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Recently, I read that many parents of depressed teens and young adults have difficulty finding a therapist for their children. one mother said she contacted over sixty therapists and they all said they were full. The article, published on the Good Morning America website, described the rising suicide rate among teens and women in their 20s, and how they were unwilling, or unable, to seek therapy for depression, anxiety and other serious conditions. . the article offered an explanation you’ve probably heard many times: there aren’t enough mental health professionals to keep up with the demand.
Reading: Why therapists dont take insurance
of course we need more mental health providers in our country. but this is not the whole story by any means. The truth is that providers often have room on their schedules, but not for patients who pay with insurance. I know this because I’ve turned away patients claiming my schedule was full, when in fact it was only full for patients who couldn’t pay my fee out of pocket.
That was when I took out insurance. Today, I am one of many providers that do not accept insurance, making my services inaccessible to many. this is a difficult calculation for therapists, so let me explain why providing affordable therapy is so difficult and what can be done about it.
When I started my psychotherapy practice twenty-five years ago, I wanted to earn a good income, but I also wanted to help people who couldn’t easily afford therapy. Eventually, I joined as many insurance panels as possible so that many of my patients could pay a low copay, typically $15 to $40 per session. insurance companies reimbursed me at the rate of $60 per session. that was considerably less than my going rate of $120 to $150 during that time, but by accepting insurance I was able to treat those who would have struggled to pay my usual rate. Still, I kept some appointment slots open for private pay patients who were uninsured and willing and able to pay more for therapy. (Under the terms of the insurance agreements, we were not allowed to accept patients with insurance who could choose to supplement insurance payments or pay more privately. We treated them according to their insurance plans or were unable to see them at all.)
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everything went well for the first three or four years. then I began to notice something a little worrying. while most employed people get raises from time to time, years went by with no change in my compensation from insurance companies. I checked with other therapists and everyone else experienced this as well. it got to the point after a few years where we were being paid less per session than the price of a manicure and pedicure or a salon haircut. Not to disparage salon workers, but they typically don’t need to invest years of education, training, and postgraduate expenses to qualify for their jobs. In the meantime, I was able to increase my private pay rate over the years to match the going rate in our profession.
When I was working with insurance companies, I needed to submit documents for each patient, and sometimes an insurance representative would ask me for twenty to thirty minutes about the need to continue a patient’s therapy. these additional requirements were often time consuming and unpaid. I was especially upset when insurance companies questioned my treatment protocol. it was in their best interest to keep the treatment as short as possible. and while my reimbursement rate was stagnant, my patients were complaining about sharp increases in their insurance premiums. Of course, at this point I realized that the insurance companies were the ones who benefited from this agreement.
My office expenses, including rent, utilities, and malpractice insurance, have increased almost every year. vacation time or other time off was self-funded. the low insurance compensation I received from the insurance companies was worth less and less. I already did some volunteer counseling for an organization, and I pretty much didn’t want to volunteer for insurance companies as well. I finally stopped working with insurance companies after a decade of practice.
more and more therapists only see patients who pay us directly. none of my close colleagues who have been in the practice for a long time accept insurance. A quick perusal of the Psychology Today website in my general community shows that less than twenty percent of the therapists listed accept insurance. Typically, these therapists are relatively new to the profession and are building their practices. many therapists find it much more rewarding to be in charge of our own therapy practices rather than relying on insurance companies to treat us fairly. we set our own rates. many of us offer sliding scale payments to try to accommodate those who cannot easily afford therapy.
Some therapists will accept insurance, but only for a limited number of clients, and often when contacted by potential clients with insurance, they will simply say they are not available instead of trying to explain the situation.
If you can’t use your insurance because all the therapists on your panel say they’re full, it’s important to contact your insurance company and put the matter in their hands. you (and your employer) are paying premiums and are entitled to the service. have the insurance company contact the therapists and find some options for you. If you need therapy more urgently, you can try asking therapists if they have appointments available for clients who can pay out of pocket.
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If out-of-pocket costs are too high for you, here are some suggestions for finding the most affordable treatment: Ask about sliding scale fees (today’s psychology listings indicate which therapists offer a sliding scale). contact family service agencies and other social service organizations that offer therapy at lower prices. You can also try to seek therapy at a university psychologist training center; they often provide lower fee sessions with graduate students who are accumulating hours towards their licenses and are well supervised. group therapy can be a possible alternative to one-on-one therapy, and the fees are much lower.
A final suggestion for finding affordable treatment is to ask for shorter or less frequent sessions. some therapists may be willing to accommodate you this way if they believe the treatment may still be effective.
I hope that insurance companies will increase their therapists’ reimbursement rates to increase the number of appointments available to their members. no one wants to pay monthly premiums and not be able to receive mental health care, and it is essential that everyone seeking mental health assistance be able to obtain it. But even if more mental health providers join the field, they will still need to be able to make a living at their jobs.
if you need to talk, or if you or someone you know is experiencing suicidal thoughts, text the crisis line to 741-741 or call or text 988 to reach suicide & ; crisis lifeline.
state of mind is a partnership of slate and arizona state university that offers practical insight into our mental health system and how to improve it.