1. Limited Insurance Coverage: Despite having insurance benefits, many individuals find themselves paying for therapy out of pocket. The options offered by their insurance plans often don’t align with their needs or have limited availability for new patients. 

2. Complex Insurance Processes: The process and regulations regarding mental health care billing are very nuanced and labor-intensive. Insurance companies often scrutinize mental health services more due to their inherent ambiguity, leading to complications in reimbursement. 

3. Out of Pocket Practices: Many mental health providers operate independently, lacking the support of administrators and billing specialists. This administrative burden can be overwhelming and detracts from their primary focus on patient care. 

4. Access Challenges: Limited access to mental health care is a significant barrier for many individuals. Even with the Mental Health Parity and Addiction Equity Act, a landmark achievement aimed at ensuring equality between mental health and physical health benefits, the landscape is riddled with loopholes, making affordable mental health care a distant dream for some. 

Tips for Affording Mental Health Care 

1. Sliding Scales: Some therapists offer sliding scales to accommodate patients with tight budgets. These can make therapy more affordable but remember that therapists need to sustain their practices too. 

2. Open Discussions: Have open conversations about affordability with your therapist. Discuss what you can pay and find a reasonable agreement. Most therapists are willing to work with their patients to make care accessible. 

3. Teletherapy: Teletherapy has become a widespread intervention over the past few years and can be more accessible and cost-effective. Many sessions are covered by major insurers. Some of the most popular teletherapy platforms include Better Health, Teladoc, MDLive,  

4. Low-Cost Resources: Organizations like the Substance Abuse and Mental Health Services Administration, the National Association of Free and Charitable Clinics, and the Open Path Psychotherapy Collective provide treatment locators to help patients find low-cost and discounted treatment across the country. 

5. National Institute of Mental Health: Visit the National Institute of Mental Health’s website for additional resources, including a helpline, podcasts, webinars, and support groups. 

While the challenges of affording mental health care are real, there are options and resources available to make treatment more accessible. We hope that over time, there will be improvements in mental health care affordability, ensuring that anyone seeking access to these interventions can do so without impediment. 

Read Less

[00:00:36] Allie: The prioritization of mental health awareness in our healthcare system, workplaces and schools has become more prominent as society recognizes the impact of mental health conditions. According to the National Institute of Mental Health, one in five U.S. adults lives with mental health conditions of varying degrees of severity. Many people are speaking out about their mental health struggles and de-stigmatizing seeking therapeutic treatment. 

[00:01:02] While preparing for this episode, I spoke with some of my friends about the affordability of therapy. Surprisingly, I found out that a significant number of them were also paying for therapy out of pocket, despite having jobs with health insurance benefits. They shared that the options offered by their insurance plans often didn’t align with their needs or have limited availability for new patients. 

[00:01:26] So, is the issue rooted in the limited coverage of therapy by insurance providers? Or is it the complexities and challenges that therapists face when attempting to accept insurance?  

[00:01:39] Allie: Hello and welcome to The Hidden Costs of Health. In this show, we’re exploring the burden of medical expenses in this country and how a health event can quickly spiral into financial toxicity.  

[00:01:53] I’m Allie Sandler, a producer for Empowered Us.  

[00:01:59] [Music Ends] 

[00:01:59] In 2008, The Mental Health Parity and Addiction Equity Act (MHPAEA) was passed, a landmark achievement aimed at ensuring equality between mental health or substance use disorder benefits and physical health benefits and insurance coverage. Yet, even with this legislation in place, we find ourselves navigating a landscape riddled with loopholes, making affordable mental health care a distant dream for some. 

[00:02:27] Additionally, a significant number of mental health providers operate outside the confines of the health insurance system, leaving patients stranded in an out of network wilderness. While approximately 90% of non-mental health physicians accept commercial insurance, only 56% of psychiatrists follow suit.  

[00:02:49] Due to the challenges of affordability and lack of access to mental health services, many individuals’ mental health conditions go undiagnosed and untreated. Some therapists do offer sliding scales to accommodate patients whose budgets cannot bear the weight of weekly payments. However, it’s crucial to recognize that therapists, like any professionals, need to sustain their practices and livelihoods.  

[00:03:14] [Music] 

[00:03:15] The delicate balance between accessibility and sustainability poses a challenge for both therapists and patients alike. Also, having conversations surrounding money and affordability can feel overwhelming and sometimes filled with complex emotions. But what happens when a person wants to prioritize their mental health and it’s either uninsured or unable to find in network coverage while still staying on a budget? 

[00:03:44] [Music Ends] 

[00:03:44] Alex: My name is Alex Grobstein and I’m a full-time artist. I’ve been going to therapy throughout my life and utilize it as a resource whenever I’ve needed. I’ve had insurance, but as I’ve gotten older and, and chose to go my own path in terms of my career and not have a, a set health care through, through a company, I’ve just had to pay through myself or, yeah, I’m currently paying out of pocket. 

[00:04:10] For me, I look at therapy the same way other people look at physical fitness – it’s an investment in yourself and in your overall health. And for me, it’s important to utilize that resource that you have in order to, overall, just to improve my life and my relationships. 

[00:04:28] There have been times where I’ve struggled to pay for therapy and it’s affected my ability to look for a therapist or want to go because I know that it, financially it was either buy food or pay rent or go to therapy. And I thought, okay, I’ll just go to the gym and try and find other ways to help my mental wellbeing. 

[00:04:49] And it’s really unfortunate that you have to decide. In a perfect world, we would have a better system that, that would enable you to go and see someone. Luckily, I’ve been seeing the same therapist since 2020 and he understands my financial situation and we’ve come to an agreement on the cost. There have been times where I’ve seen a psychiatrist to change medications where it’s been $300 and follow up visits are $100.  

[00:05:15] Allie: How did you bring up the conversation of affordability with your therapist?  

[00:05:19] Alex: We just had a conversation of what I would be able to pay, and what would be reasonable for him. It’s also a matter, from my perspective, I want it to be respectful towards their profession, the work they’ve put in, but also just making it available for me. I’ve obviously continued to go a lot more because of that, with not having a financial stress of needing to come up with money in order to help [Music] my mental health. 

[00:05:46] Allie: It’s no surprise that the strain of financial challenges can significantly affect our mental wellbeing, creating a relentless cycle that proves exceedingly hard to break free from. This struggle becomes even more daunting when the prospect of accessing mental health care remains financially out of reach.  

[00:06:07] [Music Ends]  

[00:06:07] Melanie: My name is Melanie Lockert and I am the author of the book “Dear Debt”, host of the podcast The Mental Health and Wealth Show, and a freelance writer. 

[00:06:16] My journey with debt and mental health started in 2012 when I found myself deep in student loan debt and I felt very anxious and overwhelmed about how was I going to ever tackle this debt? And it caused a lot of depression and anxiety, and that’s eventually what led to my blog, Dear Debt, in January 2013. 

[00:06:36] I realized I needed an outlet to share these emotions, and so many other people reached out to me saying, I feel the same way. One of the most stark findings that I came across was that there is a link between debt and depression and also debt and suicide. There’s, propensity towards suicidal ideation, depression, financial anxiety. And it just makes sense, right? Debt is paying for our past. And it’s at the expense of paying for our present and our future, right?  

[00:07:05] I know when I was struggling with my mental health, I looked at a local college and they offered a counseling clinic for students who were about one semester away from graduating. And they offered $15 counseling sessions, and I was on food stamps at the time, and so I negotiated it down to $5 a session. 

[00:07:25] And it was very helpful to be able to talk to someone about my problems for that cost, but yeah, I think absolutely that the cost of therapy and mental health care is completely prohibitive for many people, and that just makes the problem worse, because if people are already not doing well mental health wise, they cannot afford the care, and it’s this really vicious cycle of not [Music] being able to get better.  

[00:07:52] Allie: So, after hearing from Alex and Melanie, and through my research, the issues of money and its correlation to mental wellness are glaringly clear. It’s apparent that both individuals seeking support, and the professionals providing it, share a common desire for enhanced accessibility to mental health services. But why aren’t they more accessible? And what are some possible solutions? 

[00:08:19] [Music Ends]  

[00:08:20] Greg: My name is Greg Keilin. I am one of the co-founders, and now Chief Strategy and Growth Officer for Prosperity Behavioral Health.  

[00:08:28] We are a business support partner for behavioral health care providers. So basically, what that means is that we try to help them manage the business operations, so insurance billing, accounting, so that the providers can focus on treatment. Our mission is to improve patient access by helping providers operate sustainably and grow so they can serve more [Music] patients.  

[00:08:54] Allie: Many mental health care providers operate independently, lacking the support of administrators and billing specialists. If you’ve listened to any of the other episodes of The Hidden Costs of Health, you’re already well aware of the intricate challenges posed by billing complexities and individual insurance policies.  

[00:09:12] This task alone is a full-time job, and simply too much for a therapist to take on, on top of treatment. The weight of these administrative responsibilities can prove overwhelming, detracting from their primary focus – the wellbeing of their patients.  

[00:09:29] [Music Ends]  

[00:09:30] Greg: The way that sort of helps support patient access is most of the people in this country who need mental health care don’t have the financial resources to pay out of pocket for it, and so they need to rely on their insurance for some or all of the cost of care. And so, if the providers aren’t able to access those benefits and get reimbursed for the services from the insurance companies that makes it impossible for the patients to get the care that they need. And so, that sort of is how the cycle all connects to itself. 

[00:09:59] Allie: So, I’m about to ask you a big question, which is basically the reason we’re creating this episode in the first place, which is – why is billing for mental health care so difficult and who’s to blame for its’ difficulty? 

[00:10:12] Greg: I would say that one thing that makes it difficult is the ambiguity that’s inherent in mental health that is much less present in a lot of other types of healthcare. There’s metrics and measurements in other forms of health care, you can take your blood pressure, you can measure your glucose levels in your blood. 

[00:10:32] There’s lots of very objective, quantitative ways to measure lots of other illnesses and disorders that aren’t nearly as applicable in mental health care. And so, one result of that is that there is some… ambiguity about exactly what services are being provided, or whether the services are really necessary, or whether the services are having the desired effect. 

[00:10:57] And insurance companies, that ambiguity is real. And so, there is a certain amount of legitimate questioning and scrutiny that the insurance companies bring to the table to make sure that they aren’t being, scammed, but it also creates plenty of opportunity for the payers to, let’s say, lean into that ambiguity in order to reduce either the amount that they’re paying or increase the frequency with which they deny claims or authorizations for services. 

[00:11:27] And what I always like to remind people is that insurance companies have a very simple business model. They make a profit by collecting premiums and not paying claims, and so they have a very strong profit motive and frankly their shareholders would sue them if they didn’t maximize their profits. There’s legitimate laws around that. 

[00:11:47] So, the insurance companies have an interest in paying as little as possible and as few claims as possible, and so there’s that tension there between, yes, obviously the patients and the providers need to get treatment and get reimbursed fairly for the treatment that they’re providing, but the insurance companies have a contrary motive, which is they want to limit the amount of expense that they incur for these services. The principal reason why most therapists are out of pocket only is because they don’t have the time or energy or knowledge to deal with the insurance billing process. 

[00:12:17] I can say as a person who is in therapy, I pay out of pocket, and I submit myself out of network to the insurance company for reimbursement. And even as someone who is in this business and who knows this process inside and out, I hate doing it. It takes me a ton of time, and frankly half the time I don’t get it right the first time and I have to resubmit, and this is even as somebody who’s in the business of doing this for a living.  

[00:12:43] [Music]  

[00:12:44] Allie: Greg mentioned to me that it’s easy to view insurance companies as adversaries, but we must remember that they’re responding to company demands and shareholders’ profit expectations. However, within these companies, there are individuals who genuinely want to help patients. Greg and the employees at Prosperity Behavioral Health build relationships with these case managers who truly wish for patients to receive the care they need. It’s important to recognize that these companies are composed of people with good intentions, despite some constraints. 

[00:13:20] [Music Ends] 

[00:13:21] Greg: I always want to remind people that the patients are humans, the clinicians are humans, the case managers are humans, and ultimately we do all, generally speaking, as individuals, want the same thing, which is we want the patients to get better, we want what’s best for them, and that is always what gives me optimism that some of these challenges are solvable because fundamentally, all of the people involved have the same objective. There are just all of these external structures in place that prevent us [Music] from getting aligned on carrying that out. 

[00:13:55] Allie: Through all of the different conversations I had about mental health care affordability, one major theme emerged – the consequences of not being able to access treatment when needed. There’s a direct correlation between the absence of proper mental health care and increased physical health issues down the line. 

[00:14:13] From the most direct consequences such as the development of physical illnesses stemming from untreated mental health conditions, like eating disorders or suicidal ideation, to indirect consequences that emerge over the long-term, such as elevated stress and anxiety leading to heart problems and an increased risk of diabetes. The toll on one’s physical health is undeniable. It’s a twofold impact. The financial burden adds to the weight of healthcare expenses, especially for those without adequate insurance, and the diminishing of a person’s quality of life.  

[00:14:49] As I learned through these conversations and my research, the landscape of mental health care affordability is far more intricate than a simple standoff between insurance companies reluctant to cover such care and providers opting out of insurance networks. The process and regulations regarding mental health care billing is very nuanced and labor intensive. And while this is true, they shouldn’t serve as excuses for the status quo to persist.  

[00:15:17] In the meantime you do have options. As Melanie mentioned, seeking out therapy sessions at your local college might be possible. And as Alex highlighted, see if your therapist is willing to work with you on a sliding scale that’s more feasible for your budget. Teletherapy has also become a widespread intervention over the past few years, and can be far more accessible and reasonable and many being covered by major insurers.  

[00:15:45] The Substance Abuse and Mental Health Services Administration, The National Association of Free and Charitable Clinics, and the Open Path Psychotherapy Collective provide treatment locators on their sites to help patients find low cost and discounted treatment across the country.  

[00:16:03] The National Institute of Mental Health also provides resources, including a helpline, podcasts and webinars, and support groups. I definitely recommend checking out their educational tools as well. 

[00:16:17] I’m hopeful that over time there’ll be improvements to mental health care affordability, ensuring that anyone seeking access to these interventions can do so without impediment.  

[00:16:28] We understand that a lot of people learn in different forms, so there will be a corresponding blog to this episode where we fully define the terms and also provide different tips and resources, whether they were mentioned today or in addition to that. So, check it out on empoweredus.org. We’ll link it in the show notes.  

[00:16:46] Also, if you found this episode to be informative and impactful, please share it with anyone else that you think may need to learn about this. It may fill in some of the gaps of their knowledge. 

[00:16:58] We at Empowered Us are committed to advocating for affordable healthcare for all. We look forward to continuing these conversations with patients and experts to both educate and create new solutions. Let’s keep pushing for change together. Take care and see you next time. 

[00:17:16] [Music Ends] 

Read Less