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Tell me if this sounds familiar to you: you decide that you would like to see an in-network therapist. You look through your insurance company’s database to find a therapist who takes your insurance and you call a few that you like.
You don’t hear back.
You then call several more therapists from the network until one returns your call. At this point, they tell you that they aren’t accepting new clients, they don’t take your insurance anymore, or they have a wait list.
You’re several hours, days, or weeks into your search and you still don’t have a therapist. It might leave you wondering:
If you’ve had this experience, you are certainly not alone. It can be so discouraging, particularly at a time when you would like extra support. It’s important to know that this situation is not a rejection of you; it is due to the way insurance works for therapists.
We at MyWellbeing are here to help. We’ll explain why it’s hard to find an in-network therapist, and a few ways you can find support more quickly without breaking the bank.
When I started looking for a psychotherapist, I thought the process worked similarly to the way I found primary care doctors. I could simply look through insurance directories to find support, right?
Not exactly.
Across all medical specialties, 89% of providers accept insurance. However, the rate is much lower for mental health practitioners. For example, psychiatrists are the least likely medical providers to take health insurance, at 55%. Some types of mental health providers aren’t even covered by insurance at all.
Why are mental health practitioners less likely to take in-network insurance? There are a few reasons:
Before a therapist can be reimbursed in-network, they need to join the insurance company’s panel. The applications require a lot of paperwork, and practitioners have to apply to each insurance company separately.
Insurance companies rarely follow up on the applications, so providers often have to follow up with insurance to make sure their application is being processed and hasn’t expired.
Additionally, insurance companies don’t always accept therapists’ applications to join their network. Rejections are rarely a reflection of quality. Instead, insurance companies close applications in particular zip codes or areas if they are “over-saturated.” If an area is “over-saturated,” even the best therapist in the region won’t be able to join until other therapists leave the panel.
Some insurance companies haven’t increased their reimbursement rates (the amount they pay in-network therapists to provide a session) for mental health providers in 10-20 years. Other insurers have cut their reimbursement rates.
As a result, the average reimbursement rate is far below the average fee therapists charge. In New York City, the average reimbursement rates for therapists can be less than ⅓ of the average fee.
Because reimbursement rates haven’t increased with the cost of rent and food, it is difficult for therapists to pay their business expenses (like the rent on their offices and the fees for HIPAA-compliant tools) and personal expenses when they only receive in-network reimbursement.
Additionally, in-network insurance paperwork can easily take an extra 30 minutes per session, which therapists are not paid for.
When a therapist submits a claim for reimbursement from an insurance company, it is not always paid on time. Sometimes, practitioners are paid months after the therapy session occurred.
Finally, there are times when therapists aren’t paid at all for appointments. If the insurance company decides that there is a reason that they shouldn’t pay for treatment, they may not provide reimbursement for an appointment that has already happened.
That brings us to. . .
Therapists prioritize privacy and trust, which also encourages them to focus on out-of-network care.
Using in-network insurance to pay for therapy gives the insurance company a presence in your care. Your insurance company can stop paying for your treatment if they decide that it isn’t “medically necessary.” They can only pay while you’re “in crisis,” or just cover the first few sessions.
This means that you and your therapist may need to rush your work together or cut your therapy short. However, healing is unpredictable. It takes different amounts of time for people to feel better, and it’s hard to standardize a specific number of therapy sessions that will work for everyone.
For insurance companies to cover therapy, therapists must provide them with a “diagnosis” and a reason to use specific treatments. The disorder that they diagnose must also be a covered disorder. You may want therapy for something that does not fall under a diagnosable condition, or you may want to continue with therapy for personal growth. Using in-network insurance makes both of those scenarios more difficult.
While therapy is confidential, the diagnosis a therapist provides for in-network care can follow you in certain circumstances. For example, a court of law can compel an insurance company to provide your diagnoses if they are relevant to a case. A diagnosis may also prevent you from receiving other types of insurance (like life insurance), even though you deserve equal access to those services.
Finally, using in-network insurance gives your insurance a say in who your therapist is. If your insurance changes (if you start a new job or your job changes insurance plans), you may have to switch providers. It can be challenging and time-consuming to start over with a new therapist.
Access to mental health care and affordability is really important to the vast majority of therapists. However, they often prioritize opportunities outside of insurance to make therapy more affordable.
The reason for this is that in-network providers are not always less expensive than out-of-network therapists. Sometimes, they even cost more.
If your plan has a high deductible, you may have to pay for therapy fully out-of-pocket for weeks or months before your insurance covers any of the costs. Even then, the co-pay can be quite high for in-network insurance.
To make therapy more affordable, many therapists offer a sliding scale, or a flexible fee based on financial need. Through sliding scales, therapists work with clients to find a rate they can afford.
You can learn more about how to access sliding scale therapy here.
It is common for the best therapists not to accept insurance, particularly in cities like New York. However, there are other ways that you can find a therapist who might be more affordable than an in-network provider, and who will be a better fit for your needs.
In short, you will find more therapists who are available and a good fit for your needs if you search outside of your insurance company’s network. However, this doesn’t mean that you can’t use your insurance to reduce the cost of therapy.
Out-of-network benefits help you use your insurance to pay for care from therapists who are not in-network with your insurance company. Based on your specific plan, your insurance company may cover up to 75% of the cost of seeing a therapist who isn’t in-network with your insurance.
We’ve written a full piece on how you can figure out what your insurance will cover out-of-network and get reimbursed for therapy here.
It is important to balance respect for the therapists’ value and what you can truly afford. If you need significant financial assistance to afford therapy, or you can’t afford therapy at all, there are resources available to help you.
If you are in New York, California, Florida, or New Jersey, we can take finding a therapist off your to-do list. We match therapy seekers with the *right* therapist for them for free. You can get started here. (At this time, our matching is only available for out-of-network care.)
If you are not in NYC, we wrote a guide on how to find the right therapist that may be helpful to you.
We want you to know that you deserve therapy and you have options to find it, even if you’re having trouble finding a therapist who takes your insurance. If you have any questions or thoughts, please feel free to reach out at [email protected]; we’d love to hear from you!
Mariah was Head of Growth at MyWellbeing. She is a marketing expert in the areas of content strategy, digital advertising, business growth, and anything related to helping therapists grow their practice.
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