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Decoding the Forms of Payment Therapists Accept
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The first step in knowing what you can afford to pay for therapy is knowing what forms of payment you can use. There are probably more payment options than you think, and one of them could be a game-changer for you.
Some of the ways to pay for therapy include:
- Paying out of pocket with cash, a check, or a debit card
- Paying using a special account for medical expenses like a Health Savings Account (HSA)
- Paying via credit by using a credit card or a payment plan set up by a health organization
- Paying out of pocket to see a private practice therapist but paying a special, discounted, or sliding-scale rate
- Paying out of pocket to see a therapist at an agency where you get a heavily discounted rate because of income or special eligibility
- Getting free therapy due to qualifying for a program with special eligibility (such as by being a veteran) or by going to a special local program unique to your area
- Using insurance to see an in-network therapist for the cost of a co-pay or coinsurance
- Using insurance to see an out-of-network therapist for more than you’d pay to see an in-network therapist but (hopefully) less than you’d pay out of pocket
Insurance is often the easiest way to get affordable therapy. If you can find the right therapist in your insurance network, you may be able to enjoy top-tier therapy for a minimal price. But not all therapists accept insurance, and you may or may not have an insurance plan with an affordable deductible and good mental health benefits. When insurance isn’t an option, these are some of the best places to look for affordable therapy:
Where to Find Affordable Therapy If You Don't Have Insurance
- Integrated primary care clinics
- Community counseling centers
- Publicly-funded mental health agencies
- Other programs affiliated with the public mental health system
- University mental health departments or college counseling centers
- Churches or faith organizations that offer free or low-cost pastoral counseling
- Veterans’ groups and organizations or providers with special eligibility for veterans
And if you’re a member of a special group—for example, if you’re a trauma survivor, a person of color, LGBTQIA+, or a person with an income at or below a certain amount—you may be able to get free or low-cost counseling from a non-profit or charitable organization in your community. In some cases, grant-funded organizations offer free or low-cost therapy to the community at large and not just special populations.
Learning what options you have and how a therapist can work with you will help you set up your therapy budget. Therapy can be expensive, but there are ways to make it more affordable. Our mission at OpenCounseling is to increase awareness of all the methods there are to lower the cost of therapy. We hope these suggestions have sparked some ideas and have put you on the road to finding the therapy you need at a cost you can afford.
The first step in knowing what you can afford to pay for therapy is knowing what forms of payment you can use. There are probably more payment options than you think, and one of them could be a game-changer for you. Read on to learn if there’s a way to pay for therapy that could make therapy more affordable for you.
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Private Pay Options
Private pay. Being a “private pay client” means you’re paying out of your own pocket for therapy. You’re not using insurance and charitable or grant funds aren’t covering part of your bill for you. There are ways you can save when you’re paying out of pocket, but let’s go over some basics first.
Different ways to pay. Most therapists accept cash, checks, and credit or debit cards. Cards are easier and more convenient to use than ever, thanks to apps and tools that allow people to accept credit card payments through smartphones. However, you should always check with a therapist first to make sure they accept the payment method you want to use.
How credit cards can help. A credit card can make therapy more accessible. If you make enough per month to cover what therapy costs, but you don’t necessarily have all of those funds available at the time of your weekly therapy appointment, you can use your credit card at the time of your appointment and pay it off by the end of the month.
Keep in mind we do not advise going into credit card debt for therapy (or for any other reason). You can lose a lot of money on credit card fees and can even end up in an impossible financial situation if you get behind on payments.
Health Savings Accounts: A Payment Option You May Not Have Considered
Some employers allow you to set an amount that will automatically be drawn from each paycheck and put into your HSA. Sometimes, HSAs are promoted alongside high-deductible plans. These plans may have lower monthly premiums, saving you money in another way.
Money you spend on premiums is money you’ll never get back, but money stays in your HSA until you spend it. In some cases, you can put into an HSA what would have gone toward premiums and have enough to cover your within a planned amount of time.
Beware of the Hidden Costs of High-Deductible Plans
(Please note we’re not recommending this as the best option, because it rarely is; plans with lower deductibles are often the more affordable option. It really depends on whether the amount you’re saving on premiums—if any—will end up being the same as or more than your deductible. Be sure to review your plan options well before deciding.)
Most HSAs give you a card that works like a debit card. When you use the card, it pulls from funds that are already in your account. (Note that HSA cards don’t work like credit cards; you can’t “charge” an amount you expect to have in your account later.) It can be hard to use an HSA at places that don’t accept credit or debit cards. (Though many HSAs also send you a checkbook.)
In many cases, you can use an HSA to pay for therapy, but you should check with your benefits provider and therapist first. There are rules for using HSAs that may limit how you can use yours.
Ways to Make Private Pay Easier
Setting up a payment plan. If you don’t have a credit card, or don’t want to use one, you may be able to set up a payment plan with a therapist that works in a similar way. Ask if you can pay once a month, or every two sessions, or whatever works for your budget. Not all therapists will agree to this, but some will, and it never hurts to ask.
Working with large healthcare organizations. Due to the unfortunately common problem of hugely expensive medical bills, many large healthcare organizations have entire departments dedicated to setting up payment plans for patients who can’t pay their entire bill all at once.
For example, even if therapy costs $300 a month, they may let you pay $100 or $150 per month. In many cases, unlike with a credit card, hospitals don’t charge you interest on the amount you owe. (Make sure to check whether an organization charges interest before you assume, though.)
Working with private practice therapists. Keep in mind that many therapists in private practice—in other words, therapists who are self-employed—can’t afford to take on the same level of risk as a large healthcare organization. If a private practice therapist is willing to set up a payment plan with you, they will probably expect you to stay pretty current with what you owe.
Instead of payment plans, many therapists are willing to offer discounted rates, which ultimately saves you more money. One of the most common ways therapists do this is by offering sliding scale rates.
Special Ways to Save When You're Paying Out of Pocket
Sliding scale rates. Many therapists are willing to accept less than their standard asking rate. If you see on a therapist’s bio or profile that they offer sliding scale rates, this means they’ll assign you a rate that’s based on your income. That amount can be significantly less than the rate they advertise.
A therapist will often set a price range from the lowest amount they can accept all the way up to their standard rate. For example, their sliding scale might go from $60 to $120. Whether you're assigned $60, $70, $90, or $120 will depend on which rates they assign to which income ranges.
During your initial call with a therapist, you should confirm that they still offer sliding-scale rates. Sometimes, therapists have limited “slots” for sliding-scale clients, and sometimes they stop offering a sliding scale but forget to update their bio. Make sure you’re clear about what you can afford to pay and be willing to shop around if the therapist can’t meet it.
To Save On Therapy, Ask About Sliding Scale Rates!
We think sliding scale rates are such a helpful and important option that we’ve written a whole other article about them. You can read that article for more detailed information about how sliding scale rates work. You can also read our article on how to negotiate fees with a therapist for tips on working with therapists who don’t automatically use a sliding scale.
Affordable agencies. You’ll often spend less if you see a therapist who works in an agency instead of a private practice. This is even more true if the agency where you go see a therapist is:
These types of organizations often have the lowest sliding-scale rates you can find. They can also sometimes offer special discounts because of grant funds or charitable donations they receive.
Seeing a less experienced therapist. You can often save money by seeing a therapist who hasn’t been in the field long and who is still trying to build their practice. Therapists just starting a private practice tend to charge lower rates. At community counseling agencies, you can often see trainee or associate therapists for a lower rate. If you want to learn more about the pros and cons of seeing a less experienced therapist, you can read our full article about it.
Using Insurance to Pay for Therapy
However, that’s not always true, and it can be tricky to get the most out of your insurance benefits.
For one thing, many therapists don’t accept insurance, so you have to decide if it’s worth it to pay more to see a therapist who doesn’t accept insurance or if you can find someone who’s the right match in your insurance network.
If you can find the right therapist in your insurance network, that’s probably (but not always) your best option. If you avoid common insurance pitfalls, you can enjoy top-tier therapy for a minimal price.
For More Information
For in-depth guides on using insurance for therapy, you can read the following articles:
- How to Get the Most Out of Your Mental Health Coverage
- How to Choose an In-Network Therapist
- Using Insurance to Get Online Therapy
Otherwise, read on to learn some of the most important things to look out for.
Using In-Network Benefits for Therapy
This is one of the simplest ways to get affordable therapy. Pick a therapist who’s in your insurance network, set up an appointment, and bring your insurance card with you.
For tips on how to find in-network providers, you can read our article on using insurance to get online therapy. Many methods in that article work for offline as well as online providers.
Before you start shopping for an in-network therapist, though, you want to make sure you know how your benefits work.
How to Learn More About How Your Plan Works
To find out how your mental health benefits work, follow these steps:
- Call a customer service representative or review your plan documents to confirm that you have mental health benefits. Most plans should have mental health benefits by now, but some older “grandfathered” plans that were established before the Affordable Care Act may still not include mental health benefits.
- Look on your card or Summary of Benefits to see what your co-pay or coinsurance is for a specialist visit. This tends to be how therapists are classified in insurance tiers. Make sure to confirm in your plan document or on the phone with a customer service representative that therapists are classified as specialists in your plan before you assume, though!
- Make sure you know what your deductible is. That’s the amount you have to pay before your insurance contributes anything. In high-deductible plans, the deductible can cost as much or more as what it would cost you to pay out of pocket for therapy all year.
When this is true, you may be able to save money by not using insurance. (Remember when we said that high-deductible plans usually end up costing you more? Yeah.)
Using Out-of-Network Benefits to Pay for Therapy
Using out-of-network benefits can sometimes save you money if you want to see a therapist who’s not in your insurance network. But they can be tricky to use and have hidden costs.
Fortunately, we’ve written an in-depth article on how to spot and avoid the pitfalls when you want to use out-of-network benefits:
An important fact we discuss in that article is that with out-of-network benefits, you are the person responsible for filing your claims.
Plan to Wait for Reimbursement if You Use Out-of-Network Benefits
In many cases, you will have to pay the therapist the full amount they charge upfront, then take the “superbill” they give you—the statement listing all of their charges over a certain period of time—and send it to the insurance company. This can be a problem if you can’t afford to cover the cost of therapy until insurance reimburses you.
Some therapists will submit a claim on your behalf. But whether you send the claim or your therapist does, you are the one responsible to appeal the decision if the insurance company denies your claim.
If insurance doesn’t deny your claim, but offers partial payment, you’ll be expected to pay the difference between what the therapist charges and what the insurance company paid. (This is called “balance billing.”) Whether it’s worth it depends on how much insurance actually covers.
A Special Note on Medicare and Medicaid
Our nation’s public insurance plans are a great way to pay for therapy. You can look for providers who are in-network with Medicare and Medicaid the same way you would with any other plan—go to your insurance provider’s website or filter for providers that accept Medicare and Medicaid on Psychology Today.
There are definitely therapists out there who accept these plans. But it can alleviate some frustration to go into your search knowing that fewer therapists tend to accept them than other plans because the amount they cover is often lower than what commercial insurance plans cover.
On the other hand, Medicare and Medicaid often cover things that commercial or employer-based insurance plans don’t cover at all.
Learn More About Public Insurance
For more information about the benefits and drawbacks of public insurance plans, you can read the following articles on OpenCounseling:
If all else fails, you can usually find local non-profit or publicly-funded providers that accept Medicare and Medicaid. Mental health clinics and agencies run by larger hospital and healthcare organizations are also a good place to look.
Charitable and Grant-Sponsored Free and Low-Cost Therapy
Special eligibility. There are a few different ways you can get low-cost or free therapy. One way is if you’re a member of a certain demographic or cultural group. For example:
You May Be Able to Get Free Therapy If You're a Member of a Special Group
Free or inexpensive therapy programs for special groups include:
- Veterans and trauma survivors are eligible to get free therapy through Give an Hour.
- Veterans also qualify for many other free and low-cost mental health services.
- Members of churches or other faith organizations can sometimes get free pastoral mental health counseling at or through their faith community.
- Homeless shelters often provide (or work with outside agencies that provide) free therapy to people who are homeless.
- Domestic violence shelters often offer free therapy to domestic violence survivors who are staying there or going there for other services.
- Local non-profits often offer free counseling or therapy to groups they focus on, such as people of color, people who are LGBTQIA+, or certain age groups.
- Publicly-funded mental health agencies often receive special grants that help them provide low-cost services to people whose income is within a certain range, as well as other demographic groups that qualify for grant-funded services.
One way to find out if you qualify for a low-cost program is to call a state or local mental health hotline, especially a hotline run by your city or county’s public mental health program. The people who answer can usually help you figure out if you qualify for public mental health services and/or determine what other local non-profits might be an option for you.
Local availability. Sometimes, you can get free or low-cost therapy even if you’re not a member of a demographic group with special eligibility. Sometimes, it’s just a matter of having good local resources.
For example, you may live in a community where local leaders have partnered with a non-profit to create a special mental health program open to all members of your community.
During a special event, certain services may be discounted or become more widely available. Many organizations offered free or low-cost therapy during the initial wave of the coronavirus pandemic, for example.
You May Be Able to Get Free or Inexpensive Therapy Even If You're Not Part of a Special Group
You may also want to look into the following ways you may be able to get therapy for free or for very low cost:
- Your employer might include free or low-cost mental health services as part of your benefits, such as through an EAP.
- Your primary care clinic might be an integrated clinic that offers therapy alongside primary care services for a minimal fee or co-pay.
- University mental health departments or counseling centers in your community may offer free or low-cost therapy to people who are willing to be seen by a student or trainee.
As with special eligibility, the best way to find out about affordable options that are local to your community is to call a state or local mental health crisis and information line.
There are more ways to pay for therapy than you might think.
Different Ways to Pay for Therapy
To pay for therapy, you can:
- Use credit to make it easier to pay out of pocket;
- Get a discount from a therapist who offers a sliding scale;
- See an in-network therapist for the cost of a co-pay;
- Use a health savings account to manage your medical expenses;
- Know the right places to go in your community to find the lowest therapy rates; or
- Go to a local program that offers free or low-cost therapy to people in your demographic.
Learning what options you have and how a therapist can work with you will help you set up your therapy budget. Therapy can be expensive, but there are ways to make it more affordable.
Our mission at OpenCounseling is to increase awareness of all the methods there are to lower the cost of therapy. We hope this article has sparked some ideas and has put you on the road to finding the therapy you need at a cost you can afford.
Note: The original version of this article was written by Jason Simpkins. This version has been updated, edited, and expanded by Stephanie Hairston.
Sliding Scale Therapy: What It Is and How to Get It
How Can I Negotiate Fees with My Therapist?
Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments.