How do you pay for therapy?
December 12, 2019 2:40 PM   Subscribe

[CA/USA therapy/insurance filter] “See a therapist” is go-to advice here on the green, so I’m trying to grasp the practical aspects of following that advice. Namely, how much has cost you to get the help you need? More details inside.

I’m thinking now is a good time to get some help from therapy. But when I look at out of pocket costs for my area ($200+), I hesitate. Is that really what you all are paying? I also don’t have a good sense for how long I should expect to be in therapy to get the results I'm looking for.

I have had a brief stint in therapy, but I wasn’t wowed by the in-network therapy options my insurance offered at the time. Now that I’m choosing a health insurance plan for 2020, I’m not sure it’s worth paying higher insurance premiums for a lower copay and the restriction of a potentially “okay” in-network therapist, or if should just pick a lower cost health insurance plan and resign myself to paying out of pocket prices to get the therapy I’m seeking. My issues are not at the level of serious trauma, but I'm looking for help processing recent difficulties and identifying a positive path forward. It's been overwhelming trying to decide and the default is to not bother with therapy, but maybe you all can help.

My main questions are:
- How much do you pay per session and via what method (insurance vs. out of pocket)?
- Do you have recommendations or considerations for choosing one route over the other?
- Assuming I find a good therapist and am willing to do the work, what is the minimum number of sessions I should expect to attend for issues at my level of severity? There’s a big difference between 15 versus 50+ sessions when paying out of pocket.

Additional questions:
- I was originally planning on choosing a Kaiser plan and seeing one of their in-network therapists, but the Kaiser therapy experience outlined previously gives me serious pause. Has Kaiser gotten any better in this regard based on recent experiences, or are they still pretty terrible for therapy?
- This is the first time I will be paying for health insurance on my own (not through work), is it worth looking at health insurance plans outside of Covered California?
- Any recommendations to therapists and/or insurance plans for West LA also welcome!

I’m currently leaning towards paying out of pocket as anecdotally I hear that fewer therapists are willing to take insurance these days, but I’d like to hear about your recent-ish experiences with therapy to better understand what it will reasonably cost me in the long run to to get good therapy. In case it matters, I live in Los Angeles and have no physical health issues that would otherwise lead me to selecting a health insurance plan with higher premiums.
posted by Goblin Barbarian to Health & Fitness (33 answers total) 12 users marked this as a favorite
Here in Manhattan I pay a shocking $350/session. My person does not accept insurance, but will provide a bill that you can submit to your insurance company. However, it does not seem like my insurance provider (Aetna) will cover anything near that amount. So I am taking it on the chin financially, considering it an investment in my own health and stability. A close friend describes her experience with therapy as "the best $9000 I ever spent" so I'm hoping its worth it for me too.
posted by BusyBusyBusy at 3:08 PM on December 12, 2019

I tried to get Kaiser to pay a year ago. What happened was they gave me info for their sorta farm-out service that handles people who manage to insist on mental healthcare. Magellan, I think? They were so hard to work with, I gave up and paid out of pocket. $200 sounds like the high end of the going rate, to me, for the bay area, which I assume is comparable to LA, but reading above, I see there are shocking outliers.
posted by less of course at 3:16 PM on December 12, 2019

Self-pay has never really been a financially viable option for me. I paid $20/visit when I had insurance via my job (in California), and currently I am bizarrely fortunate to pay nothing because Medicaid (in Philadelphia) covers therapy and I found a good therapist at a mental health services agency that takes Medicaid. I will say that having somewhat limited options has meant that I haven't done *much* therapist shopping (i.e. after I found someone I stayed with them if they seemed OK) and therapist shopping might have been helpful to me. On the other hand, the affordable price has meant that I've stuck with therapy when I might not have otherwise; when I was uninsured I considered paying $50 sliding scale (to see a newly-graduated intern!) and ended up convincing myself that I could spend $50/week on other things with a greater net improvement to my life.

When I was looking for a therapist previously, I had a somewhat difficult time finding people who took my insurance AND were also taking new clients AND met the criteria I wanted, but I may have been more particular than you. You could call or message a bunch of therapists on PsychologyToday's therapist finder who look promising and take the insurance plans you're considering and ask if they are taking new insured clients. (Occasionally I ran into therapists who were taking new clients but did not want to take on any more insured clients at that time, only self-pay clients, or therapists who were no longer taking the insurance plan I had even though they were on a list, so I started asking that question flat-out.) If you get enough bites from that search I'd just try going the insurance route.
posted by needs more cowbell at 3:17 PM on December 12, 2019 [1 favorite]

When I lived in Illinois I paid $125/session out of pocket. Currently I've been seeing a therapist through my employer's Employee Assistance Program. I get three free visits per issue, and he hinted that some employees have multiple "issues" per year. That might be something to look into, at least to get a feel for what you want in a therapist.
posted by christinetheslp at 3:30 PM on December 12, 2019 [3 favorites]

I had (and loved) Kaiser until last month, when the AB5 kerfuffle forced a long-term freelance client to hire me on as an employee with benefits. I thought Kaiser was fantastic in just about* every area, but I certainly didn't enjoy paying my $600/month out-of-pocket premium.

*Fitting for your question, my asterisk specifically applies to their mental health services, which I could never work out to my satisfaction. I wanted a therapist tailored to my specific issues and concerns, and there were vanishingly few options even in terms of finding a practitioner who was accepting new clients. Kaiser's mental health division seemed overwhelmed by demand, and I couldn't find a therapist both close to me and within a time frame I could accommodate on a weekly basis.

For various reasons, I had to make my mental health an immediate priority, so I took the employment change as an opportunity to cut and run from Kaiser altogether. But I had to do a lot of math on my new employer's health plan offerings. I ultimately went with a PPO because I found a best-of-my-life-amazing therapist just a few blocks from my house, and I wanted to take advantage of the 60% coinsurance coverage on my out-of-network appointments once I crossed the deductible threshold.

My base monthly premium is higher under a PPO, of course, but since my therapist doesn't accept insurance to begin with, an HMO plan was never going to be an option. So I'm paying out the nose until I cross the deductible threshold, but after that I'll only be paying 40% of my therapy.

More data: My therapist charges $150 for an individual session, but I'm seeing them twice a week for the time being, so I'm getting a package deal of $200/week. It's a lot for sure, but getting my head back to a level place is worth the sacrifice. And I'm not putting any kind of time limit on it. Every time I've quit therapy, I've ended up going back a few years later, far worse for wear and wishing I'd never stopped. So I have to roll this into my permanent ongoing expenses. (Which means I can't afford to fire all my other freelance clients.)
posted by mykescipark at 3:31 PM on December 12, 2019 [1 favorite]

My current therapist charges approx $180/session, in Seattle. She is currently covered by my insurance (Cigna PPO), so I pay a $25 copay. When we started she wasn’t covered yet, so I paid full price.

It took me a while to find a therapist I could work with, and I honestly didn’t see any correlation between therapist quality and whether they were covered by insurance. IME, paying directly gives you a wider range of available therapists to choose from, but that’s about it.
posted by a device for making your enemy change his mind at 3:41 PM on December 12, 2019

I've been going since the end of 2011 and I'm not sure how much longer it'll go for. I'll know more once I start actually getting some important stuff done.

I pay $180 per session and go either every week or every other week, depending on how I'm feeling. I'm fine with that amount, which basically means I'm fine with my therapist, though I might go more often from time to time if it was a bit cheaper. My previous therapist for the first three years, who was old and had one foot out the door, let me cry poormouth to the tune of $100/hr, which in hindsight feels like more of a waste of time than money, but was nice of him regardless. This isn't to say that you don't get what you don't pay for, I think it was just him being nice. I pay $250/25min for pdoc, which feels a bit high, and who I've only been seeing since my newer therapist.

I've found all of my people through the Psychology Today list, which is probably not the best way to shop, but like I said I'm fine with it for now. I pay out of pocket, and I'm pretty sure none of these people take/took insurance.
posted by rhizome at 3:51 PM on December 12, 2019

I got therapy through Kaiser here in CA. I found a wonderful therapist who was covered by their out-of-network referrer, Magellan, and the sessions were $10/pop! And then Magellan and Kaiser together managed to fuck up their billing so badly that my therapist stopped being covered for no clear reason and in frustration she gave up on taking insurance. So now I pay out of pocket, at a rate based on my income, and I only go bi-weekly.

I've never worked with Open Path myself, but they have providers in CA and they work with people whose insurance won't cover their needs.
posted by peppercorn at 4:00 PM on December 12, 2019

My therapist charges $220 per 50 minute session. But he takes health insurance (Blue Cross/CareFirst), so I just pay a $30 copay. It took a few emails but I managed to find two therapists in Psychology Today that took my insurance. Mine has a PhD in counseling psychology and I see him every other week to help process some anxiety and stress.
posted by inevitability at 4:02 PM on December 12, 2019

My therapist’s rate is $200, I pay $150. Before our first session I looked honestly at my finances and came up with a number that I could pay and not feel stressed out about, or resentful. And she agreed. So know that you can and should have that discussion. If she had not been able to negotiate (which would have been totally okay), then I was prepared to keep looking. Because I knew I did not want therapy to stressful financially. I’m also on a PPO as someone stated above, so after paying my insane deductible I will get 60% reimbursement of whatever insurance thinks she should be paid, NOT her actual rate. (Have I told you how much I hate insurance?)

I always go PPO route. I also work and live in LA. It will be VERY difficult to find someone in-network period (especially on west side). I called dozens of people who were in-network and no one called me back. A therapist friend told me later that when you mention you want to use insurance many therapists will write you off.

The other thing I’ve found in LA, and seen in my patients, is that there are a LOT of people calling themselves therapists here who, frankly, have pretty sketch credentials and I would never see. Figure out the type of therapy you think you would benefit from and then go from there. Look at years experience. Look at their credentials. Stay away from the therapists who offer you 20 different modalities. That’s a load of crap and no one person is proficient in a million modalities. Do they do CBT well, DBT, psychodynamic?

As for how long? Really hard to say. I’m a very high-functioning human being, successful, look and seem normal and I am! But I also expect and hope to be in therapy the rest of my life because it’s such a stabilizing force for me and has led to so much good. I have had CBT and it was useful at the time, but psychodynamic therapy is most powerful for me.
posted by namemeansgazelle at 4:04 PM on December 12, 2019 [1 favorite]

Before you go down the Kaiser road, find out what sort of coverage you would have for mental health services. I was on a shit plan last year and didn't realize how expensive my attempts at mental health care were until after I received the bill. Will your visits have a set copay? Find out! My mental health coverage through the crappy plan was such that I would have been better off paying out of pocket and avoiding the Kaiser process.

Also time-wise, it took months for an available therapy appointment after my initial intake (which also took a month to schedule) and then when I showed up, the therapist offered to refer me out to a local group under contract with Kaiser. This was all out of the Pasadena Kaiser location.
posted by mandymanwasregistered at 4:08 PM on December 12, 2019

I have a $0 co-pay for an in-network therapist. I downloaded the list from my insurance company and called all of them (eventually, after agonizing over it for months). I basically ended up with two options, and only one was closer than an hour drive, so I haven’t shopped around at all.
posted by bradf at 4:12 PM on December 12, 2019

Check if you have access to an Employee Assistance Program (EAP). Information about this is probably separate from your medical benefits information. An EAP typically pays for a small number of sessions, and after that, if you need more, you could continue with the same therapist if you want, paying for the rest yourself. They'll tell you their rate upfront.
posted by Former Congressional Representative Lenny Lemming at 4:27 PM on December 12, 2019 [1 favorite]

It was hard to find a good therapist who accepted my insurance but even a $25 copay was tough for me to do at the time when I badly needed therapy. The primary difficulty for me was that I couldn't find ANY information online about any of the therapists my plan covered (none had Yelp reviews or even a tiny web presence, none were on Psychology Today's therapy finder) except for one office which consistently employed good therapists... and paid them so badly (I suspect) that they tended to quit and move on to greener pastures very quickly.

I didn't even consider paying out of pocket.
posted by Jeanne at 4:44 PM on December 12, 2019

The Kaiser California mental health workers are about to go on strike again so I would say, no, things are not better.

If you are willing to work with someone who is still building their practice, the Open Path Collective has a network of licensed therapists who are willing to offer low cost sessions ($50, I think)

I also know of some people who have had great experiences working with interns or associates (graduates still accumulating the 3000 hours of that need for licensure). It is hit or miss but definitely more affordable if you find someone that you can click with.

If you can find an insurance plan that pays a reasonable percentage of your costs for out of network providers, that might give you the most options.
posted by metahawk at 4:45 PM on December 12, 2019

My psychologist here in suburban Cleveland charges $150 a session. I'm so so so so lucky she takes Medicaid because a lot of therapist don't. I don't pay anything. It's truly a blessing.
posted by kathrynm at 5:13 PM on December 12, 2019

I am in Victoria, Australia. I pay $120 a session with my therapist (who is not a psychologist). I see him when needed; sometimes that’s twice a month when I’m working through something, other times it’s once every two months as a “maintenance” level of checking in.

My partner pays about twice that for a psychologist, with a small partial reimbursement for up to 10 visits via Australia’s public healthcare system.

The cost is definitely a factor in how regularly I meet with my therapist, and it has made me very focused on doing the work outside sessions.
posted by third word on a random page at 6:01 PM on December 12, 2019

I have Blue Cross and I live in a rural area in Vermont. My therapist is $85-ish. My insurance covers the first three visits of the year and then I pay full price until I meet my deductible and then I pay... something (I never hit my deductible). This is for talk therapy. I also have a psychiatrist who I see infrequently for medication. These visits cost more, maybe $150-200. My medication costs basically nothing. My clinic is sliding-scale, so if I was making less than 30K a year, I would pay substantially less. If I lost my job during the year, I could get the amount I pay adjusted on the spot, which I appreciate. My clinic takes Medicare/Medicaid. I go regularly but when things are going better I'll space out my appointments and I don't go at all in the summer.
posted by jessamyn at 6:11 PM on December 12, 2019

To the best of my knowledge, everyone I know who is in therapy pays via insurance. Finding someone who takes the right insurance sucks but paying out of pocket is not feasible.

I've been out of therapy for a couple of years but I seem to recall my copay was about thirty dollars, but that's in Pittsburgh where cost of living is low.

I think it would be very reasonable to approach a therapist with an idea of roughly how many sessions you can afford, and have a frank discussion of what's achievable.
posted by Stacey at 6:15 PM on December 12, 2019

My therapist doesn’t take insurance, and I pay out of pocket because he’s good. It’s $150 a session and I usually see him every two weeks. I earn a reasonable living, but I’m not wealthy. Of course, I realize I am better off financially than a lot of people.

For some people, therapy is absolutely not feasible without insurance. But I think in the US, there can be a general attitude that you shouldn’t have to pay for it even among those who can afford it. Lots of people pay for other types of self care that aren’t covered by insurance and are expensive: massage, manicures, private lessons, hair coloring, vacations. I prioritize therapy over other things. This is in no way meant to criticize those who don’t, and again, I know lots of people who need therapy really can’t afford it. But for me it is a worthwhile to pay out of pocket to see the person I want to see.
posted by FencingGal at 7:01 PM on December 12, 2019 [1 favorite]

In San Francisco, I pay $85 per session. It's about to go up to $100, since my guy has an income based sliding scale and I got a raise. Like almost every therapist I spoke with earlier this year, he doesn't accept insurance but has written out hours diagnosis so that I can submit for partial reimbursement from my insurance provider (they give me back about $30/session).

Timing is harder to answer. Some kinda of therapy, like ACT, can be time-linited from the get go. Others, like Internal Family Systems, are more exploratory and open-ended, or at the very least with long lead-in periods in which your therapist is learning about you before you really start digging in. I'm a year into doing both of these pretty concurrently in response to a series of unfortunate events that left me overwhelmed and locked in grief and anxiety. I am INCREDIBLY grateful for the experience, and I really wish I'd taken the time and expense to get a year or two of this under my belt when I still felt well and adjusted. I've accepted that seeking therapy when already in a crisis means that I should be comfortable leaving the process more open-ended.
posted by late afternoon dreaming hotel at 7:15 PM on December 12, 2019 [1 favorite]

My insurance covers therapy ($60 copay) but even paying that every week is cosy-prohibitive for me. What I ended up doing is using the practicum clinic at a nearby university. It’s pay-what-you-wish, which is a godsend.

The only sort-of drawback, of course, is your therapists are students (in my case, they’ve all been PhD candidates) so, eventually, they leave and you have to start with a new therapist (depending on how long you’re in therapy. I’ve been in the program for several years now)
posted by Thorzdad at 7:20 PM on December 12, 2019

the restriction of a potentially “okay” in-network therapist

I question this premise. Exactly how many therapists in-network did you try seeing, and exactly how many are there? I'm not convinced of your hypothesis that your network has some method of determining which the bad therapists are and then onboarding them, you know? I'm being glib but there's a kernel of a point in there that I'm trying to make.
posted by MiraK at 8:00 PM on December 12, 2019 [1 favorite]

My therapist (LICSW in Cambridge, MA) charges $150/50 minute session, and does not work with insurance. I am very lucky to have a BCBS policy that will pay ~80% of out of network costs after meeting your deductible, and to work at a company that has an HRA that pays my deductible. What this means in practice is that I pay out of pocket, then I submit my invoices to my insurance provider (BCBS). BCBS sends me an explanation of benefits, explaining that their covered portion will be ($150/session minus $X copay), once I’ve hit my deductible. My HRA then automagically sends me a check for $150-$X per session. I take my paperwork from that, and submit reimbursement for my $X copay/session to my flexible spending account (FSA).

Basically, through an absolute fuckton of paperwork, I pay approximately $20/session, and that comes out of my pre-tax FSA.
posted by amelioration at 8:40 PM on December 12, 2019

$150/hr in DFW Texas. Self pay. There is one female provider in the county on our insurance list. That person is not taking new patients. I 'treat myself' to one session every quarter.
posted by toastedbeagle at 8:52 PM on December 12, 2019

In Utah, my non-insurance rate was about $120 to $180 per session (I can't fully remember). But WITH my insurance it was $20. We have the highest insurance coverage on offer from my spouses work because of me. {smiles and eyerolls} BUT then I couldn't get into the office anymore. And they can't charge your insurance unless you're physically in the office. (GREAT for disabled people.)

So I looked online and landed on BetterHelp - due it it's offerings - specifically video sessions. They also don't accept insurance and I don't think mine will cover it - again, because I'm not in a physical office. It's $65/week, paid monthly for me. Technically there's no limit on sessions but most therapist will do a session every 1 to 2 weeks. After a not-great one I landed on a fantastic therapist and am really happy with that choice. (You literally click a button to switch therapists.) So don't ignore online therapy of some kind as it seems to be discounted since you can't usually bill insurance. ETA: My therapist is a local LCSW.
posted by Crystalinne at 12:08 AM on December 13, 2019

Free through my employer's EAP. I have a primary care doctor who I get along with (similar enough personalities) and I took the list of eligible therapists in my area to his office. He was willing to look it over and see if he knew any of them from his professional experience/network and from other patients, and he circled three that he thought might be good for me. I looked up and talked to all three and the one I ended up seeing was a really good fit.
posted by Lady Li at 1:00 AM on December 13, 2019

I see an in-network therapist. With my high-deductible insurance, I spend $10 per session once I meet my deductible. Even if I had to meet my deductible with just therapy appointments (which isn't the case) it works out to $70 an appointment.

It was tricky to find an in-network person who was taking new patients, but I don't feel like I compromised on quality of care.
posted by toastedcheese at 4:21 AM on December 13, 2019

I've ended up paying out of pocket both times I have tried to use insurance, since dealing with that kind of thing is exactly what I can't do when I need mental health services.
However, I've had great experiences with university training programs twice - better than the two times I have gone to a regular psychologist/psychiatrist ($130/$150). In the programs I found:

1. The interns/grad students were closely managed, so it felt more like there was a team on the case.
2. The cost was nominal - not more than $20 a session.
3. They required a minimum commitment - one semester for one, one year for the other. So that kind of resolves your "how long should it take?" question. You might not solve it all in that time (or you might!), but you will have enough time to get a handle on the issues at the very least.

Since you live in a large city, there may be good options for you. I found on reddit - 6 years old, but it gives you an idea - low cost therapy centers LA. You can probably find more recent/better leads.
posted by hiker U. at 6:51 AM on December 13, 2019 [1 favorite]

I use a sliding-scale clinic here in Denver that mercifully has appointments available on Saturdays. I pay $65 a session and reading this thread is making me extremely grateful for that amount even though it's a lot for me. I found it extremely difficult to find a therapist on private insurance that was a) competent b) taking new patients c) had any availability at a good time for me. My copay through traditional insurance is 20% of the adjusted cost of the visit, so that's pretty unpredictable.

I realize the OP is in LA, but if anyone reading this thread is Denver-based and wants the details of this clinic feel free to MeMail me. The only downside for me for this group is that it took an eternity to get established as a new patient.
posted by zeusianfog at 10:37 AM on December 13, 2019

To your third question, you usually have some type of intake appointment with the therapist where you discuss what you're trying to accomplish and they explain their modality/approach. This might be a space where they can ballpark a number of sessions for you.
posted by sm1tten at 1:23 PM on December 13, 2019

Here are some things which aren't well known. There is little correlation between how good a therapist is and what they charge. Most therapists charge different amounts for different patients for various reasons and the differences can be quite large. Many therapists feel that insurance company payment rates are horribly low and only accept it because it's hard to find patients to come without it and because insurance lists are a built in referral source. Office rental costs are a significant factor in what therapists charge and fancy offices in popular locations are particularly expensive. A therapist who may be good for you may be horrible for someone else and vice versa.

Though none of this explicitly answers your questions, you wanted to know about the "practical aspects" and it's good to keep these things in mind while "shopping." Like with any purchase, there's a certain amount of "marketing" that may influence your choice and this needs to be consciously considered.
posted by Obscure Reference at 4:49 PM on December 13, 2019

Therapists in my area charge around $150 (if they're masters-level clinicians) to $400 per session, probably on average around $200-$250 per session. The therapists who are more senior often do not take insurance, whereas those who are just starting out/trying to build their panel often will. BCBS is probably the most widely accepted insurance among therapists who do accept insurance.

I agree that therapy with trainee therapists (social work interns, psychology interns, psychiatry residents, and training analysts if you are interested in psychoanalysis and live in a place where there is a psychoanalytic institute) may be a good way to go. In your area, UCLA, USC are known to be good training programs- maybe give those a shot?

As a trainee therapist, I feel like all of my therapy cases get more attention because I discuss treatment approaches in weekly supervision - you basically have a whole team of more senior clinicians behind the therapist, and they bring in different perspectives. The drawback is that there is turnover in therapists as they graduate from their programs (which is why July - September, the beginning of the academic year, is when it may be better to start therapy). Still, trainee therapists can follow their clients up to 3+ years depending on which program they're in.
posted by gemutlichkeit at 8:39 AM on December 14, 2019

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