%20(175%20%C3%97%20350%20px).png)
Of course, when we are looking for a therapist, we want to work with someone we can afford. Many of us assume we want to work with someone who is in-network with our insurance (more on exactly what this means below).
I'd like to share a few secrets with you. But first, a request: Please read this post in its entirety before X-ing out of this screen and assuming therapy is outside of your price range. That may not be the case.
Secret #1: As frustrating at it may be, you will likely have more options for therapy if you go outside of insurance, or use something called Out-of-Network benefits (more below). I will share with you why.
Before I dig into your options outside of insurance, let's first understand our options within insurance.
Generally, if a therapist is in-network:
The general benefit of this system is: If a therapist is in-network, you only owe a co-pay at the time of your session.
Secret #2: A number of flaws exist with the insurance system the way it currently works, which cause the vast majority of therapists (especially in NYC) to not accept insurance in-network.
Here are just a few:
This list is not exhaustive, but provides a glimpse into the ways that working with a therapist outside of insurance may actually empower you to feel more independent and more in control of your own work and progress, without being at the mercy of an external third party.
During your search for a therapist, you may come across something like this on your therapist's website, or the website of the group practice they work at:
"We work with clients insured by many insurance companies on an out-of-network basis. Our licenses, training, and education qualify for out-of-network reimbursement. This means that most insurance plans allowing members to go out-of-network for mental health will reimburse you for our work, according to the payments they allow. Check the nature of your insurance and what it will reimburse you."
You may be thinking, "Cool, what does all that mean?"
Secret #4: These things called "Out-of-Network Benefits" can be a tremendous cost-saver if you have them. Through Out-of-Network benefits, you may be able to receive money back from your insurance company even if you are seeing a therapist who is not "In-Network."
Let me explain. And note: Should any of this add to the confusion rather than relieve it, please do not hesitate to email me at [email protected] to break it down even further.
Out of Network implies that the therapist is not "in-network" with your insurance company. Building off the above, this means the therapist is not in your insurance company's directory, or "yellow pages."
However, insurance companies recognize that they do not work with every single therapist. They also recognize their in-network database cannot accommodate the demand for therapy, and they likely do not work with enough therapists who have open availability.
Based on your specific plan, or how much you have spent on healthcare expenses otherwise, the insurance company will pay you money back after your sessions to help your work with your therapist become more affordable for you.
Some more terms to talk through:
The specific deductible, percentage reimbursement, and allowable amount varies widely by person and by plan. Your out of pocket spending does not need to be on therapy -- it is possible you have already "met your deductible" through other healthcare spending.
Now we're talking. Though talking with insurance providers (or, let's be honest, making an IRL phone call) can be intimidating, I urge you to take a few minutes to make the call. The call likely won't take more than 10 minutes and you'll be so relieved to know this information. It may mean a lot of savings for you.
Call the number on your insurance card and ask:
With the above information, you will learn what amount you have to spend for your benefits to kick in (your deductible), and you will learn how close you are to that. You will also learn what percentage insurance will pay you back once you reach that point.
Each month, your therapist will provide you an invoice or receipt for your session fees. If your therapist does not do this, ask them to. They will understand. You submit this invoice to your insurance company to receive your reimbursement.
If this all sounds like a head ache, you're in luck. Secret #5: A sister organization, Reimbursify, can help.
Through Reimbursify, you can quickly and easily register, find your provider, file your claim, and get reimbursed.
If you prefer to not use an app, I recommend discussing with your therapist how to "file your claim" to receive your reimbursement. Once you do this a few times, you will get the hang of it, and it will feel like clockwork. The first step is often the hardest and most overwhelming but it does get easier.
If you have ever searched for a therapist, particularly here in NYC, you know how difficult it is to find a therapist who accepts your insurance in-network. Some of the reasons for this are mentioned up top. The most pressing? Insurance companies do not reimburse a living wage and therapists want to prioritize the privacy and trust between you and your therapist to do the best work possible for you.
Running with the same example as above: If your co-pay is $55 but you have to see an in-network therapist, who can be extremely difficult to find, or your out of pocket expense becomes $85 to see any therapist who has a license, you significantly broaden your options. The average rate for therapy in NYC is $250/session; however, you can let your therapist know you have financial concerns, and they will likely be open to negotiating a fee with you that fees fair and appropriate for both of you.
You can finally connect with a therapist who is uniquely fit to help you and your particular needs, rather than searching merely based on whether the therapist is in-network with your insurance provider.
Most therapists, particularly here in NYC, offer something called a "sliding scale" to clients who express financial need. This means they are willing to negotiate their fee with you to help your work together become more accessible for you.
For example, if a therapist's full fee is $200, they may be able to accommodate fees much lower, perhaps as low as $80 per session, depending on your needs. Most therapists prefer to have this conversation with you to determine together what is reasonable and fair for both of you.
As intimidating as it may feel, I encourage you to reach out to a therapist who you believe may be a strong fit for you to inquire about their sliding scale. The worst thing that happens is the therapist says they are not offering a sliding scale at this time. Better to know in the beginning!
A note worth mentioning: Please honor the therapist's experience and time. Many of you may really need a sliding scale. That is absolutely okay and you deserve therapy. That is what sliding scales are for.
If you believe you can invest in therapy, I urge you to do so. The more you value your time and the more you value the time and experience of your therapist (to the best of your ability and budget), the more you will get out of the work. More on evaluating your budget below.
Once you know your benefits, I recommend reviewing your budget, and being honest with yourself about what you are able to invest in yourself and your therapy.
Food for thought: Eating out, say, 3 times per week, costs on average $7,575 in New York City per year. Paying $100 for therapy, going once per week, and taking 4 weeks off (people get sick and go on vacation sometimes) will cost you $4,800 per year. You are buying a weekly reserved time with a live person who has training and experience to uniquely help you become the best version of yourself. I personally believe that is worth cooking groceries more often.
Sometimes, you really cannot afford more than a co-pay. We have all been there. You still deserve therapy and you still have options. In this case, going through the search for an in-network therapist, or visiting an agency or institute may be the best route (please don't hesitate to reach out if you need an agency or institute recommendation in NYC).
If you really can afford to invest in your healing, but you aren't yet sold about whether therapy is worth the money, I urge you to give it a chance. Set a time period -- say, 6 months, or one year -- to experiment. If you do not notice changes in your thoughts or behaviors, learn more about yourself or your intricacies, or feel marginally lighter after each session, you can at minimum say you've really tried.
I hope this rundown of insurance and your payment options has been helpful for you. As always, please do not hesitate to reach out ([email protected]) with any more specific thoughts or questions.
Alyssa Petersel, Co-Founder and CEO of My Wellbeing and author of Somehow I Am Different, graduated from Northwestern University in 2013 with dual BA degrees in psychology and international studies, graduated summa cum laude from New York University in May 2017 with her Master's in Social Work, and graduated from The Writer's Institute non-fiction program at CUNY Graduate Center in May 2017. A native New Yorker, Alyssa now lives in Brooklyn and enjoys running, coffee, community, and social justice.
Complete our free, confidential questionnaire to easily and quickly match with 3 personalized coaches or therapists.
