It’s important to choose a therapist that you can afford to see regularly. Understanding how payment works can help you know which therapists are within your budget. There are different ways to pay for therapy. Here are the most common options:
I. Health Insurance
Insurance coverage can be complicated. Almost all health insurances have a mental or behavioral health component. Services need to have a medical diagnosis to be covered. How much is covered depends on the specific plan. Here are the basics:
- HMO: This plan requires your Primary Care Physician (PCP) to make a referral. The therapist must be in-network. The cost will likely be the copay amount per session.
- POS: This plan might not need a referral for out-patient/office visit of mental health services, but often is limited to in-network providers. If your plan has a deductible amount, it must be met before you begin paying a copay per session. The rate per session is set by the insurance. Normally it is lower than the therapist’s regular rate.
- PPO: This plan does not need a referral. You can choose to see an in-network or out-of-network provider. The deductible still needs to be met first. The rate is the insurance’s set rate. For in-network services, your copay is applied thereafter. For out-of-network providers, the rate is the regular rate of the therapist of your choice. Then coinsurance begins. This is a set percentage of the rate you are responsible for according to your plan. The common range would be 80%–60% of the therapist’s regular rate.
For college students, there is often an on-campus counseling center. Counseling is covered under your student health plan.
II. Fee for Service / Private Pay
You pay the therapist’s regular rate out of pocket. This often happens when you are choosing an out-of-network provider, a specialist, or a therapist of your choice that your insurance does not provide or cover.
A few therapists might provide a sliding scale structure. This is a flexible pricing or payment system where costs change based on a person’s income or ability to pay.
III. Employee Assistance Program (EAP)
Many employers provide EAP benefits. Short-term counseling is one of its benefits. It is limited to a few sessions, but it is free! A diagnosis is not needed. The number of sessions depends on your EAP. It can range from 3–10 sessions per issue, per year. Issues can be stress, grief, relationship needs, parenting… Your dependents each have the same benefit. These sessions need prior authorization, and you must see therapists on the EAP panel.
IV. Reimbursement Through Tax-Free Contributions
Your Flexible Spending Account (FSA) or Health Savings Account (HSA) through work can be used to pay for mental health services. This includes the copay, coinsurance, deductible, and private pay, as long as there is a medical diagnosis with those services.
About the Author
Mimi Leung-Pang is a licensed marriage and family therapist in Fremont. She has had a private practice for 30+ years. She has the following certifications: International Board of Christian Counselor (BCPCC), Critical Incident Stress Management (CISM), Saving Your Marriage Before It Starts (SYMBIS), Grief Counseling Specialist (CGCS), and Clinical Trauma Professional (CTP). She was selected into “Guide to America’s Top Mental Health Professionals” 2006 edition. She is also a crisis care consultant with R3 Continuum. She lives in the Bay Area with her husband and a dog. She has two sons, two daughter-in-laws and a granddaughter. You can learn more about her at www.mfc-c.net.
[Photo Credit: Andre Taissin]