The Cost of Mental Health Care: How Much Should You Spend?
When I was three months pregnant, I felt sick every day, the sight of my husband made me mad, and his smell drove me crazy. To make matters worse, I was also three months into a new position at work.
The toxic work culture was taking its toll — I switched to survival mode. I took care of only the absolute essentials to get by. I stopped getting my hair done and ironing my clothes entirely. I pushed myself to bathe, even though that was a battle. I cried all the time — in the shower, in the car, and even on my way home.
Despite all of these stresses, I continued to beat myself up.
“Stop crying, Kara,” I told myself. “What do you have to cry about? Just woman-up and push through.” But the bottom was clearly dropping out.
Still, denial allowed me to function a little longer. That is, until I found myself spending my Christmas vacation alone on my couch desperately searching Psychology Today for emergency counseling.
My Out-of-Network Experience
My first day of therapy started a few years ago. I worked with Toni — a young, kind therapist who gave me the right amount of push and support. But she was also out-of-network, which meant that she was expensive.
My health insurance would only partially foot the bill for my sessions because, technically, I could have received similar services from the many in-network counselors and therapists.
And God knows, I tried to go the cost-effective, in-network route. But it wasn’t adding up.
Very few of the therapists I reached out to returned my call for an initial appointment. With those that did, I didn’t feel a connection. There was no chemistry. I didn’t feel that I could trust, confide in, or feel vulnerable with them, so making progress would have been virtually impossible.
How Much Does Therapy Cost?
When I finally made the decision to work with Toni, I called my health insurance provider to crunch the numbers.
Each 60-minute session cost $150, and my insurance was willing to pay $55 for each. After I met my $150 deductible, I had to pay $95 out-of-pocket every visit. In all, it amounted to $380 a month.
I religiously attended therapy for 11 months, which meant a total of $4,180 in out-of-pocket costs.
And it could have been worse — without insurance, I would have had to pay $7,200. But on the other hand, if I had chosen one of the therapists from my network — which had a copay of $15 — I would have paid only $660.
The Cost of Mental Health Care: How Much Is Too Much?
Based on these numbers, I could have saved big on therapy if I’d settled for in-network therapists. But that’s just it: I would have settled.
From the little nudges she would give me to come in when I was feeling discouraged to the continued support that she still provides even though I no longer see her, Toni has provided me the help that, although expensive, was much needed.
I liken the process of looking for a therapist to that of looking for a partner. While it would have been nice if my husband were independently wealthy, it wasn’t necessary for love. Similarly, I would have been ecstatic to find an in-network therapist that I connected with. But I didn’t.
That doesn’t mean you shouldn’t look for an in-network solution, because you never know who you might click with. Just because a doctor is in-network doesn’t mean they are inferior. They simply have agreed to work with your insurance and handle requisite paperwork and bureaucracy that many therapists won’t.
The experience of finding a therapist helped me to truly understand the difference between cost and worth.
While cost is the dollar amount that we place on a service, its worth is a little deeper and extremely personal.
I was in a financial position to pay extra, and since I value my emotional and mental health, I realized that I needed support in re-establishing my self-respect and identity. I knew that choosing the more expensive option would make the most sense for me and for my goals.
How Therapy Eventually Paid for Itself
In therapy, I had the chance to rebuild myself and rewrite the narrative of who I was.
Through my inner work, I cultivated the courage to establish and maintain boundaries. I also gained a deep level of respect for my feelings, an awareness of my passions, and a trust in my ability to make the best decisions for my newborn baby and me.
In concrete terms, between the time that I began therapy and the time I finished, I left my toxic position at work and found a new one where I was valued for my contributions. I nearly doubled the revenue and client base for my personal business, and I still feel better in my own skin.
So, is the cost of mental health care worth it? My answer: Hell, yes!
How to Deal With Insurance and Mental Health Care
If you’re looking for mental health services but don’t know where to start, we’ve got you covered. We sat down with Emily Gelber-Maturo, director of Smart Policy Works, to get some simple answers to all of your insurance questions.
What mental health services are covered by my insurance?
“Mental health services covered by insurance providers typically include outpatient assessment, therapy or treatment, and inpatient care,” Gelber-Maturo says.
How long are these services provided by my insurer?
“Limits on the number of mental health visits in a year used to be common, but federal parity law has largely eliminated annual limits,” Gelber-Maturo notes.
“However, insurance companies may impose limits based on ‘medical necessity.’ The best place to get information on covered services and costs is the Summary of Benefits and Coverage, which is typically provided to you by your insurer and is available if you request it from them,” she says.
And if that’s hard to find, your insurance card typically has a phone number on the back, as well as a website where you can find details of your coverage.
What’s the difference between in-network and out-of-network?
“A simple way to think about in-network and out-of-network is less expensive and more expensive,” Gelber-Maturo says.
“Some health plans won’t pay for out-of-network care at all, and if they do, it is always higher than in-network care. In-network means that your health plan has pre-negotiated with those providers.”
“The best protection for your wallet is to stay with in-network providers,” Gelber-Maturo continues.
“When evaluating your plan options, check whether the providers you see now are in-network.”
While it’s true in-network is less expensive when thinking only about money, there is an intangible cost of making sure you “click” with your in-network provider. If you don’t find someone you are comfortable with in-network, you may want to consider the more expensive route if you are already working with someone you like.
What does it mean to “meet a deductible”? And what is coinsurance?
“Think of deductibles as the cover charge for health services. There is a certain amount that you have to pay out of pocket for health services before insurance starts chipping in. These vary widely from $0 to thousands. If you think you will need a lot of health care services during the year, it is wise to choose a lower deductible plan,” Gelber-Maturo says.
“Coinsurance is essentially splitting the bill. Your plan pays a bit. You pay a bit. This applies after you have paid the deductible. Let’s say my coinsurance is 30 percent. I pay 30 percent after I’ve paid my deductible, and my plan pays 70 percent on covered medical services.
“As an example, I may have a plan where I have a $300 deductible with 20 percent coinsurance. My copays for in-network office visits are $30.
“I may go to a therapy visit and pay a copay of $30, as long as I have already spent $300 on medical services to meet my deductible. If I haven’t, I pay the full cost of the office visits up to $300, then my insurance will kick in and I pay only my copay.
“If I receive inpatient mental health care at an in-network (contracted with my insurer) facility and my bill comes out to $10,300 total, and I have not used any medical services prior to this hospital stay, then I owe my $300 deductible plus 20 percent of the remainder of the bill. So I would end up paying $2,300.”
It’s important to ask a lot of questions up front until you fully understand your benefits.
What’s a copay?
“A copay is an amount that you are responsible for at the time of service,” Gelber-Maturo explains. “Most of the time, copays do not count toward your deductible, nor your coinsurance costs.”
Tips for Navigating Your Insurance at the Therapist’s Office
While your therapist may be listed as in-network on your insurer’s website, the directories can be out of date. It helps to check on the phone with both the provider and insurer to make sure your mental health services are covered and to what extent.
Know Your Copay
If you anticipate needing therapy frequently and you’re working with an in-network professional, seek a policy with a low copay. This way, you can attend as often as you need.
Talk to Your Therapist
Besides attending therapy, if you seek help from an out-of-network professional, talk to your therapist about a pay-what-you-can or “sliding scale” option. You can also look for community resources and other affordable therapy options.
Additional reporting by Connor Beckett McInerney.