It is not fair, I agree. I think many psychiatrists (and often also psychologists, more than social workers), don't take insurance. I think part of the reason is because they don't make as much as other doctors and because some insurance providers won't pay them at parity with doctors in other medical fields. They tend to pay social workers a higher percent of their fees than psychologists with Ph.D.s, that obviously often charge more. Plus, I happen to live in a somewhat affluent area (though I'm not). Psychiatrists and psychologists can get away with not taking insurance.

My psychiatrist doesn't take my insurance, but luckily I do have "out of network" coverage. I pay notably more than my husband pays his "in network" psychiatrist. We're also lucky that we don't have maximum annual visit restrictions with our insurance. When we were insured under the insurance I had from my workplace there were.

My psychiatrist is quite unique. He doesn't require that I pay for every session at the very end of the session (and then have to submit a receipt to our insurance for us to be reimbursed for out of network amounts). He rather submits multiple sessions to my husband's insurance and then after he gets paid, he bills me for the remaining amounts. I like this arrangement, except he sends me the bill so infrequently, that the bill is ultra high. I generally see him every 3 weeks. There was one time he didn't bill me for a year. In previous years I'd actually ask "When are you sending me the bill, Dr. Z?" I really adore my psychiatrist, though. I've been seeing him for almost 15 years now. I will only change if/when he retires or we move. Then I'll try to get an in-network psychiatrist.

I'm very lucky that my medications are all available as generics. There were times in the past when most of my medications were only available in name brand. I don't recall exactly, but I think I was sometimes spending well over $300 per month just on medications. Maybe even close to $500. Now I spend about $30 total for seven different medications. The copays for a couple are only about $2 per month. Before a couple became available as generics, I did save some money using coupons. Anyone on name brand only meds should always look for coupons online. Always! The coupons apply even if you do have drug coverage.

For several years, I have made sure to go to a therapist that takes my insurance since my psychiatrist is out of network. I used to mostly only go to psychologists with Ph.D.s, but it is getting more and more difficult to find an available in-network psychologist. This time I had to choose a social worker. She's very good, but not as good as my last two psychologists with Ph.Ds.