If you’ve ever seen your therapist’s fee schedule, you’ll already know that therapy is expensive! One hour of therapy can cost anywhere from about $50 to over $400, depending on the therapist, his/her credentials, and years of experience. If you’ve been prescribed medication to supplement the therapy sessions, the cost each month can easily add up to several hundred more dollars. This is especially relevant in the brand name prescription meds. It’s not unusual for the “sticker price” of a month of sessions and prescription medication to be over a thousand dollars!
Most people naturally look to their insurance plans as a way to cover the cost of therapy and medication. But modern insurance plans can be bewilderingly complicated, and what treatments and medications they cover – or don’t cover – can be hard to predict. Even though your insurance plan will likely have its own set of rules and restrictions, it’s worth exploring what most insurance plans typically cover so that you’ll be armed with a good idea of what your plan should provide as basic coverage.
Most insurance plans cover between 20 to 30 therapy sessions each year, and pay between 50 to 80 percent of the therapist’s bills. The patient has to pay whatever remaining costs out of pocket. If you’re covered by federal Medicare, typically Medicare will pay for 50 percent of the therapist’s bills. That’s not as good as many private insurance plans, but Medicare won’t cap or limit the maximum number of therapy visits each year.
If your insurance company is willing to cover 20 or 30 therapy sessions per year, the next hurdle is to make sure that the insurance coverage extends to the diagnoses and treatment plan that your therapist has set for you. This is a gray area that depends entirely on your insurance company’s rules. Diagnoses related to anxiety, depression and relationship problems are almost always covered, as are mainstream treatment plans based on one-on-one private sessions with your therapist. It may be harder to find coverage for such things as IQ tests, quitting smoking, weight loss, or screening for learning disabilities. And treatment plans that use hypnosis, aromatherapy, art therapy, herbal medicine, or any therapeutic technique that the insurance company sees as too far from the mainstream or not scientifically proven to work, will probably not be covered at all.
Many people also want to know if their insurance plans will let them choose their therapist, or if the plan will choose a therapist for them. Most likely, your insurance company has a list of therapists in your area that the company has approved for reimbursement of bills under your plan. If you want to see a different therapist not on the list, your insurance plan may allow that, but you may be required to
• pay a higher percentage of the therapy bills out of pocket,
• get a referral to that therapist from a doctor or therapist already on the insurance company’s approved list, or
• be limited to a lower number of visits per year.
And what about prescriptions? Prescription coverage is probably covered by a different section of your insurance plan than the one that covers your therapy visits. Most likely, the insurance company will pay for all but a small percent of the cost of your medication, at least for those prescriptions on the company’s approved list of drugs. There may be a discount on the amount you have to pay out of pocket, if you are able to use a generic medication instead of a brand name.
If your prescription is not covered at all by your insurance, and you can’t afford to pay for it yourself, you should probably talk with the prescribing doctor to find an alternative medication. It may even be possible to contact the maker of the drug for help. Some pharmaceutical companies offer discounted prices and financial assistance to those who need to use their medications, but who don’t have the insurance coverage or private means to pay for them.
Lastly, if your insurance plan doesn’t stretch far enough to cover the therapy you need, it’s a good idea to talk about it with your therapist. He or she may be willing to reduce the hourly fee, set up a payment plan, or even talk to your insurance company to try to secure additional coverage for you. Sliding scales are very common. Don’t feel any embarrassment by raising the subject with your therapist: a good therapist will place his or her client’s well-being first, ahead of financial concerns. Of course, it would be unrealistic to expect your therapist to reduce the hourly fee to nothing at all, but if you’re facing a financial difficulty and need your therapist’s help, it’s always a good idea to ask. You never know!
