[Hopefull]

I am fascinated by how much money it takes to be allowed to talk with someone for an hour.
Diagnostic Assessment: Masters/CADC: 139, PhD: $185, MD: $247
Individual, couples, family therapy: CADC/Masters: 124/hr, PhD: $165/hr, MD: $216/hr
My insurance only wants to allow $80 on individual therapy. So the agency has to eat the rest of the price. Is that how most people's insurance is? My insurance seems to always negotiate a cheaper price than the sticker price. Does that make the sticker price for self-paying people higher? Does the uninsured have to pay the sticker price or go somewhere else?
Group therapy: CADC/Masters: $57/hr
Neuropsychology Testing: PhD: $242/hr
Medication check (15 minutes): MD: $113
I think my insurance only allows $98.90 for a medication check. Again the agency has to eat the difference. Is this normal?
Medication check (20-30 minutes): MD: $144
Intensive outpatient program: $175/day
Intensive outpatient program-eating disorders: $200/day
Psychologcal Testing: PhD: $242/hr The price list is probably out of date because I received when I first met the T in November of 2005.
My co-pay on the MD's 15 minute medication check is $19.78 while the therapy co-pay (Masters) is $26. Does any of your insurance companies seem to encourage medication over therapy? I think mine does. They limit the number of therapy session but don't limit Pdoc medication checks.
My insurance allows 30 sessions a year and makes you pay for the first $500 dollars (deductable). What is some of your insurance benefits like on mental health?

[(JD)]

I think your prices and allowances are about normal for decent insurance. Remember, part of the reason prices are high is because insurance only pays a percentage.

There is a mental health parity act before Congress as we speak, so that insurance companies will have to pay for necessary mental health visits, rather than limit them. Hopefully, it will pass completely and soon.

[withit]

I shell out $150 per session! I have met t's who shouldn't be getting more than $50 a session, yet they charge a hefty $150!
My previous t rolled back her fee for me, from $150 to $75, so that I could afford it.
My insurance only covers in-network providers, and they do not match the level of expertise I seek in a therapist. Therefore I see an out-of-network provider and self-pay. Sux big time.
This week I plan to ask for a fee reduction as my resources are running low and I do want to stretch my few remaining dollars...
How I wish there were some resource where I might get some financial assistance to help me pay for weekly therapy.

The insurance I have right now covers 30 visits per calendar year with a copay of $20 per visit.

However my employer has decided to do away with that. Beginning May 1st I will only have catastrophic coverage after a $3000.00 deductible. grrr to them

Recently I began treatment with a therapist who i found by contacting a psychoanalytic institute; she is a candidate at the institute. Her normal fee is $85/session but she has adjusted it for me since my insurance doesn't cover her services (she is not in their network).

I have to say that, as hard as it is for me to come up with $70 a week, I really like the fact that the insurance company is not involved in this in any way. This is strictly between her and me and there are no insurance hoops to jump through regarding diagnosis, treatment modalities, length of treatment, claims to file, etc.

They are expensive, but well worth it, and they have invested hugely in their education and internships.

[spiritual_emergency]

<blockquote>
Hopefull: So the agency has to eat the rest of the price.

I'm not aware of any agencies in this area that "eat the rest of the price". More commonly the individual pays all of the fee up front and then applies to be reimbursed through their insuring party up to the amount provided. For example, if the cost was $150.00 and the insurer only covers $80.00, the client will "eat the rest of the price".

Typically, insurance is offered as part of an employment benefit package but benefit packages are generally not offered for menial workers (i.e. waitstaff, janitorial, child care workers, etc.) No benefits package = no insurance. This means that those engaged in specific fields or those who are not employed at all can often not seek therapy for the simple reason that they can't afford it.

[Juliana]

I didn't have to pay anything for the CBT I received a few years ago. My therapist was a psychology PhD student and giving therapy was part of his studies. My family doctor arranged it for me. There were other free options available to me at a local teaching hospital and a mental health clinic as well. When I was sick I didn't have an income, so I needed something free. I chose the PhD student and he turned out to be extremely competent and helpful.

I live in Canada, so doctor's appointments and psychiatrist's appointments are always free. I saw a psychiatrist in addition to the therapist. Private therapy with psychologists and other types of non-prescribing therapists can be expensive (unless you have insurance to cover it -- my current insurance at my job covers 80%), but there are other options here.

I'm just wondering if there are any programs in the U.S. similar to the therapy I received -- going to a mental health clinic or teaching hospital that offers therapy from a student for free or at a much lower price. It bothers me that therapy seems to be so cost-prohibitive for some people. IMO, it should be easily accessible to everyone who needs it -- regardless of their financial circumstances. People who are struggling with emotional and psychological problems don't need the added stress of extra financial worries. Everyone deserves to get help.

[spiritual_emergency]

<blockquote>
I talk mostly to individuals who have gone through psychosis and/or been diagnosed as schizophrenic, so that's the area that concerns me. They come from all over the world and all of them either own a computer or have access to one, so we're talking about a specific subset of the population but a highly variable background. In other words, someone wealthy enough to own a computer but not necessarily wealthy enough to cover a few hundred dollars a week for therapy.

As you note, there are options -- church groups may offer therapy, some students offer therapy, sometimes a person can get in as part of a research study but most of these are not going to be tailored to the needs of someone who has gone through psychosis or been diagnosed schizophrenic. For those who do have computer access and who are motivated to help themselves, the internet can be a wonderful tool. There are numerous sites out there as well as communities such as this one that can assist those who are "self-helping".

Of course the same is true of many other people out there with different labels or diagnosis. They might not be employed either. It would be interesting to put together a thread with ideas, such as the ones you suggest, specifically to help those folks.

[Juliana]

Thanks for the info.

I had a successful career before I got sick. But suddenly, I couldn't work anymore and I stayed that way for about 4 years. My regylar savings got all used up, then I cashed in my retirement savings and then I had to accept charity from my family and go on social assistance. I am so thankful that there were psychiatric and psychological resources available to me. It was a real eye-opener for me -- realizing that if it could happen to me, it could happen to anyone.

When I was in university, I volunteered in a soup kitchen every Sunday afternoon at a local church. The majority of the homeless people I got to know had serious mental health issues but had fallen through the cracks and not gotten the help they needed... and that's how they ended up on the street. It's heart-breaking. I was fortunate enough to have a doctor who was a strong advocate for my health when I wasn't strong enough to advocate for myself. She made sure I got the help I needed. I just wish everyone could be so lucky.

[sunrise]

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Again the agency has to eat the difference. Is this normal?

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Yes, this is not uncommon. If mental health providers sign on to be part of a health insurance plan's preferred provider group, they agree to charge less than their regular fee to patients/clients who have that plan. This is true for any health provider who is part of the plan, whether GP, surgeon, dentist, psychologist, etc. For example, my GP charges $190 for a physical exam if you don't have insurance, but only $140 if you have a certain plan, like I do. He has to "eat the difference" in cost and charge me less than his "true" fee. This is called the provider "write-off." Unfortunately, the person who doesn't have that insurance plan has to pay the full fee and "eat the difference" himself.

My first counselor charged me only $90 per session because she was a preferred provider. I don't know what her full rate was to people without the insurance plan. Of that, I only paid $9 per session for up to 20 sessions a year. It was great. Ahhhhh, those were the days. My current therapist charges me $125, and my insurance will not pay a penny of his fee. So I pay the full amount out of pocket. He's worth it, but I do have some frustration at the arbitrariness of who the insurance will reimburse for and who they won't. He is much better than my first counselor, but yet the insurance plan judges him less fit. They were both master's level therapists. I hate insurance. I guess, like ECHOES, though, I do see some advantage to not having my insurance be part of our interaction. I pay for therapy because I want it, it is very important to me, and no insurance company becomes apprised of my diagnosis or treatment details. I am also extremely motivated in therapy to make progress, perhaps in part because I pay so much of my own cool cash for my therapist's services. The clock is ticking each minute we are together; it is up to me to make sure I am getting my money's worth. I feel the responsibility and I do not dally in therapy or go in there and sit in the chair and say nothing.

My health plan considers psychiatric visits to be medical visits rather than mental health visits, and will pay for them at 90% for an unlimited number per year. Yes, I guess the insurance would rather that you took drugs than had therapy.

Another interesting tidbit is that my insurance will not pay for couples therapy or family therapy, only individual psychotherapy. I think they may pay for family therapy if the diagnosis involves addiction.

[OliviaC]

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_Sky said:

There is a mental health parity act before Congress as we speak, so that insurance companies will have to pay for necessary mental health visits, rather than limit them. Hopefully, it will pass completely and soon.

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My insurance already has parity, so my visits are not limited. I was a bit surprised and so was my doctor, as this HMO BC/BS parity seems to depend on your workplace benefits and what they decide to allow. Doesn't seem quite fair. That is great news, Sky; mental health visits should not be limited!

OTOH, my insurance doesn't cover many psych drugs unless they are generics which I hate. Luckily I only take one and found a generic which is closest to the name brand; in fact made by the company who manufactured the name brand.

[Perna]

I always thought therapists were "wealthy" but they're not really if you do the numbers. I forgot they have to run a business, pay rent on their office, etc. And it's not like they can see 8 people a day 5-6 days a week, they have to go to meetings and take continuing ed courses and have a "life." My T got up to $100 an hour, PhD psychologist in a "big" city/good area with me paying out-of-pocket. But I know she only worked about 3 days a week so assuming she had 4 full pay clients x 3 days = $1200 a week x 45 weeks a year (she worked much less as she travelled 2-3 months a year) = $54,000 and that's before paying rent and business expenses, etc.

My therapist friend works for the State of Georgia so gets a "salary" and not much in the way of expenses but a whole lot more interference and paperwork, etc. I guess it's possible to make more if you work more but there's a limit I think and you often have to have an assistant to help with billing, etc. when insurance is used (I paid out of pocket).

I think with clinics therapists give up some freedom and get more hassle than independent therapists but for less/shared money they get a secretary/billing clerk and rent/space, etc. And the hours can be greater since there's more therapists (so they can work evenings and on Saturdays and Sundays perhaps since there's more therapists with so many different hours needed so the clinic has "more" money coming in for a greater period of time because even though a therapist might be away some other therapist is still working/billing, etc.

So, they might collect $80 ("standard" insurance payment) x 5 therapists x 6 hours a day x 6 days a week x 50 weeks = $720,000 - $220,000 (divided by 5 therapists :-) for rent and assistance/office supplies, insurance, etc.) = $500,000/5 therapists = approximately $100,000 each (they'd get more or less depending on how much they actually worked, their "share").

[lauren_helene]

I pay about $30 per session (copay). I'd pay whatever I need to though, he's worth it

[Juliana]

You're right. I don't think therapists are in it for the money. It's a hard job and it takes an exceptional person to do it well.

By comparison, I charge $85/hour for freelance graphic design work or editing (when I have time). It's easy and I just do it from my home -- very little overhead. So, therapist's prices are not outrageous. I just wish there was a way for everyone to afford them.

[sidony]

I am lucky in that my insurance does cover some of my visit. They cover 75% of their "Usual Customary Rate." Of course their UCR is only $78 which is considerably lower than what my therapist actually charges (he charges $135 an hour), so I pay the difference (roughly $77 a visit). Still I'm glad that they help at all since he's not a network provider and I suppose they could refuse to cover him at all. I'd go to him regardless though as he's been incredibly helpful to me. And I think I value it more because I'm really invested in it.

For group therapy my therapist charges $65 an hour. I'm thinking that's about average in the area where I live (big city).

Interesting thread!
Sidony

[Crystal88]

I don't know I never see the bills cause Im on state welfare medical coverage here its called the "medical card."

[Hopefull]

Well, it may not matter soon because I will probably lose my health insurance soon. I am down to eight hours a week at work. So, I am not sure what I will do if I want to continue my relationship with T and psychiatrist. I might just have to settle for crying a lot. I will be looking for work in a week or two-I have to clean up my apartment. My landlord willl probably visit in a few weeks and see how it looks-grrr.
My copay is around $26 an hour. Some of you say that $70 or more is worth it to talk to a T. I'm not sure anything is worth that. I mean if I paid that on a regular basis, I'd want T to feed me. (I took money out of savings to pay for my rent) $26/hr equals around three hours worth of work for me! I feel that T is worth $50 to me (5 1/2 of work) but not much more.
As for the T's payrate, my teachers all claim that we shouldn't be in this major (addiction counseling) if we are in it for the money. However, I told my teacher that I want an apartment with a wash machine, dryer, bath tub and a second sink for me to wash my dishes. I'm so greedy aren't I? I also want consistent hours and reliable health insurance (I work in retail. My hours go up and down. I have been without insurance before).

[sidony]

Hopefull, I'm sorry you're in such a rough situation right now. And certainly you're not greedy to want a consistent income and some reasonable benefits! People are in different financial situations so 5 hours' pay would mean very different amounts to each person. Maybe you can find a therapist who works on a sliding scale? I've heard people mention having some success along those lines. Getting established in a career is really tough. Good luck with your work search....

Sidony

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Hopefull said:
Well, it may not matter soon because I will probably lose my health insurance soon. I am down to eight hours a week at work. So, I am not sure what I will do if I want to continue my relationship with T and psychiatrist. I might just have to settle for crying a lot. I will be looking for work in a week or two-I have to clean up my apartment. My landlord willl probably visit in a few weeks and see how it looks-grrr.
My copay is around $26 an hour. Some of you say that $70 or more is worth it to talk to a T. I'm not sure anything is worth that. I mean if I paid that on a regular basis, I'd want T to feed me. (I took money out of savings to pay for my rent) $26/hr equals around three hours worth of work for me! I feel that T is worth $50 to me (5 1/2 of work) but not much more.
As for the T's payrate, my teachers all claim that we shouldn't be in this major (addiction counseling) if we are in it for the money. However, I told my teacher that I want an apartment with a wash machine, dryer, bath tub and a second sink for me to wash my dishes. I'm so greedy aren't I? I also want consistent hours and reliable health insurance (I work in retail. My hours go up and down. I have been without insurance before).

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[jbug]

I have medicare/medicaid so I don't pay for my therapy or pdoc appts. I go to the county mental health place though and they have a sliding scale. When I didn't have insurance I paid $11 for therapy and $9 for group therapy and $25 for doctor visits. When I worked for Walmart they only paid half of my visits and I had to pay $50 a visit for both pdoc and therapy. I am about to lose my medicaid though and still won't have to pay because they will get me a medicaid spend down and my portion of my visits after medicare pays will go towards the spend down.

Jbug

[sujunew]

I pay nz$80 a session. I was going fortnightly as the welfare system I use pays a max of nearly 50% a week (by going fortnightly the sessions were more or less paid for) but now that I have increased this to weekly I have to pay 50% of each visit myself. May not sound a lot but when things are as stretched as they are at the best of times it is very difficult. However as she is the 1st t I have ever 'clicked' with I will not be letting her go easily!!!
p.s. all hospital appts e.g. to see the hospital psychiatrists, psychologists and nurses are free here unless you are not a nz citizen.

[OliviaC]

I just dug out all the mail that Magellan sends me with amounts paid to therapist, pdoc, etc. for the last couple months. I hadn't paid much attention because I go weekly and these things come every week!

Anway, in January, the bill to my insurance (Magellan of Blue cross/blue shield) was $157.00 for PhD = what a weird amount billed?! Then insurance paid $89.00 and I made copayment of $10, so $99.00 for PhD.

Then in February & March, the clinic billed the insurance company $169.00 (again a strange amount)? for PhD and insurance paid $94.00. I paid $10.00, so total $104.00.

I can't be bothered worrying about how much they bill or if they go up in cost, all I know is I pay $10 per visit......

man you guys with good insurance are so lucky! I'm really reallly glad for you and in awe of your generous and thoughtful and forward-thinking insurance companies.

I pay out of pocket and have worked in insurance for 22 years.

[lauren_helene]

What I noticed about my insurance payments was when I first started seeing my T, he billed $120. I forget when it changed but lately its been $150 but my copay and the insurance payment amount have not changed.

I'm not sure what significance the $30 difference was for him but I also plead ignorance on the matter

Well he's free to set his rate no matter what the insurance company/comanies reimburse. But one thing that raising their fee does it that when number crunchers look to see what the average rate is in order to determine the amount the insurance companies will approve, they use the data they have which is the amount charged...so.. if the billed amount increases (overall--from various providers of the same service) then the amount the insurance company will allow, or will consider reasonable or customary, also may increase. So the T might receive a higher reimbursement. Surgeons and other providers do that too.

It's good for those who pay a set copay because that doesn't change. For those that pay a percentage of what their insurance allows, then their share goes up too.

It is a convoluted little game, isn't it?!

[lauren_helene]

That explanation makes sense Echoes...!