If you or a loved one is struggling with mental health, one of the first concerns that may crop up is the cost. When treatment costs are excessive, it can seem like a good idea to delay finding a therapist. But how much does therapy cost? While a simple answer would be nice, the truth is that determining therapy cost is complex and may depend on the style of treatment needed for an individual patient.
Medical billing practices are often opaque, and even with preapproval and insurance, you may find yourself facing unexpected and expensive bills for medical procedures — including mental health treatment. So when asking “How expensive are therapists?” the first step is often a call to a covered provider. While no reputable mental health agency can offer a firm price upfront, many can provide an expected cost per session based on the type of treatment you need.
Inpatient vs Outpatient vs Remote Therapy
The type and scope of treatment has a lot to do with the total out-of-pocket costs for patients. The answer to “How much does a therapist cost?” can range from $0 per session with the right insurance to more than $200 per hour when paying direct, and that’s for outpatient therapy. So, how much does therapy cost a month? If you have weekly sessions at an average of $75 per hour, it works out to $325 per month.
Inpatient programs can cost substantially more. A five-day psychiatric admission to Northwestern Medicine Central DuPage Hospital in Illinois left a patient with a bill in excess of $20,000, and that was after a $9,000+ bill reduction. With hospitals unable to answer simple questions about costs, under- and uninsured individuals have a natural reluctance to seek help for mental health care concerns.
Remote therapy is a growing segment in the mental health care provider space, allowing those in areas with limited access to physical offices the same ability to access care. Since more than 110 million Americans live outside of urban centers where mental health care is more readily accessible, remote therapy is a boon to those who might otherwise struggle to connect with a therapist or psychiatrist. The therapy cost via a remote program is often much lower than the cost of in-person visits, particularly for those with no mental health insurance coverage.
Insured vs Uninsured
The cost of care for an insured patient is routinely much less than the same care offered to an uninsured patient. These cost differences are apparent in both mental and physical health professions. However, patients can more readily find affordable physical health professionals, particularly those who accept insurance. Many mental health providers operate outside of insurance networks. Why? Because while mental health parity laws force ACA-approved insurance plans to offer the same level of coverage for mental and physical health, there are hidden costs heaped on mental health providers.
A psychiatrist with a similar level of education to an MD often receives a lower reimbursement rate from insurance companies and is forced to file more paperwork. This combination of factors encourages mental health professionals to offer private pay services rather than in-network options. Bottom line: Many therapists don’t take insurance. When they do, you might be required to pay up front and request reimbursement from your insurance company. With a psychiatric evaluation often ranging from $250-$350 just to get started on a treatment plan, that can be a seemingly insurmountable barrier for those with limited means.
It’s also important to note that addiction treatment falls under the same category as mental health when determining costs for treatment. Many addiction recovery programs start with an extended inpatient stay, which may artificially inflate numbers for those who don’t suffer from addiction but do need treatment for another mental health issue. For example, the average cost of care for a patient with major depressive disorder can exceed $10,000 as of 2016. However, the actual amount billed to a patient can vary dramatically depending on the patient’s insurance plan.
Mental Health Parity, Explained
In 2008, the Mental Health Parity and Addiction Equity Act passed and became law. While it took an additional five years to gain some understanding of what parity in health care would look like, the goal of the legislation was simple: equal coverage for both mental and medical care under an insurance policy.
What exactly does that mean, and how does it affect therapy costs? It means that if your insurance offers unlimited visits to a medical specialist, it must also offer unlimited visits to a mental health specialist.
Prior to the passage of the MHPAE act, many insurance policies limited the number of covered mental health visits per year. For someone with chronic depression or a diagnosis of schizophrenia or bipolar disorder, this could lead to near-constant interruptions in treatment.
In practice, while parity laws were meant to bridge the gap between mental and physical health, not all plans reach parity, not all states demand it and even when the law requires parity, you might not get good coverage for mental health or medical care.
Keep in mind that parity simply means equal coverage, so if your medical care limits the number of visits to your doctor, it can also limit the number of visits to a therapist or psychiatrist on an annual basis. Equal coverage doesn’t mean good coverage, so if your medical coverage is mediocre, expect the same when it comes to your mental health coverage.
Plans Required to Meet MHPAEA Standards
The MHPAEA doesn’t require every insurance plan to suddenly add mental health coverage, so you may or may not be protected under these laws. The size of your enrolled member group and of your employer play a large rule in determining which policies include equal coverage for mental health.
In general, health plans for employers with more than 50 employees must meet MHPAE standards for mental health parity unless the policy was created prior to the effective date of the law. Some employers with long-standing health care agreements may have been at least temporarily allowed to continue to offer their older plan.
The Federal Employees Health Benefits Program, Medicaid Managed Care Plans, State Children’s Health Insurance Programs and any plan purchased through the Health Insurance Marketplace must include mental health benefits at coverage equivalent to medical benefits.
Some state and local governments may also follow these regulations, though some states have their own parity laws that may be even stricter than federal guidelines.
Plans Exempt From Parity Laws
Some examples of plans that aren’t required to offer parity include Medicare, although this federal health insurance program currently does.
Medicaid fee-for-service plans may also opt not to cover some mental health services, though managed care plans through Medicaid must.
Some large contract employers are exempt due to existing insurance contracts, though as those plans and contracts expire, these plans may see updates that more closely match the intent of health parity laws.
Both self-employed individuals and small businesses can buy insurance plans that are exempt from parity laws and, in some cases, exclude all mental health coverage.
To find out more about your coverage and whether your plan is required to meet parity laws, contact your benefits administrator or HR department.
Covered Services Under Parity Laws
Plans that must meet federal parity law guidelines must follow some basic rules. Below are examples of treatment options that must be offered for mental health if they’re covered under medical health plans.
- Inpatient treatment, in or out of network
- Outpatient treatment, also in or out of network
- Intensive outpatient services
- Partial hospitalization
- Programs that offer residential treatment
- Emergency care
- Prescription coverage
- Co-payments
- Deductibles
- Out-of-pocket limits
- Facility type
- Provider reimbursement rates
In addition to the type of care, federal parity laws also apply to scope and clinical criteria. Insurers may not use separate clinical criteria when deciding to cover mental health treatment versus medical treatment. Insurers must also provide the standard for determining whether a treatment is warranted and medically necessary when asked by a plan member and must have comparable treatment networks available to their plan members for mental health care. No insurer can simply avoid adding mental health care coverage by failing to negotiate a reasonable in-network group of providers.
Is Your Plan Following Parity Guidelines?
While parity laws are in effect, some plans may be slow to adopt all the required changes to meet new regulations. Be on the lookout for some of these signs that your plan is dodging some or all of its obligations under parity laws.
- You have a higher co-pay or are limited to fewer visits with your mental health care providers versus medical doctors.
- Mental health care access requires preauthorization while standard medical services don’t.
- You’ve been denied mental health services but your plan won’t explain why or provide the clinical criteria used to make the decision.
- There are no mental health providers in your network accepting new patients, but there are plenty of doctors available for other health care needs.
- Your plan denies coverage for residential mental health programs but offers it for medical issues when needed.
Before taking any steps to report failure to comply with parity laws, it’s important to know whether your plan is required to meet them. Be sure to take a look at some of the guidelines for which plans may be exempt before taking further action. If you do need to file a complaint, first contact your insurance company to obtain the reason for the denial of coverage.
What About the Uninsured?
While most health care costs are mitigated through the use of public or private insurance, some people have no insurance and thus are expected to pay the full out-of-pocket costs associated with mental health care. For those with a medical plan that excludes mental health coverage, there may be local providers that offer sliding scale fee structures that can help expand access to coverage.
For those with no insurance and limited means, there are often treatment options that may be available at no cost to you. State-sponsored programs may offer counseling and therapy for free or at a very low cost to those who qualify, while employers may also have workplace programs in effect that allow you to obtain mental health services external to your medical insurance. Some employers maintain an emergency hotline for employees to call for various services, including mental health.
Networks such as SAMHSA can provide information about local mental health providers that offer free or low-cost services in your area. You can search online or call the hotline to get referral information. Programs offering free services may have a waiting list or only accept a limited number of patients, but the more options available, the faster you can start treatment.
Private Pay Is Also an Option
For those who can afford it, private payment for services is always an option as a fast track to mental health care. While the price may be higher than many can afford, some clinics may offer sliding scale rates to help patients receive care. Since so many mental health professionals avoid participating in networked insurance plans, private pay is often the best option when seeking immediate help outside of a hospital setting.
At Restore, patients can choose to pay directly or let the billing experts at the practice handle any issues with your insurance company. Patients have both inpatient and outpatient treatment options and access to mental health professionals trained in the treatment of conditions ranging from depression and anxiety to bipolar disorder and PTSD.
Finding Affordable Mental Health Treatment
At Restore, our goal is to offer top-notch care in a relaxing and restful environment. We accept many different forms of insurance to help remove one barrier to seeking treatment. If you aren’t sure about your coverage and how to get help, contact a member of our admissions team. We can do the legwork with your insurance company so you know you won’t be facing any unexpected bills after your stay.
