What is therapy going to cost me?

We’ve seen a cultural shift from therapy being stigmatized to being widely regarded as tremendously valuable. But how do we actually, practically put a value to it? What is it going to cost you? Well, there’s obviously the time component. Committing to weekly therapy is time-consuming, and not just the time in session. Ideally, you’re taking what you’re learning in session and working to apply it in your life. But then there’s the financial component. And as you’re probably already well aware, therapy is often expensive in this way too.

Why is therapy expensive?

One of the main reasons for this is that while most therapists love the work they do, being a therapist is hard. The rate of burnout in the field is very high. And in order to maintain their ability to do their best for patients, therapists can’t see too many people in a week. (In this practice we cap the number at 25 sessions in a week). Since therapists only get paid for the sessions they have scheduled, they have to be able to earn enough money per session to make that balance out.

The other main reason for the high cost is the role of insurance in healthcare. Put simply, insurance companies are often resistant to paying for therapy. They also try to put very strict rules on therapists regarding how to do their job; for example, pre-determining how many sessions a patient will get (often just a handful), oversight and review of session notes, rejecting claims, taking weeks to pay, and even finding ways to “claw back” payments to therapists weeks, months, and even years after paying out, often for mundane clerical errors.

And then there are the very low reimbursement rates. Simply put, it would be very hard for a therapist in New York City to be able to afford to live here if they only had in-network patients – unless they worked way too many hours.

Ok, but can we do anything to make the cost more manageable? Is there any way to use insurance constructively?

All of these (and more) are reasons why the majority of therapists refuse to deal with insurance companies. So what can be done? While dealing with insurers is never fun, there are actually two ways to accept insurance: “In Network” and “Out of Network.”

An “In Network” therapist is not far from being an employee of an insurance company. In exchange for a steady stream of patients, some therapists will accept the strict rules, oversight, and low reimbursement. (This may make sense in places where few people use therapy, or for people who feel more risk averse for other reasons.)

Enter “Out of Network”. When a therapist is Out of Network, they can choose to work with those insurance plans, saving a lot of the unwarranted oversight and logistical hassles, and with a better reimbursement rate.

This can lead to higher session costs for the patient, especially if you don’t factor in the cost of having insurance in the first place. But the truth is that many insurance plans with only In Network benefits have very high deductibles, meaning they won’t pay for therapy at all any time soon, and many require you to make copays that lead to you having very similar out of pocket costs to going to an Out of Network therapist.

And as mentioned, this potentially higher cost has to be balanced against the therapist managing their ability to see a healthy amount of patients and avoid burnout.

In our experience, if your insurance plan has Out of Network benefits, you can expect them to pay between 50-80% of your session cost, and sometimes even the whole amount!

How do I find out if I have Out of Network coverage? And how does Aitia handle Out of Network billing?

Some practices will bill you the whole cost upfront and then help you get reimbursed by your insurer. We go the extra mile of handling it all for you and having them reimburse us directly, saving you a good bit of money upfront by charging you the difference between our fee and the reimbursement.

You may not know whether you have out of network coverage on your insurance, because plans aren’t often marketed that way. A good rule of thumb is that PPO plans are highly likely to do so, and EPO plans never do. Confusingly, some plans are listed as both! In those cases, they are unfortunately just EPO plans for our purposes.

We work to take the hassle of dealing with insurance companies off your plate, so we’re happy to check for you what your out of network coverage is.

If you want to do it yourself, just call the number on the back of your card and ask them what your Out of Network Deductible is, what your copay or coinsurance is, and what the reimbursement rate is for Out of Network mental health treatment.

Do you accept medicare or medicaid?

Unfortunately we are not able to do so. We recommend reaching out to NYC 988, a free service provided by the City of New York, for help with that.

Anything else to consider?

As we mention elsewhere on this site, if you don’t have Out of Network benefits or would rather not use insurance for other reasons, and worry you can’t afford therapy, please ask us about our sliding scale policy.