Welcome to my new series for therapy seekers!
Over the next several weeks, we’ll be exploring the ins and outs of therapy— I’m talking license types, therapy modalities, niches/specializations, and so much more— so that you can find the right therapist for you or your teen daughter.
Missed the last post? You can check it out here.
If you’ve ever been searching for a therapist that fits your budget, you’ve probably wondered at some point how, exactly, you pay for therapy. After all, there’s in-network and out-of-network therapists, private pay only therapists, sliding scales, and more. Trust me, it gets overwhelming fast.
In today’s blog post, I break down the different ways that you can pay for therapy whether you use your insurance or not, as well as affordable therapy options you may not have heard of.
My hope is that, by this end of this post, you’ll have a better understanding of how you want to pay for therapy so that you can find the right therapist for you or your teen daughter.
Using Your Insurance: In-Network and Out-of-Network Benefits
If you have insurance through your employer, a health care exchange, or a private plan, there’s a good chance you’re paying a pretty penny each month for it. And, understandably, you want to use your benefits to pay for therapy. After all, isn’t having insurance supposed to make care more affordable and accessible?
Unfortunately, the answer is a bit more nuanced than that.
Firstly, not all insurance plans are created equal. Some plans don’t cover mental health services at all. Some plans have such a high deductible before insurance covers anything that you’re essentially paying out-of-pocket for therapy anyways.
And secondly, not all therapists take insurance. If you’d like to understand why, check out my blog post “Why Doesn’t My Therapist Take My Insurance?”.
But let’s assume that you have a PPO plan with good in-network and out-of-network benefits and a low deductible. There’s two ways that you can pay for therapy using your insurance benefits:
In-Network (INN)
To use your in-network benefits, you’ll need to find a therapist who is credentialed with your insurance and takes your specific plan. Most people look through their insurance directory to find a provider, but be mindful of outdated or incorrect information.
I recommend using your insurance directory to gather a list of 3-5 therapists that you then verify with a search of their website. You can also use a directory, such as Psychology Today, to find an in-network therapist. You can filter by in person or virtual sessions, gender, faith, ages they work with, specializations, and more. Or, if you’re brave, you can do a Google or AI search for local therapists.
Regardless of which route you take, you want to make sure that the therapists:
Still take your insurance
Are accepting new clients,
Offer appointments on the days and times that work for your schedule (e.g. after school, evenings)
Have experience and training in working with the concerns bringing you to therapy (e.g. anxious high achievers, burnout, perfectionism, HSPs, etc.).
Out-of-Network (OON)
To use your out-of-network benefits, you’ll need to find a therapist who is not in-network with your insurance and who offers out-of-network reimbursement support.
This can look like monthly superbills (a specialized receipt) that you submit to your insurance for reimbursement for the cost of therapy, or it can look like a 3rd party service like Mentaya or Thrizer that submits OON claims on your behalf.
Before your insurance will start reimbursing you, you’ll need to meet your out-of-network deductible. If your deductible is $1000 and your therapist charges $175 per session, you would be able to start being reimbursed after 6 sessions.
Some insurance plans will reimburse up to 80% of the cost of out-of-network therapy after meeting your deductible, which can help make specialized therapy more affordable. Using the example above, if you pay your therapist $175 per session, your insurance could reimburse you up to $140. That’s a huge cost savings!
Working With A Private Pay Therapist
A private pay therapist, unlike an out-of-network therapist, doesn’t offer superbills or a 3rd party service to help you utilize your OON benefits. Instead, you pay the full session fee privately.
Now, I know what you may be wondering: why would I choose to work with a private pay therapist when an out-of-network therapist is an option?
And that’s a great question. It comes down to a few key things:
Diagnostic Privacy: When you use your insurance benefits (in-network or out-of-network) to pay for therapy, a diagnosis is required for insurance to cover services, just like if you went to your doctor or a dermatologist. Some clients don’t want a diagnosis on their medical record or that of their child’s, so they choose to pay privately.
No Insurance Restrictions: Insurance carriers often place restrictions on therapy, including what diagnoses they’ll cover, how long treatment can last, and what interventions can be used in treatment. These restrictions are often not in your best interest as a client, but fighting them can be incredibly time-consuming, exhausting, and discouraging for both you and your therapist. Some clients choose to pay privately because they want therapy that is as flexible as possible and is designed to support their unique needs and concerns without insurance restrictions.
Finding the Right Therapist: There are so many great therapists out there, but finding the right one for you or you child that’s in your insurance network can be incredibly challenging. If you’re looking a therapist who specializes in exactly what you’re looking for (such as high-functioning anxiety and overthinking, chronic stress and burnout recovery, perfectionism and self-worth) AND has the personality and therapeutic style you want, you’ll typically have more options if you’re paying out-of-pocket. Therapy is an investment in your growth and healing, and you want to make sure you’re investing in the right therapist to help you with that.
Affordable Therapy Options
Pro Bono, EAPs, & Community Mental Health
Did you know that there are ways to access therapy for free? If you’re flexible about who your therapist is, there are some great options that may be available to you:
Pro Bono: Some graduate student counseling or therapy interns offer pro bono therapy to people in their community while being supervised by a fully licensed therapist. You get the benefit of free therapy, and they get to build their clinical skills. Win, win.
EAPs: If you have a W-2 job, your employer may offer an Employee Assistance Program (EAP) for limited therapy sessions, often 6-8 sessions a calendar year. You work with a fully licensed therapist about something impacting you at present (e.g. caregiving responsibilities, job stress, life transitions), and it often doesn’t cost you a thing. And if you click with your therapist, they’re often in-network with your insurance and can keep working with you once you use all your EAP sessions.
Community Mental Health: Depending on where you live, there’s often at least one mental health agency in your area. Some work with specific populations (e.g. children and families, people who are navigating the immigration process, people who have recently been released from prison and are integrating back into society, military veterans, etc.), while others offer numerous lines of service. Sometimes these agencies are funded by grants, donations, or state contracts. Other times they’re in-network with Medicaid and/or Medicare to serve people below the poverty line. But the costs that are passed onto you are often minimal or free.
Sliding Scale
Some therapists offer limited sliding scale spots on their caseload, often reserved for clients without insurance, that can’t afford their services otherwise, or that are experiencing economic hardship (e.g. getting laid off from your job, sudden death in your family, etc.).
There may be an application you’re asked to fill out about your finances, and some therapists may require pay stubs or bank statements as proof. This isn’t because your therapist doesn’t trust you; it’s to make sure that their sliding scale spots go to people who truly need it.
Once you’re on a sliding scale, your reduced fee will probably be re-evaluated every 3-6 months depending on your therapist’s policies to check that your situation hasn’t changed. And some therapists only offer sliding scale spots on a time-limited basis, such as 10 sessions or 6 months.
If there’s a therapist you’d like to work with who doesn’t take your insurance and whose fee is outside of your budget, ask them if they offer a sliding scale. The worst thing they can say is no.
And if your budget is extremely tight, I recommend checking out Open Path Collective. They’re a nonprofit who list therapists that offer fixed sliding scales between $40-70 a session so that you know exactly what therapy will cost you.
HSA/FSA Cards
A final way to make therapy more affordable is to use your HSA or FSA card. These are pre-tax dollars that you’re putting into an account for health care, which includes your mental health. And the best part is that many therapists, including private pay only ones, accept HSA/FSA cards for payment.
Frequently Asked Questions about How to Pay for Therapy:
What’s the difference between an in-network & out-of-network therapist?
An in-network (INN) therapist is someone who is credentialed with a given insurance panel (e.g. Aetna, UnitedHealthcare) and has agreed to see clients with that insurance at the contracted rate. They directly bill your insurance after collecting your copay or coinsurance.
An out-of-network (OON) therapist is someone who is not credentialed with your insurance. They do not bill your insurance, but offer ways for you to be reimbursed for the cost of therapy after meeting your deductible, including monthly superbills and 3rd party services like Mentaya.
What’s the difference between an out-of-network (OON) & private pay therapist?
An out-of-network (OON) therapist is not credentialed with a given insurance panel but offers a monthly superbill the client can submit to their insurance company or partners with an OON reimbursement services, like Mentaya. The client pays their therapist the full fee, but may be able to be reimbursed up to 80% for the cost of therapy after meeting their OON deductible. Sometimes this end up being a similar amount to what an in-network copay or coinsurance would be.
Private pay only therapists are not credentialed with any insurance panels and they don’t offer superbills or OON reimbursement services.
Why would a therapist choose to be private pay only instead of out-of-network?
If a client wants to utilize their out-of-network (OON) benefits to help them afford the cost of therapy, the rules and restrictions of insurance apply, even if the therapist is being paid their full fee. OON reimbursement requires a diagnosis, which a client may not want in their medical record, and the clinical documentation may still be audited.
Some therapists choose not to have insurance involved in the therapeutic process at all by being private pay only. And some clients choose to be private pay for the diagnostic privacy and clinical flexibility, even if their therapist takes their insurance (they sign an insurance opt-out form) or offers OON reimbursement support. The client always has that choice for their care.
Can a therapist be both private pay & out-of-network?
Yes! In my practice, I offer both private pay and OON options so that clients can decide what works best for them. If a client was to avoid a diagnosis for themself or their child, or if they want maximum privacy and flexibility in their care, they choose private pay. If a client wants to be reimbursed up to 80% for the cost of therapy, they choose out-of-network.
Why don’t more therapists offer a sliding scale?
Some therapists aren’t able to financially sustain sliding scale spots on their caseload. Since a sliding scale is a reduced fee, a therapist that offers it is taking a pay cut to make their services accessible to someone who could not otherwise pay their full fee. Sometimes a therapist can’t afford to take a lower amount for their therapy hour, even if they want to.
That’s it for today, folks! Come back next time for a behind-the-scenes look at free consult calls, including why they’re helpful in determining if a therapist is the right fit for you, how to get the most out of them, and the structure that I follow in all of my consult calls.
And if you have any therapy-related questions that you’d like me to cover in future blog posts, you can text me at (214) 702-1785 or send me an email at hello@storiedsoulstherapy.com.
Hi, I’m so glad you’re here!
I’m Madilynn Szoboszlay, LCSW and founder/CEO of Storied Souls Therapy.
I specialize in working with high-achieving and highly sensitive (HSP) women and teen girls across Texas, Arizona, and Montana navigate anxiety, burnout, and perfectionism to feel more confident and grounded in their own skin.
Interested in working together?
Schedule a free 15-minute phone consultation with me to see if I’m the right therapist for you or your teen daughter.
Please note: This post is for educational purposes and is not a substitute for professional mental health care. Use of this site does not create a therapist-client relationship.