s difficult, that doesn’t mean you can’t do it. You absolutely can. It might be hard, it might go poorly at first, you might lose out on a little bit of money as your figure everything out, but you can absolutely do this. I will leave you with my three best pieces of advice for dealing with mental health insurance:
- Call your provider and your insurance company and ask the same questions about cost and care. If they’re telling you different things, call your insurance back and tell them something weird is going on and just ask them what to do. Try to be polite. Yes, the system is garbage, but the person you’re talking to isn’t. Keep calling until you feel confident. This may take a while. Like, several days. Keep calling. It’s important that you understand your insurance.
- Find a way to stay somewhat organized, and keep everything. Keep every receipt, every Explanation of Benefits (EOB), that way when someone tries to short you or not pay you back, you have the paperwork to back up your claims.
- Ask for help. I would not be able to cope with the horrors of insurance without my husband and parents helping me sift through all the bullshit. Remember, they design it this way on purpose, thinking you won’t be able to stay on top of things. Maybe you can’t, but your support system can. You are not weak for needing help navigating an intentionally confusing system. You’re gaming the system and making it work for you, and there’s nothing wrong with that.