By: Amy Marschall, PsyD – Freelance Columnist

In recent years, stigma around seeking mental health care has reduced somewhat–it has become more socially acceptable both to talk about mental health struggles and to have a therapist. At the same time, many struggle with affording services. Even if countless providers are available in your area, you cannot access care that you cannot afford.

According to Forbes, therapy costs an average of $100 to $200 per session without insurance. The Center for Disease Control reports that more than 31 million Americans were uninsured in 2022. Even among those who have insurance, the average deductible is more than $4,300 per individual and $8,400 for a family–so many cannot even afford to see a therapist with their insurance coverage, as they have to pay thousands of dollars out of pocket before their plan starts covering treatment.

If you are fortunate enough to have insurance coverage that makes therapy affordable, you then face the challenge of finding a therapist who accepts your plan. Insurance companies deliberately make billing difficult, deny claims arbitrarily, and can claw back payments up to five years after a service is completed. In addition, they require in-network therapists to accept a negotiated rate which is much lower than the therapist’s fee. Because of this, many providers cannot afford to accept health insurance and stay in business. In fact, a survey by Slate in 2022 showed that less than 20% of therapists currently accept health insurance.

So, what are your options for finding a therapist who is affordable and can meet your needs?

Call Your Insurance Company

If you have health insurance, they are required to help you find a provider who is covered by your plan. The insurance company can give you contact information for in-network providers.

If you found a therapist who you feel would be a good fit but they are not in-network, you can still contact your insurance company and request authorization to cover an out-of-network provider. First ask the therapist if this is an option–not all therapists are set up to accept out of network insurance payments. But if they are open to this arrangement, you can request this coverage. Since insurance companies are required to accommodate out of network coverage if you cannot find someone in-network, this could help you afford therapy with someone who does not take insurance.

Look For Therapists With Sliding Scale Openings

Many therapists keep a certain number of slots in their schedule for clients who pay a sliding scale rate, or a rate based on their income and means. For example, a therapist may offer $20 per session rather than $150 for a client who cannot afford the full rate.

Often, sliding scale openings are only for clients who are uninsured. If you are struggling to afford therapy due to a high deductible, an in-network therapist is required to abide by their contract with the insurance company. This means that, if the insurance company indicates that your negotiated rate for services is $100 per session, the therapist must charge you that rate until the deductible is met. A therapist who is out of network might agree to provide a sliding scale slot since they are not billing your insurance and are not contracted by the insurance company.

Ask Your Therapist About Super Bills

Since insurance companies are required to help you find care even if you cannot find an appropriate in-network provider, sometimes the therapist can provide you with a super bill for your treatment. A super bill is essentially an itemized receipt of therapy services, which you can submit to your insurance company for reimbursement. Essentially, you bill your insurance for services instead of your therapist.

Because a super bill is a receipt, you have to pay your therapist directly before you can submit for reimbursement. This can be a challenge for those who do not have the funds to pay up front even if they will be reimbursed later.

Ask About Payment Plans

If you have a deductible, you might not be able to pay the negotiated rate every session until you meet the minimum before your insurance coverage kicks in. However, your therapist might allow you to make lower payments throughout the year until the deductible is paid off. For example, if you have a deductible of $2,000 and your insurance requires that your therapist charges you $100 per session, you might be able to pay $25 per session and continue making payments after the deductible is met. Ask your therapist about options for a payment plan.

Seek Out Low Fee or Free Therapy Services

Many community counseling clinics offer free or low cost therapy services for those who do not have insurance or do not have adequate coverage to afford therapy services. These clinics are often grant-funded, allowing the therapists to be paid while offering their services at little or no cost.

Some low-cost or free therapy services in the Twin Cities are:

• Amherst H Wilder Foundation: The Wilder mental health clinic accepts Medicare and Medicaid, as well as sliding scale therapy for all ages. They accept walk-in and same-day appointments.
• Neighborhood House: This clinic offers free, walk-in therapy services for Medicare and Medicaid clients and those who do not have insurance.
• Open Path Collective: Open Path is a national therapist directory, and they have several participating providers in the Twin Cities. All providers on Open Path accept sliding scale clients and charge between $30 and $60 per session.
• Walk-In Counseling Center: Walk-In Counseling Center offers both telehealth and in-person therapy appointments. No appointment is needed, and clients can either come to the clinic or log on to the online portal during business hours to get support.

Contact Your Representatives

We are in the midst of an ongoing mental health crisis. Insurance companies report record profits while clients cannot afford care, even if they have coverage. Many therapists have to choose between sustainable business practice and offering care that clients can afford. If you are able, contact your local, state, and federal representatives. Tell them about your difficulties accessing care, and demand that they take action.