top of page

Understanding Insurance Benefits for Therapy

Sometimes the hardest part of going to therapy is figuring out how you’re going to afford it. It is estimated that up to 1/3 of Americans aren’t seeking therapy due to an inability to afford the out-of-pocket costs. Luckily, we live in a time when most people recognize the importance of therapy and investing in it, but that doesn’t mean everyone knows or understands the logistics of getting into therapy. One of the best things you can do for yourself is enhance your understanding of your insurance benefits and how to work within those benefits to get the services you need. Generally, therapy is covered by most insurance plans and is generally comparable to medical services. Each plan varies greatly, so it's best to call and discuss the finer details of your policy with your insurance provider.

Understanding your benefits is crucial to having a positive therapy experience. Most people that are coming to therapy are coming because they are having a significant amount of distress in their lives. What is a huge contributing factor to stress? Money. As much as I hate to admit it, money is always something that impacts our wellbeing. Counselors don’t want anyone to go broke getting the services they need, but counselors gotta make ends meet too. Counselors are actually one of the lowest earning Masters-level professionals. Meaning they went to school as long as everyone else, but get paid significantly less. So if you think your counselor has ridiculous fees, just remember that their fees are still ridiculously lower than what you would pay for physical therapy or regular meetings with a nurse practitioner or physician’s assistant.

If you’re more informed about your insurance it makes it less likely for to you have issues with the financial aspects of receiving counseling. Most of us have discomfort in talking about money, the discomfort is culturally built into us. We are told it is rude to ask about how much someone makes or to talk about our money in positive ways, let alone negative ways. Imagine times when money has felt tight for you. You probably were more willing or likely to tell people you weren’t going to do something because you didn’t want to instead of telling them you couldn’t afford it. The only outliers to this are probably family members or really close friends.

Even though you are going to counseling to be vulnerable, it isn’t like all of those difficulties surrounding every facet of vulnerability have magically disappeared. That shame that many experience around talking about money can easily get transferred into the therapy room. Especially when you feel like you are in a financial deficit. Being uninformed about your insurance policy makes it even more difficult because you don’t have a full picture of the financial commitment you may be making in order to receive services. This means that the bearer of bad news for your insurance coverage is your counselor. In the worst case scenario, your counselor is telling you you have a crazy deductible that you have to meet or that your copay is astronomical.

Hearing that from the person you were coming to for help can make everything feel very overwhelming and sometimes hopeless. Because the counselor just gave you more trouble when you are going to counseling to have fewer troubles. This could potentially impact your ability to feel safe and open up to your counselor. Sometimes people won’t even want to return after a first session when they hear what they will financially be responsible for in the counseling process. I can tell you that it can be a really hard conversation for a counselor to clarify your benefits for you on behalf of your insurance. We are naturally empathic and want to help in any way possible. We know we are creating an intimidating conversation when we have to talk about money. However, it isn’t really a conversation that we can avoid because avoiding it makes it way worse later if you find out your financial responsibility is more than you can afford. Good counselors will have the tough conversations with you because it’s what’s best for you. If you could prevent the emotional turmoil for yourself, and the hard conversation for your potential therapist, would you?

By initiating the conversation with your insurance prior to starting therapy, you get all the information up front. As terrible as it could be to delay therapy for a couple of months to get your finances in order, sometimes it can be more harmful to start therapy and then have to stop because financially things are too tight. When you start the process with your insurance, you’ll get a clear picture of what you can afford when it comes to counseling before creating that high emotional investment with counseling. Again, it can kind of be excruciating to put your hopes into something like counseling, just to feel like you’re going to lose it because of your insurance.

Your insurance will be able to tell you exactly how much you will be responsible for per session. Your insurance will also be able to tell you whether or not that amount will change over time. For instance, if you have to meet your deductible, the amount that you could be paying for therapy weekly could be over $100 versus being $20-$30 for a copay. Over a month, that’s the difference between $400 (a very nice car payment) or $120 (a gym membership or maybe the amount you pay for your favorite caffeinated drink monthly). Some therapists are willing to work out a payment plan while you are working toward meeting your deductible, but it can still be helpful to know in advance so the conversation with your counselor can be proactive instead of reactive.

Not only will talking to your insurance give you a good idea of how much you will be paying monthly, the conversation may give you providers that are more affordable. Insurance companies contract with certain mental health providers in the area. These providers are referred to as in-network. The main difference between in-network providers and out-of-network providers is how much your insurance is willing to be on the line for. Out-of-network therapists are therapists you will have to pay more out of pocket for so if saving dollar dollar bills is your number one priority, it will be important to know which counselors are in-network and which ones aren’t. That isn’t to say some insurances won’t cover them. Some insurance companies don’t differentiate between in-network and out-of-network. See how calling ahead can clear up a lot of questions about your specific coverage?

By having this conversation with your insurance, you have the exact numbers that would allow you to make any necessary budget changes to make therapy more feasible. I can’t tell you how many times I have heard people say they can’t afford therapy without examining the ways they could change their lives to make therapy more affordable. Think about the weekly or monthly expenditures you may have. Are any of them expenditures that you could cut out? Be honest. Just because you don’t want to cut them out doesn’t mean you can’t. Most of us have conveniences or niceties that we want to maintain, but does that mean that they are more important than therapy?

If you sit with yourself and really examine your budget, most could cut some things out to afford therapy. It could be your coffee, energy drink, or kombucha you get every day on your way to work. It could be going out to eat once a week. It could be deciding to do your nails at home for a couple of months instead of paying to get them done professionally. It could be hosting a house party rather than going out to the bar. Trust, cutting some of those things out could totally be worth the benefits of therapy. Again, if you know in advance before starting counseling, you can make some of those financial changes proactively instead of needing to make them from a reactive place after you’ve already started counseling.

If you think about it, most of the investments you make in life, you get all of the information before you buy anything. Could you imagine buying a new car or TV without knowing the price? Yet, we treat medical or mental health services like that because figuring out insurance can be confusing and intimidating. Plus, most of us hate making phone calls, and sometimes the only way to truly figure out your insurance is to make phone calls.

Any large purchase you make, you like having the information so you can make an informed decision. You are willing to make adjustments to your finances to buy larger items. You are willing to save and make arrangements to make it happen for things that you truly want. Mental health counseling doesn’t have to be any different. Especially when you consider how much it can improve your life. All it takes is one phone call to the insurance to get that full picture.

As an Amazon Associate, we earn from qualifying purchases at no extra cost to you. Funds go to furthering the reach of Mental Health.


Related Posts

See All
bottom of page