2. How do people pay for therapy?

You might be wondering why financing therapy appears before finding a therapist on this list. I know it might seem backward to think about the money first but there is a practical reason for this. Figuring out how you can pay for therapy will be the first guidepost that will help you know where to look for a therapist.

For many of us, therapy is a longer-term investment. This means that if you find a resource that is more than you can’t afford, you may be stuck ending the relationship with that therapist earlier than you wanted to — simply because you cannot afford it for long enough. This is why paying attention to how you can pay for therapy and invest in yourself longer-term can be extremely useful.

Here are the most common ways that therapy is paid for:

1) HEALTH INSURANCE:

Health insurance usually covers mental health services with a co-pay based on the policy you are subscribed to. There are some things to be aware of before seeking out coverage through your health insurance. First, health insurance companies usually only pay for services that are deemed medically necessary. Each insurance company has outlined diagnoses from the Diagnostic Statistical Manual (DSM) that are considered medically necessary mental health issues. This means that you will likely be receiving a diagnosis from your therapist when they submit for the insurance company to pay for the services rendered. A diagnosis is usually documented at the end of the first session. Second, there will likely be a co-pay associated with your sessions. This means that sometime before or after each session, your therapist will likely collect that fee from you.

You can expect that your therapist will know what your co-pay is; however, it is always safest to call your insurance company and ask them what your co-pay is directly prior to engaging in services so that you can plan for the cost. And lastly, the information that is written in your chart is your personal health record, which means you can request to have access to it at any time. In the case of getting a formal diagnosis from your therapist, you can simply ask them what they are putting on your medical record or request the chart altogether.

2) SLIDING SCALE:

Sliding scale can look different based on the agency or practice that is offering the resource but typically a sliding scale therapist means they will work with you to set a price that works for you depending on your situation. This usually comes with a clearly delineated process to find a fee based on your income.

In private practice, therapists have more control over how they assign fees. Some therapists offer spots based on what you believe you can pay. Other therapists may share the lowest rate they’re willing to slide down to. Just to be clear here, sliding scale and low-cost options are *not* “bargain therapy” and do not mean that you cannot ask for or look for a new therapist or that it will be less useful for you. All therapy services should meet ethical guidelines and your needs. If that isn’t happening, you can and probably should look for a new therapist.

3) COMMUNITY MENTAL HEALTH:

Community mental health sites are usually nonprofit organizations that offer low-cost, no-cost, or sliding scale therapy services based on whatever funding they receive. Many agencies are government-contracted sites. Government-contracted agencies usually have contracts with the local department of mental health services in your region. This means that any services that are rendered are usually paid for through the local funding such as the Medicaid program, which is a state-run insurance program for individuals who have low income or no income, or county funds.

Other nongovernment contracted agencies receive their funding through grants, donations, or even the sliding scale fees that they charge their clients. These organizations also provide low-cost, no-cost, or sliding scale services. The difference usually has more to do with what services they can offer and how much paperwork they will have to do than the quality of the therapy services rendered. Again, low-cost or no-cost therapy services are not bargain therapy in that you should be receiving high-quality services no matter how you finance it.

4) EMPLOYEE ASSISTANCE PROGRAMS (EAPs):

Some employers, especially bigger companies and organizations, have wellness benefits that might include access to a therapist on staff or a contract with off-site therapists. These arrangements usually have a session limit per year and will depend on your employer’s benefit package. You can usually find out about these resources by inquiring with your Human Resources department. These resources can be really great to help people with short-term therapy for issues that may resolve over a few sessions or even just to help people get started in the process of engaging with therapy.

5) VICTIM’S ASSISTANCE PROGRAMS:

This is a program that is not as widely known; however, it is an incredible resource for any individual who is the victim of a crime or is in close proximity to a victim of a crime. Most states have programs that assist the victims of crimes with lots of financial aid. A victim of a crime is defined differently in each victim’s assistance program but it is usually pretty clear on the program’s website and will often require documentation of a crime being committed against a person or a police report that demonstrates that. To find more information about these programs, you can do a quick online search with the keywords “Victim’s Assistance Program (your state here).” These programs offer financial support, referrals to resources, and support though legal processes.

6) SCHOOLS:

Most school systems provide access to therapy resources for their students. In K–12 programs, there is usually a school psychologist, therapist, or social worker available. To access these resources for yourself or a child, simply talk to a teacher or an administrator to get a referral for the services.

Universities often have counseling centers that provide all sorts of therapy resources, including group and individual therapy. These programs are usually limited in the number of sessions that you can have in a semester or calendar year. For that reason, they are often a wonderful resource to dip your toe in the pond of therapy and then get referrals for more permanent therapy services in the community should you want or need it.

7) SELF-PAY (OR OUT-OF-POCKET):

Self-pay is when a person is able to afford paying for therapy services out of their own pocket. If this is you, I always suggest looking at how much you can afford without stretching yourself too thin — and then looking for a therapist in that price range.

One thing to consider if you are a self-pay client is whether or not you have access to a flexible spending account, health savings account, or health reimbursement account. If this is something you’re considering or lucky enough to already have access to, talk to a financial advisor or your tax preparer to discuss this further and see how you can use pretax dollars for your therapy costs. After all, therapy should be part of your regular healthcare routine if you want or need it to be.

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