Alan Rudolph
Licensed Marriage and Family Therapist
Blog
Why Is Therapy So Expensive?
Posted on May 7, 2017 at 4:13 PM |
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Why Is Therapy So Expensive? Nicole Pajer After a bout of breakup-induced
anxiety and depression, 31-year-old New York City resident Emily Taylor decided
to look for a therapist. But finding a mental health professional to accept her
Anthem Blue Cross and Blue Shield insurance plan proved to be nearly
impossible. “I spent days looking for therapists
near me that were covered by my insurance,” Taylor said. “For the very few I
did find, I spent over five hours on the phone trying to get appointments,
[only] to find that they were either not accepting new patients or the wait
time was two months.” Taylor was able to locate plenty of
highly reviewed therapists available for private pay, however. But since the
average cost of therapy in New York is $200 to $300 per session, according to one report, that wasn’t a practical solution. Many people struggle to find
talk-based therapy that’s covered by their insurance plans. Of all
practicing medical professionals, therapists are the least likely to take
insurance. Only 55 percent of psychiatrists accept insurance plans, compared to
89 percent of other health care providers, like cardiologists, dermatologists
and podiatrists, according to a 2014 study
published in JAMA Psychiatry. *Note:
While you may find it hard to find a therapist who will take your
insurance, there is a good chance that therapists asking to be on your panel
are being told, by your company, that there are no openings as they have enough
coverage. This has been my experience in
Encino. With this in mind, I have tried to keep my fees reasonable.---Alan Rudolph That’s a big problem, since
approximately 1 in 5 Americans will experience some sort of mental health
disorder in a given year, according to the National Alliance on Mental Illness. Many will also seek counseling for divorce or grief. Treatment is highly individualized,
but experts agree that talk therapy is the gold standard for treating
psychiatric problems. A 2015 study revealed
that cognitive behavioral therapies were just as effective as antidepressants
for treating depression. So why is therapy so unaffordable
for so many people? And why don’t more mental health professionals work with
third party payers? It turns out several factors contribute to making therapy
unaffordable ― many outside individual clinicians’ control. Insurance
systems don’t support therapists’ diagnoses. Poor insurance coverage for therapy
is largely a reflection of how society views mental health, says licensed
psychologist Candice Ackerman. “Insurance companies tend to see
things more from a medical perspective ― where if you get sick, for example,
then you take a blood test, they figure out what is wrong with you, they give
you a medication and then you are all better,” Ackerman explained. “But with mental health,” she
continued, “a lot of times what we are trying to do is preventative
maintenance-type work, and it makes it a lot more difficult to justify medical
necessity with insurance companies.” On the website for Ackerman’s practice in Lakeway, Texas, she explicitly states that some of the
professionals there do not accept insurance because she wants to avoid
surprising patients. Even when insurance companies
consider a mental health diagnosis a valid billable condition, the coverage may
only be temporary. Jennifer Chen, 38, a freelance writer in Los Angeles, is
waiting to hear whether her insurance company will continue to cover her
therapy, since she’s no longer clinically diagnosed as “depressed.” “After seeking talk therapy
treatment for depression for four years, my mental health insurance provider is
reviewing my case to determine if I still need coverage,” she said. In other words, Chen’s insurance
company may determine that she is well enough to forgo therapy, even if it’s
the reason she is well. “My therapist will be attending a
review board where the insurance company will discuss my case and make a final
decision if my coverage will end or not,” Chen said. “Currently, my
insurance covers about 50 percent of my therapist’s fee. If my coverage ends,
then I’ll have to consider discussing a sliding scale fee or reduced therapy
sessions.” Insurers are starting to feel the
frustration as well. “There is a well-documented national shortage of
behavioral health providers generally ― and in health plan networks
specifically ― resulting in patients having to pay out-of-pocket for treatment
or forgo it altogether,” said Cathryn Donaldson, a spokeswoman for America’s Health Insurance Plans,
an insurance company trade organization. Therapists honestly
can’t afford to accept insurance. The gap between a therapist’s hourly
fee and the reimbursement rates they receive from insurance companies can be
massive. “I’ve seen it lower than $50 a
session,” Ackerman explains. “I charge $140 a session, so that would be a major
blow in terms of income for us.” “We can’t sustain our practices when
that kind of value is put on mental health,” she added. While $140 per session sounds steep,
Ackerman says it helps cover $2,500 a month in rent, the cost of business and
malpractice insurance, advertising, office equipment and credit card processing
fees. And like many of her colleagues, Ackerman has accrued massive student
debt. “I was in school for 10 years, and at this point, my debt is six
figures!” she said. “Therapists are health care
professionals that all have master’s degrees or higher. Many have doctorates,
medical degrees, and [have] graduated from specialized institutes for the
teaching of psychotherapy,” said Dr. Thomas Franklin, medical director at the
Retreat at Sheppard Pratt, a residential psychotherapy facility in
Baltimore. “Lawyers, accountants and architects
generally make $120-$400 per hour or more,” he added. “One should expect to pay
the same for therapy from a competent, highly trained professional.” Therapists are in a no-win position,
says Arika Pierce at the Coalition for Patients’ Rights, an organization for
non-M.D. health care providers. “Therapists are almost forced to charge the
patient directly because they are not able to be reimbursed at equitable rates
as their counterparts that have M.D. or D.O. behind their name,” she
said. Pierce says her organization is
continuously advocating to change this to benefit non-physician licensed health
care professionals and their patients. “More equitable rates across all
health care professionals would allow patients to have greater choice and
access in terms of their health care decisions,” she said. Therapists are almost forced to charge the patient directly
because they are not able to be reimbursed at equitable rates. Arika Pierce,
spokeswoman for the Coalition for Patients’ Rights Filling
out insurance paperwork is a full-time job. It’s a Catch-22: To keep overhead
low, many therapists don’t hire staff or assistants. But without them, the job
of working with insurance companies is overwhelming. “Many people who work in mental
health don’t have the volume of patients that primary care [physicians] might
have,” said Dr. Lynn Bufka, an associate executive director at the American Psychological
Association. “They might see seven or
eight patients max in a day, where a primary care practice might see many more
and also have dedicated staff who handle billing and who are very familiar with
what the requirements are with all the different payers out there.” Submitting a bill to an insurance
company can involve jumping through an array of hoops, according to Ackerman,
including justifying your services to an insurance representative, providing
status report updates and getting on the phone with providers to track down
late payments. This can be particularly complicated
because not everyone who sees a therapist has a diagnosable mental illness. “Common reasons for coming to
therapy, like couples counseling and grief counseling, are typically not
covered by insurance,” said Ackerman. In other cases, the diagnosis may be
controversial in the field. “I have a client with dissociative identity
disorder, which is formally known as multiple personality disorder,” Ackerman
added. “I don’t know if that would get reimbursement, just because it’s a
controversial diagnosis.” Some
therapists say it’s helpful to accept insurance. Not everyone agrees that accepting
insurance is impossible. Dr. Patti Johnson has dealt with her share of insurance issues ―
excessive paperwork, late payment and the hassle of continuously submitting her
clients for coverage authorization. But the Los Angeles psychologist, who is
currently maxed out with her patient load, finds that accepting insurance helps
keep her schedule full, and along with patient referrals, allows her to sustain
a lucrative private practice. “Individuals generally check with
their insurance companies when looking for referrals to a therapist. This
is a positive and easy way for clients to know about you and your services
without a large marketing budget,” she said. Johnson also notes that allowing
patients to bill their insurance opens up her client base to people of all
income levels. “Most people can’t easily afford to pay $600 to $800 a
month for weekly therapy, and without the ability to use insurance, they
wouldn’t be able to get the care they need,” she explained. Therapists
and patients have to make hard choices. To make it more feasible for
psychiatrists to take insurance, the American Psychological Association would
like to see therapy become a standard part of integrative health. So instead of
a fee-for-service model, payment would be based on treating a particular
condition. (In other words, patients would pay a lump sum rather than a
payment every time a service is performed.) “If it were up to me, our health
systems would allow three or four appointments with a mental health provider
every year, no questions asked, no need for a specific diagnosis,” the APA’s
Bufka said. This kind of yearly care could help
patients address small problems before they grow into bigger ones. For example,
a person could learn how to better manage their sleep, work with an anxious
child or navigate a complication at work. This would probably lead to better
mental and physical well-being, Bufka said, but the current billing system
doesn’t support it. For now, the insurance conundrum for
therapists remains. “You struggle with wanting to help people that come to you
that seem that they need it, but also keep your lights on in your office and
make a profit,” Ackerman said. Taylor eventually gave in and signed
up for sessions with a highly recommended psychologist who charges $250 an
hour. “I’m feeling so much better and am
still going, because it’s helpful,” she explained. But even though she thinks
her treatment is worth the price, she hopes to cut down her sessions soon. “I’ve gone about five months and
paid about $5,000 out of pocket,” she said. “I just don’t have the money. I
used my whole Christmas bonus to help with the costs.” As part of May’s Mental Health
Awareness Month, we’re focusing on treatment and the stigma around getting
help. Check out our coverage here and share your story at [email protected]. |
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