If therapy were a donation-based service, what would you pay for an average session?

Can anyone inform me as to why therapy rates in the UK are so much more reasonable than they are in the US?

I think it is mostly the higher health care costs in the US over the rest of the world in general, and a little bit the exchange rate and the current strength of pound vs. dollar.

But I don’t know for sure.

Some of the cost difference could be related to malpractice insurance, but maybe that has more to do with medical care, I don't know. When it comes down to it, though, there really is no rationale. I don't work in any kind of care field, and even though my hourly rate is considerably high, I don't really take home all that much due to expenses and taxes. It basically costs an effing lot to live and work these days.

I wish I knew, too. Therapists in Canada (my home country) have fees more in line with the US -- they regularly tip the $100 mark. I would not have been able to access the help I needed

I feel very, very lucky that I can afford a good therapist without having to pay out the nose. I did go through the public healthcare system initially, but the counsellor they sent me to was absolutely garbage!

Another cost consideration for US therapists who take insurance, or health care professionals in general, is that the out-of-pocket hourly rate and the rate the insurance pays are very different.

With my co-pay, my therapist really only gets half the oop hourly rate she charges. (Same with my gp, physical therapy, chiropractor, etc.)

Yes, but some of us pay out of pocket at 100%.

Yeah.

I was thinking of why higher costs. I’m not an insurance expert, but the allowed percentage or allowed amount seems to put therapists and clients over a barrel. To get a reasonable hourly rate from insurance companies willing to only pay half or less, the oop cost has to be higher. It stinks all around (unless you’re an insurance company).

That and just general musing as I was trying to think if I should count my therapist’s usual rate as what my insurance company pays her or her oop rate.

Good point about insurance, but it doesn't explain things. Most Ts here don't even take insurance, but I've used my insurance in the past, and it paid more than Ts in the UK get paid; much more-it was over $100 but I'd have to look it up to find exact amount. And that is for providers who only have a social work degree. Medical doctors, physical therapists, chiropracters have much more education

There are probably multiple factors, but I read that providers in the US get paid much more than in the UK. However, I've seen no mention of therapists, just medical doctors. That was in general. Unlike other providers, it seems over half of therapists don't even take insurance.

I do review every insurance benefit statement and many providers, particularly specialists, get all or close to what they charged, although ER gets close to full amount, the hospital gets much less. For outpatient, for example, my psychiatrist charged $150 for an hour visit (must have been billed as therapy, I noticed other times it was $175 for 30 minutes.) He got reimbursed $115 + my $35 copay = $150, which was exactly what he billed. Interesting that when he billed $175 he got about $90 + $35 copay = $125. I'll assume that was for medication management.

On the other hand, I saw that one physical therapist regularly charged $400, which was shocking, but when I switched to another, they only billed for $175. For the same thing. They both got reimbursed the same. There is something wrong there. So I think many don't get their full amount because they overbill, not because they are underpaid. Although it's fraud, it's very common in the US to overbill. I wonder if anyone is watching this? The insurance companies just pay it-I don't recall them ever denying a claim saying the charge was too high.

In thinking of this, I concluded that rather than being underreimbursed, I think US therapy rates, such as $200 for a session, is inflated. I encourage everyone to review their insurance statements. They can be surprising, for sure.

I wonder how much it cost? Anyone care to share? I could only find rates for internal medicine. Surely therapists don't pay as much as medical providers, especially considering side effects or harm is not well recognized.



But yeah, so many of us are underpaid these days.

I'm not sure I read my insurance statement correctly because holy Moses are they confusing, but I had a serious of (identical) blood tests a few months ago. The ones that were done at my doctor's office were about sixty bucks each. The one that was done at the hospital (because that part of the doctor's office happened to be closed that day) was billed for over five hundred dollars! And I know for a fact that the doctor's office and the hospital use THE EXACT SAME LAB! Literally the only difference was the location where the phlebotomist took the blood from my arm. My insurance only paid something in the ballpark of sixty bucks for the hospital test too and the hospital "wrote off" the rest, even though the charge was absurd in the first place.

I think my point is that the U.S. system of healthcare is profoundly broken.

I said I'd be willing to pay $100. When I was paying oop, I was paying him $120, although I could have negotiated on that amount. Now that I'm using insurance, he gets $92.50 per session. That's what the insurance company reimburses plus my copay. I've noticed that he bills them for $150, but his contract with the insurance company for how much he is reimbursed is some sort of negotiated rate I gather. Not sure how that works exactly.

For those that use insurance (in the US). If your provider is in-network, it means that they have a negotiated rate with your insurance company.

For example, the negotiated rate for a 50 minute session may be $100. Your copay is $25, and your therapist bills the insurance company $150. The insurance company, says, nope, we have a negotiated rate, it's $100. So, we'll pay you $75, and you collect your client's copay of $25 to get to the $100 rate.

It's not illegal for a therapist to "overcharge" an insurance company (as long as their CPT codes and diagnostic codes are accurate), but I won't get into morality. But, the insurance company is more often than not, going to catch it because everything is automated now a days.

Throw into the mix that different companies have different negotiated rates, and even different plans within companies have different negotiated rates and who knows what you'll pay?

Plus, throw in out of network providers and it gets even more confusing. In the above scenario, you'll be responsible for your $25 copay and then another $50 (the difference between the charged rate and what the insurance company deems fair and reasonable).

It's crazy and insane, but super interesting to me in a weird kind of way. It's almost relieving that my T doesn't take insurance.

The whole negotiated cost thing, which I know is off topic from the op, is a difficult topic for me because therapists will offer discounts to some clients who pay out of pocket, but not everyone, and what they offer as discount varies. So, on top of a cut rate for insurance, there's this other side deal, and it hurts when I think about it, so I try not to (as someone who pays full cost out of pocket).

Same here -- full cost out of pocket.

And yep, current T apparently offers reduced rates to some other folks. But, for whatever the reason, I wasn't one of them even when I anticipated having trouble with my finances (she just offered to see me fewer times then).

I pay full price out of pocket, too. No insurance, no discounted rate. I don't know your story (and I don't want to make assumptions!), but I pay out of pocket because I see a T who is very specialized and, I'm sure makes more in cash, but has also said it protects her client's privacy better. I don't know that she offers discounts, although I doubt that she does right off the bat. She may do so after a while with clients if they hit hard times, but I have no idea.

Now, I do agree that it sucks that cash clients pay more than negotiated insurance rates. That shouldn't be. I think technically they have to "charge" everyone the same, but there's no reason they can't negotiate the cash rate down, too.

It's an interesting topic; maybe it deserves its own thread.

Has anyone who wanted a sliding scale asked, or is the therapist supposed to make the move? I’ve never asked, even when maybe I should have with 2. I suppose 3 didn’t charge me as much as she could have (she charged her normal 50-minute rate for 75-minute appointments, I assume because the longer appointments were her idea, which to me is the right thing to do). Info clearly found this deeply puzzling. I guess we might be talking about that tomorrow (their different attitudes). Bleah.

I didn't specifically ask (in part, because leaving aside the issue of what she does with others, I can't in good conscience make an income-based claim) but it came up in conversation and I realized that she wasn't really keen on it (at least in my case).

I think 3 is a serious outlier when it comes to therapists.

Info seems a little more the norm.

I asked my T if she had a sliding scale. She only accepts a few sliding scale at one time. I paid her sliding scale until we tapered down our sessions.

Yeah, I just did the math and realized with 2 75-minute sessions a week at her hourly rate, 3 was essentially giving me a free 3rd session a week.

Maybe I should add them all up and send her a check and that will make me feel better?

I didn't ask because I have a decent income. I would feel really creepy if I asked for a discount and then walk in there talking about buying x or y thing for myself or remodeling work on the house. My issue is more that the cost of a thing should be based on its value, not on who is paying. I absolutely hate car buying because it's all about dickering down the price, but even that is not based on what the buyer earns (well, it could be on the buyer's end of things, but it's not the car dealer deciding that because I earn X I must therefore pay Y). Also, there is the hurt factor, when I realize that my therapist will see other people for a whole lot less money.

When I first started seeing him, I was going to use insurance, but I changed my mind before my first session. When I told him I didn't want to use insurance, he told me his rate was $120 and that we could negotiate that rate, so he made the first move. Kind of threw me. I wasn't expecting that and I don't like to haggle so I told him I would just pay his rate. (I'm not independently wealthy. When I left my last job, it was through an employee buyout and as part of the deal I got a health care spending card that had X dollars that you had 5 years to use up. I decided to use that card to pay oop because it was highly unlikely I would use up all the money on regular medical expenses.)

ETA, now that I'm using insurance, I kind of feel bad that he's only getting $92.50 and not the $120 I was previously paying. I offered to pay the difference on top of my copay. His response was that he can't legally (I guess because of the negotiated rate thing?) and that he was used to it.

This is an interesting thought exercise. What I would gladly pay my t based on her worth to me and what I can afford are two separate issues, but I went with what I think she is worth to me and chose >100. I don't know what her actual fees are but based on others with her training and experience I would guess around $150 - $175.
I have seen several "counselors" who charge between $60-80 and they were very much useless to me. They didn't have an understanding of my issues at all.
The two psychologists who have helped me have both have > 7 years of university training and are continually upskilling in trauma based therapy. They one I currently see doesn't just "sit there and listen". She has specialist skills that I need her to have to help me heal from "catastrophic developmental trauma." She is among only a handful of people in my city who understand DID and the only one who has the experience and specialist skills (advanced EMDR training) to treat me.
She is of great worth to me and I would gladly pay her whatever I could afford because I need what she has to offer in order to change the things in me that I need to change.

The average cost for therapy in my country is 50 euros (60 dollars). Once I came across a therapist who charged 70 euros (83 dollars) per hour but that's rare (she also was a sex therapist so maybe that's why). I think 60 dollars is too much for what therapists actually do (not what they claim to do) which is: sit there, listen and remember what I have said. So if it was up to me, I would pay 20 dollars for 50 minutes because that's what a therapy session is worth imo. I've read that some therapists in the US charge as much as 200 dollars per session and I find that completely insane. How can a therapist even justify such an exorbitant price?

Surely a therapist, even the worst of them, must do more than just sit there listen and remember what clients have said. So many people have written that ins different parts of this forum.
I try to think of telling just any old Joe Bloggs who would be willing to sit there, listen and remember what I've said and I think "hell no!" And then I think if I wouldn't be willing to say this stuff to just anyone then there must be something more that a therapist does than "sit there, listen and remember what I've said." I want and expect so much more from a therapist than that and am willing to pay for it. What I want from a therapist is definitely much more than than just listening to me.

I think it can be extremely helpful and useful to have someone just sit there and listen while you vent. I just don't think it deserves a big salary in exchange. You expect more from therapists, I don't. Whenever therapists have tried to give me some insight, most of the time all they gave me were some platitudes. Once in a while what they said was somewhat helpful and made me think but it wasn't very often. I don't want to pay to hear platitudes but I suspect some people must like them considering how well self-help books sell. Anyway in my experience that's what therapists do: sit there, listen, remember what I have said. Which is fine by me. We don't all use therapy the same way as we don't all have the same issues/goals.