How do people pay for multiple sessions per week?

I’m in the United States, so my question is mainly for U.S. clients. I see a psychodynamic therapist once/week and am thinking about twice/week. I know he sees some clients 3x/week. He has disclosed that he himself underwent psychoanalysis 4x/week for five years. That can’t possibly be paid for by insurance, can it? I’m in a healthcare field and have been advised that I should not use insurance to pay for my therapy as that could affect my disability insurance, etc. I think that’s ridiculous, but I’ve had multiple people tell me that. So, I’ve been paying out of pocket for once/week therapy. I technically could pay for twice/week, but it will hurt, and I’ll need to convince my husband. This has gotten me wondering how others pay for it? Three and 4 times per week must be absolutely exorbitant. How did my T pay for 4x/week? Although his salary is probably decent, that doesn’t really seem doable. I wonder how many sessions/week would be covered by insurance?

My insurance paid for 2x a week for quite a while, more than a year. It might depend on what diagnosis you have and all insurance companies are different. I could have paid out of pocket for twice a week but it would have required sacrifices. I could never afford 3x or 4x a week but my T only works two days a week so for me it's a moot point.

I don't know why using insurance would impact your disability claim but I'm not an expert.

My insurance pays for 2x a week and I have been going for a year and a half now. It does depend on your diagnosis. Personally I can't even imagine going to therapy 3-4 times a week and I am dealing with DID, MDD and C-PTSD. I would either have nothing to talk about or I would be too stressed dealing with trauma that often.

I’m in the us and am in high frequency treatment(4-5x/week). My insurance pays, as my policy doesn’t differentiate between mental and physical health needs, so I just have to meet our deductible and then pay a copay, and then if we hit out of pocket family max, it’s covered at 100%.

I don't have any children.

My insurance pays 60%, since my T is out of network. For now, they’ve been covering twice a week—keep worrying they’ll stop. Before we were paying for both marriage counseling and my individual therapy—stopped marriage counselor but same amount is still in budget.

As much as payment, I am always interested in how people find the time, motivation and concentration to go to therapy more than once a week.

I've been going 3x/week for almost a year now. Insurance will pay for the 1st session minus the copay. For some of that time, before I hit my deductible for the year, I had a health care card that was part of a severance package from a previous job. Right now I'm waiting for my state to pay for some sessions as part of a crime victim's compensation fund that will pay for at least 15 sessions. I pay out of pocket for everything else. I'm lucky to have a good job and, like Stopdog, I don't have kids.

I know it seems like a lot of therapy, but I need the support right now, so I hope no one is judging me for it.

I can't really afford it, but I need it, so I mostly do it anyway. How do I pay for it? Well, mostly by never indulging myself and by stressing about money constantly. I also found myself having to dip into my IRA a few times. My new strategy is selling my plasma. They didn't want me at the regular donation center because I have an autoimmune disease, but the medical supervisor suggested I look into places that specialize in plasma from people like me and I could actually get paid more. I'm in the process of getting qualified for that now. My parents were pretty horrified when I told them I was selling my plasma, but hey, it would pay for an extra session.

Oh, and my insurance pays for both sessions minus the copay, which is $25 + 10%.

We pay out of pocket for my husband and my individual sessions and occasional couples session. If I upped to twice a week we would have to cut something out of our budget. This is a place of privilege though and I fully admit that and am very thankful. I could use insurance if I didn't see my therapist but it's not worth it.

I go 4xweek but as I'm not in US then I guess the money question is really not for me and so I will respond to the above post instead.

In terms of time, I'm in academia and my work time is flexible. Also, I have morning sessions, which on some days are very early morning.

As for the motivation - this is just part of my life right now and I'm used to it.
I don't really need any specific motivation for going to my sessions - this is just what I'm doing as part of my daily routine.

Regarding concentration, it is often difficult to switch mindsets and starting productive work after coming from session. However, with such frequent sessions, I think the therapy is conducted in principle differently compared to less frequent therapy. With once per week session you have to go and process and cover as much as possible and then there is a clear break of one week. With 4 weekly sessions the process feels almost like continuous and there is not that much pressure to cover much in any single session as there is time and thus important things reveal themselves quite naturally over time. There is no particular concentration or effort related to that.

My insurance paid for not only more than 1 appointment a week but also more than one therapist. I could have never afforded $250 a week for therapy. I would call ypur insurance company as not all do.

As far as it effecting disability, I have never heard of that

We dont use insurance, I pay out of pocket. My therapist gives me a much lower rate than what she charges on her website.But money isnt that big an issue for me.

My only advice is if you are a crime victim you may be able to find a place that is funded by the government (in my case) or there may be victim compensation funds as well which I know there are but personally haven't looked into.

Like I posted on the other thread, I recently moved to 3 x a week. Right now my insurance covers it. I talked with them and they do random audits as well as if there is a huge spike in claims. During an audit, my T will have to justify medical necessary. I did 2 x wk for just over a year before moving to 3 x wk. So, hoping that is not a huge spike to them. My T keeps saying that we'll work something out if there becomes a problem with insurance. She has also indicated that she charges less for out of pocket than she does insurance. I would not be able to afford to see her this frequently if I was paying out of pocket.

As far as schedule, I see her at different times on the different days, all in the afternoon to early evening. I am lucky that my job allows me to float my hours as long as I am "available" between 9-3pm, so I work an early morning shift. I like not having to go to work afterwards. T did say that it is common for people that go 4+ times a week to not have such a problem after session because of knowing they just have to make it to the next day - makes it easier to set it aside. There is the possibility that in the fall I will move to early morning appointments.

I know some T's work weekends and others work late evenings. My couple's counselor worked 6pm-10pm 3 nights a week.

I pay a reduced fee for 2x a week therapy and then file out of network claims through insurance. It reimburses 2/3 of it.

Can I ask--you can PM me--what insurance you have? I'm worried about mine continuing to cover twice a week (it's out of network, so they only pay 60%). I'm just worried about the audit and that they will decide to deny paying sessions I've already attended. (I have to pay T up front, then submit to them for reimbursement.) They've been behind in compensating, but it's been for stupid reasons, like someone put in the date as the previous year for a session (when I wasn't even seeing this T!), issues with reading the PDFs, etc. I keep having this paranoia that they will say they can't cover twice a week and won't cover the past 5 months or something. But I also don't want to ask for fear it will trigger an audit. Also wondering if it would help for T to list something besides Major Depressive Disorder as the reason code, like maybe if he listed 2 or 3 things (he's confirmed I have generalized anxiety plus OCD), they'd be more willing to pay?

LT-- you are lucky your insurance covers any of it out of network. Mine would cover 0. I am out of network but I pay T directly anyway, its a whole weird set up we have. If nothing else, maybe go down to 2x a week, 2x a month, and the other 2 weeks you go weekly? That might be willing to let them pay for you longer.... insurance is weird and frustrating.

Yeah, that's something I thought about, if they ended up rejecting it. Monday and Friday one week, Wednesday the next. Which would end up costing just a bit more (over 2 weeks) than what it currently is with insurance. Plus, I assume insurance would still cover once a week...Maybe I should try that soon anyway, just to pull away a bit...

I see my EMDR T twice a week and started doing that a couple of months ago. Insurance has been paying. I had to stop seeing T1 (talk therapy) because I did not think insurance would pay for 3x a week and did not want to get flagged.

Insurance covers 2x per week for me. I do suspect they'd be reluctant to pay for more than that, which is frustrating since I'm beginning to think that 3x per week might be helpful, but it is what it is and I definitely feel fortunate to have found a therapist who even works with insurance to begin with. With 3x or 4x weekly psychoanalysis, my understanding is that therapists often lower their rates in order to make that frequency possible, though it could still be expensive regardless.

As for time, motivation, and concentration--my work schedule is flexible enough that carving out two time slots is manageable, and therapy feels important enough that I make it a high priority in terms of both mental energy and scheduling. There are ways that 2x per week feels easier than 1x, and ways that it feels harder, and so I suspect the same is true of more frequent sessions.

Can you tell me how 2x/week seems harder? I think my T said something once about it being more “intense” but I’m curious what you’ve noticed.

My insurance paid out of network reimbursement (70%) for twice a week for 5 years with no questions asked. They also paid for 3x a week one month when I needed it, again no justification needed.

Then I switched insurance. It’s technically the same plan, but through a different employer. Their contract with the insurance company must be very different, because insurance has been on my case since day one of the new plan. After a few months, they did a case review with my T, and decided that they will only pay for once a week. They said that we could have one more week of 2x/week, and then they would only pay for once a week thereafter.

So for now I’m down to once a week, as I can’t pay for a second session myself. (We are appealing the decision.)

I can't imagine paying out of pocket for once a week, let alone two, three or four. And as others have pointed out, the logistics of finding time, scheduling them and actually getting benefit every session.

"Intense" is a good way of summing it up. Twice weekly often seems to stir things up more deeply, and many weeks it feels like it makes therapy and the content/issues we're working on have a larger presence in my life overall. On the flip side, having two sessions feels like it's better able to contain that intensity in a (mostly) manageable way.

It's definitely a net positive and I'm really glad I can go twice a week, but my current experience is that it makes therapy into a significant project pretty consistently. As opposed to my experience going once weekly where some weeks therapy felt like a big deal and some weeks it was pretty relaxed, and didn't register heavily or take much energy, 2x makes it feel almost like a work or volunteer commitment I've taken on, where the investment is expected/required whether I feel like it or not. And not in the sense that my therapist is holding my feet to the fire or anything, more that it's something my psyche and internal processes are holding me to and demanding I pay attention to.