This is a spin off, but it is also a JAWM. Cost of mental health/therapy.......

[Joanne]

Professional Counselors (and, to a lesser extent, social workers) are a low paid masters level clinician. Most of the LPCs (and equivalents) I know have more than one paid gig to "make it." This is especially true for those professionals with one provider in the family.

 

When I began my masters, insurance reimbursements were typically just under $100. The lowest was around $65 and the highest around $92 - slightly more for an intake vs. any follow up. Today, insurance pays between $35 to $62, slightly more for an intake. They only pay for 45 minutes, btw, although most therapists I know still see their clients for 50 to 60 minutes.

 

My cost for a small private practice in a suburb of a major metropolitan area is approximately $1000 a month.

 

Many therapists are moving towards private pay because "we" can afford to keep seeing clients at $50 an hour. I personally continue to take insurance because I have been (and still am) a parent who "needs" to use the benefits my health insurance pays for (and I keep an additional job to HAVE those benefits.)

 

Jobs for therapists at non profits, hospitals, and agencies are also typically less than $60k.

 

Blame the system; not the individual or collective professionals. I LOVE my job and various roles, but none of them would be sufficient stand alone.

 

 

 

[regentrude]

I can't "like" your post, because the situation is not likeable. So, let me say that I am supportive and find it disgraceful.

[LucyStoner]

ITA. Private pay also makes sense for many solo practitioners because the hassle of billing insurance isn't without it's own cost. And hair loss from the frustration.

 

ETA: reimbursement rates vary between locations and degree I think. All of the counselors various family members are seeing now are getting $80-90 from insurance plus $25 co-pay from us OOP or if it's for the kids, that $25 generally is picked up by our secondary insurance. I am the weirdo who opens, reads, checks to ensure each visit is paid for and then files the EOB. Insurance has burned us too much to not be vigilant.

Edited July 16, 2016 by LucyStoner

[Melissa in Australia]

Just so you can compare rates to a different country

 

I pay $100 per hour for the private speech pathologist for the twins

 

I also pay $170 per hour for the twin's psycologist. Though as they are on a mental Heath plan I get reimbursed $130. They can have 10 visits per year each

 

Occupational therapy is covered completely by the public health system

Edited July 16, 2016 by Melissa in Australia

[*lifeoftheparty*]

..

Edited December 18, 2016 by *lifeoftheparty*

[TrixieB]

ITA. Private pay also makes sense for many solo practitioners because the hassle of billing insurance isn't without it's own cost. And hair loss from the frustration.

 

ETA: reimbursement rates vary between locations and degree I think. All of the counselors various family members are seeing now are getting $80-90 from insurance plus $25 co-pay from us OOP or if it's for the kids, that $25 generally is picked up by our secondary insurance. I am the weirdo who opens, reads, checks to ensure each visit is paid for and then files the EOB. Insurance has burned us too much to not be vigilant.

 

I agree that reimbursement rates must vary by...something.  Ours get roughly $140/hr, split between insurance & our coinsurance.  It is almost identical amount whether the provider is PhD or Masters.

 

If you're a weirdo, then I am too.  I check every EOB and compare against bills.  Which reminds me I have a billing office to call on Monday...

 

[Audrey]

I agree with you, Joanne.  There is not nearly enough value placed on good mental health care (and adequate access to it -- which is another issue, I know).  I do not know what mental health care providers get paid here.  I don't pay anything for a psych, but accessing one can be difficult for new patients.  Depending on the therapist, that could be private pay or covered by provincial or covered in part by provincial.  It depends.  IMO, it should all be covered and there should be incentive programs for people to pursue careers in mental health care.  They subsidize doctors to undertake certain types of practices.  They should do the same to encourage psychs and therapists.  Maybe that's a different rant... but anyway... I agree with you.

Edited July 16, 2016 by Audrey

[Anne in CA]

I, also, cannot "like" your post. There is not enough respect for mental health as a field. Last year I had an employee who was clearly on the edge try to kill himself by taking a bottle of Norco. He had been on a Medicaid waiting list to see someone for his depression for nine months. Seriously???!! Then they still wouldn't do anything for him. Pumped his stomach, watched him a few hours and sent him to jail and then home. His wife was freaked out and couldn't have him around their child so he ended up with distant relatives.  

 

I'm sorry, Joanne. It's not alright.

[Joanne]

I, also, cannot "like" your post. There is not enough respect for mental health as a field. Last year I had an employee who was clearly on the edge try to kill himself by taking a bottle of Norco. He had been on a Medicaid waiting list to see someone for his depression for nine months. Seriously???!! Then they still wouldn't do anything for him. Pumped his stomach, watched him a few hours and sent him to jail and then home. His wife was freaked out and couldn't have him around their child so he ended up with distant relatives.

 

I'm sorry, Joanne. It's not alright.

Oh, Anne. Please don't feel bad for me! What I do now is a heck of a lot better than running poker tournaments, cleaning office buildings and then getting up to homeschool mine and various others.

 

All jobs combined, I make quite a bit of money. It is not sustainable or tenable for the long term but don't feel bad for me!

 

I am sorry about your friend. Practitioners here won't get on panels due to the pay. Medicare won't even credential LPC's; only social workers. I just had a recently and repeatedly acute client get ssd and Medicare but would have to stop seeing me - bye, bye continuity of care, rapport, and therapeutic alliance. Client and partner offered to reduce sessions and pay a lowered rate out of pocket. I accepted because I care.

 

Still. Life is good.

[Ravin]

My DD's counselor charges us out of network, but as far as I know, gets the full 80% of her fee from the insurance company. We pay $30, so she's getting $150/hr.

 

This is more profitable for her than working for JFCS was (they administer medicaid MH services, we pay OOP to continue with DD's ped psychaitrist there since gething private insurance); we followed her to private practice because we had transitioned to private insurance, aND DD likes her.

 

We wouldn't be able to afford her without insurance.

Edited July 16, 2016 by Ravin

[Mosaicmind]

I have my master's in counseling and decided long ago I wouldn't get licensed because the population of people I want to counsel usually don't have insurance or the insurance won't pay for a faith based counselor. My counselor was licensed at once and as the regs got stricter for faith based she let her license lapse. Still she's been successful in getting some insurance companies to pay despite her being unlicensed. She's also been told by many clients that they are willing to pay out of pocket to see her instead of other counselors. In fact there is a large group (15) of counselors that offer faith based counseling to those who want it and none are licensed. These counselors, including mine, are getting anywhere from $50-$125 per hour.

 

I believe that a good counselor is worth their weight in gold and many people I've talked to say they are willing to pay out of pocket if they have to. Some do it just so it's not on their insurance record. When I started counseling myself in 2003, I was seeing a faith based counselor that worked out of a practice with many counselors and several offices. Our insurance would pay for 2 visits per month and unfortunately one of those visits had to be a med check visit with my psychiatrist so I was only able to see my counselor once a month. I kept getting worse and finally a friend heard of a counselor who did faith based counseling and specialized in my particular mental illness, which was a miracle, because most counselors we looked into wouldn't take me. I was very fortunate, after coming home from my first psych hospitalization for 8 weeks in another state, that this counselor agreed to see me for free.

 

My experience wasn't the norm but it's because of this that I chose to go to college and get my degrees so I could help others like me, with my diagnosis and experience. It's hard to find good counselors because they are few and far between and I believe it's because they aren't paid near enough. It's always boggled my mind why people will pay big bucks for the right physician but aren't willing to do the same to heal their mind, spirit, and emotions, which imo are more important.

 

Thank you to Joanne for working your butt off for little money to help in healing precious minds.

[DawnM]

We are keeping my kids on my DH's insurance instead of moving them to mine because he has such good coverage.  We get unlimited mental health visits for the year at $20 cost to us in-network, or 65% coverage out of network.

 

We choose to go out of network because that is the best place for my son.  

 

Individual therapy ranges from $175-$250 per hour.  We pay 35% of that.  ($61.25-$87.50)

 

Group therapy is aprox $75/session, but we sign up for 9 weeks, so $675 per 9 week session.   We pay $26.25 per session or $236.25 per 9 weeks.    Honestly, I think sometimes he gets more out of group therapy anyway, and they have a "free" parent session at the same time, which I really enjoy.  It is well worth the cost.

 

But we couldn't pay full price.  We could possibly budget 2x per month OR group therapy and 1x per month, but if we had to pay out of pocket, we could not do all that we do.

 

Dawn

 

Edited July 16, 2016 by DawnM

[kroe1]

Irrespective of the costs, most people cannot afford healthcare in any form right now. Copays, exclusions, uninsured fees, non covered expenses, etc. are not something many insured families save for. At least in the short term, many people have to resort to a do-it-yourself approach even when they are insured. This seems to be worsening for those I see in the ER rather than getting better. At least the uninsured usually had something to contribute. Now those formerly uninsured are sacked with OCare big insurance premiums which really do not pay much on the medical bills. I do not know if this is the same for mental healthcare.

 

If I need a pair of jeans, I can choose to go to WalMart or get a designer brand at the mall. I know the costs on the front end. I do not know if the jeans are well made and will withstand wear and tear. But, I can examine the stitching and make a reasonable estimate. Admittedly, I do not know if the style will last awhile, or if my weight will remain so that the jeans fit properly.

 

I wish healthcare purchases were similar to jeans. I should be able to know costs on the front end. I should be able to know which hospital is the WalMart equivalent and which is the mall store. I should be able to "return" the purchase if it didn't work. Furthermore, I should be able to refuse the extra cups, tissue boxes, 15 needle stick attempts, plastic basins, etc. that someone will throw on my bill which I will not want or use. Likewise, with mental healthcare, I should be able to know who is likely to get results and who is not, in what amount of time. And, do not forget the elephant in the room, the astronomical cost of malpractice for the providers, ancillary staff, and hospital, keep the prices three to four times what it could be without that cost.

 

Having basic supply and demand principles dictate healthcare would more likely improve the costs, and the related wages for everyone.

Edited July 16, 2016 by Minniewannabe

[wendyroo]

I don't think this violates JAWM...

 

From my point of view, the mental health institution is suffering similarly to the public school institution.  There are some truly excellent practitioners, a lot of so-so, semi-competent practitioners, a few bad apples and a MOUNTAIN of red tape, bureaucracy and high costs that do not get passed on to the professionals on the front lines.

 

If I had access to an excellent mental health care professional, I would happily pay the $150 an hour that I currently am forced to pay to someone whom I consider not quite mediocre.  I would happily pay the $150 so that after 2 years of weekly visits my son's therapist would actually REMEMBER MY NAME!!!!  I would happily pay the $150 so someone was willing to do family therapy because my son simply HAS TO learn how to interact with his siblings in a way that does not include hitting and kicking them in the faces.  I would happily pay the $150 so my son was more than a number on a file that floats to the top of the pile once a week; so his mental health professionals would treat him more like a sculpture in need of gentle, painstaking molding and less like an anonymous buggy computer that can be fixed by mindlessly reading the next prompt of the help desk script.

 

I have nothing but respect for mental health care professionals who are trying to offer exceptional, compassionate, continuous care to patients who are all to easily lost in the midst of a broken system.

 

Wendy

 

[JFSinIL]

May I share your post with my dd, she is thinking of changing her major from elementary education to counseling...her probable fiancee wants to be a social worker....I foresee them living on ramen noodles the rest of their lives.

Edited July 16, 2016 by JFSinIL

[AmandaVT]

*hugs* Joanne. 

 

Are you sure about all insurances only accepting the 45 min code? Here, only United restricts to a 90834. BCBS, Cigna, Medicaid and Aetna will all pay for a 90837 still. 

 

We've noticed the same fee drops from some insurances (Cigna, I'm looking at you!), especially group therapy. We had a few therapists in our practice running groups, which were very helpful for the clients and group rates dropped from over $65/hr to $12/hr! 

[Hilltopmom]

May I share your post with my dd, she is thinking of changing her major from elementary education to counseling...her probable fiancee wants to be a social worker....I foresee them living on ramen noodles the rest of their lives.

But, we do need good counselers & social workers too:)

 

Has she considered a school counselor program? She would still be in the school system and working with kids in school, that way, but have teacher schedule & benefits.

Or, dual degree- elem Ed & counseling. Or special Ed.

Trust me, lots of counseling work as a teacher too, it's just not called that officially;)

[AmandaVT]

But, we do need good counselers & social workers too:)

 

Has she considered a school counselor program? She would still be in the school system and working with kids in school, that way, but have teacher schedule & benefits.

Or, dual degree- elem Ed & counseling. Or special Ed.

Trust me, lots of counseling work as a teacher too, it's just not called that officially;)

 

My close friend is a school counselor and makes good money with great benefits. 

[LucyStoner]

May I share your post with my dd, she is thinking of changing her major from elementary education to counseling...her probable fiancee wants to be a social worker....I foresee them living on ramen noodles the rest of their lives.

Social workers who get into counseling are usually covered on insurance and the ones I know make a considerable amount of money/are quite comfortable especially compared to their social work peers who work for a salary at a school, clinic or for the state.

[Carrie12345]

 

 

Jobs for therapists at non profits, hospitals, and agencies are also typically less than $60k.

 

 

 

My LPC sister didn't even come anywhere near that in a non-profit contracted by the state.  Working full time, odd hours, often out of the office and in dangerous neighborhoods, with one of the biggest at-risk client groups, she got paid dirt.  

Mental health in this country is an embarrassment.

 

For whatever it's worth, my therapist gets paid around $75 to listen to my comparatively trivial woes.  But my sister thrives on serving the population she's chosen to specialize in.  I'm jealous and would love to follow her path but, even without a need for a second income, I can't afford to pay for the privilege, let alone believe I could come out ahead in this lifetime!

[SparklyUnicorn]

Here one therapist I went to last year got $122 per visit via the insurance contract.  That was someone in a huge practice.  I know they had a private pay rate of $65.  Then another one I went to in a solo practice got $80 through the insurance.  She would negotiate on private pay, but no clue what she'd charge for that.

 

The solo practice private pays I looked into wanted at least $150. That's not doable. 

 

I may just live in a higher cost area though. 

[JFSinIL]

But, we do need good counselers & social workers too:)

 

Has she considered a school counselor program? She would still be in the school system and working with kids in school, that way, but have teacher schedule & benefits.

Or, dual degree- elem Ed & counseling. Or special Ed.

Trust me, lots of counseling work as a teacher too, it's just not called that officially;)

 

This is what I am encouraging her to think about, to be more employable.  I just fear if they BOTH are in social work/counseling, it will be tough, and when kids come hard to afford to let one parent stay at home....or afford kidkare if both kept working.

[Murphy101]

I agree with you.

But this is true of nearly everything these days. With rare exception, it seems more and more like nothing pays a living wage reasonable wage.

 

I see it constantly. People who used to be able to carefully budget but otherwise get by just fine or better and almost all now finding that's not enough. And so spouses go back to work and or get side jobs. For health benefits. Or just to make enough to keep the lights on. And when trying to make money or more money, so much just doesn't pay enough to make it worth it.

 

It's frustrating.

And it's a bit scary too bc this is areas where things are supposedly going a lot better economically than in other areas.

Edited July 16, 2016 by Murphy101

[goldberry]

Uninsured here, we paid $50/session for DD.  Those of you that are paying $100 or more... we just couldn't afford that and would have had to do without.  It makes me sad for people who are in desperate need but prevented by finances.

 

My desire when eventually returning to school would be to pursue counseling.  I've read enough about it not to be doing it for the money.  :glare:

[SparklyUnicorn]

Yeah medical stuff has gotten stupid.  I went to the GYN for a routine check up.  My age now they do the pap along with the HPV test automatically.  For those two lab tests the lab charge was over $1500.  They did not get that much from the insurance, not even close, but what the hell.  These are run of the mill very routine tests that they probably do tons and tons of daily.  They don't cost that much. 

 

I have excellent mental health coverage though.  It is supposed to be covered in a similar manner to other medical, but you know how that often pans out.  No this truly is covered the same.  A social worker is considered basically like a primary care type doc and that is covered 100% after a $20 copay just like the PCP.  A psychiatrist would be covered like a specialist.  That seems fair.  They do charge more and are more specialized.  Hospital is covered the same.

 

 

[TechWife]

Irrespective of the costs, most people cannot afford healthcare in any form right now. Copays, exclusions, uninsured fees, non covered expenses, etc. are not something many insured families save for. At least in the short term, many people have to resort to a do-it-yourself approach even when they are insured. This seems to be worsening for those I see in the ER rather than getting better. At least the uninsured usually had something to contribute. Now those formerly uninsured are sacked with OCare big insurance premiums which really do not pay much on the medical bills. I do not know if this is the same for mental healthcare.

 

If I need a pair of jeans, I can choose to go to WalMart or get a designer brand at the mall. I know the costs on the front end. I do not know if the jeans are well made and will withstand wear and tear. But, I can examine the stitching and make a reasonable estimate. Admittedly, I do not know if the style will last awhile, or if my weight will remain so that the jeans fit properly.

 

I wish healthcare purchases were similar to jeans. I should be able to know costs on the front end. I should be able to know which hospital is the WalMart equivalent and which is the mall store. I should be able to "return" the purchase if it didn't work. Furthermore, I should be able to refuse the extra cups, tissue boxes, 15 needle stick attempts, plastic basins, etc. that someone will throw on my bill which I will not want or use. Likewise, with mental healthcare, I should be able to know who is likely to get results and who is not, in what amount of time. And, do not forget the elephant in the room, the astronomical cost of malpractice for the providers, ancillary staff, and hospital, keep the prices three to four times what it could be without that cost.

 

Having basic supply and demand principles dictate healthcare would more likely improve the costs, and the related wages for everyone.

The economic model leaves out the issue of quality of care. Measuring outcomes is not as easy as it sounds.

[Mosaicmind]

Health insurance is just a big fat joke imo. I've need surgery since Jan. 23, 2014 but because my insurance co and many others have determined that the surgery I need is experimental/investigational for my particular reason to have the surgery, I'm still bedridden and in a wheelchair. If I could have the surgery, there is a better than 92% chance that I would be able to walk again (with a cane), be off of my pain meds, able to sit upright instead of lying on my back at least 22 hours a day, and essentially have my life back. But, the insurance gods have determined that they know better than all of the doctors and experts so they will not approve the surgery.

 

I faced the same thing when dealing with insurance when I was hospitalized for my mental illness. My psychiatrist, counselors, and caseworkers kept telling insurance that I needed to stay in-patient but I had already stayed the 8 weeks/year as insurance allowed so I needed to go home. They sent me home and less than a month later I tried killing myself because I just couldn't handle it. This scenario happens all of the time. My counselor is kept in business mainly by the fact that her clients, which have the same diagnosis as I do, can't stay in-patient long enough or see her more than a couple times a month so they are always in crisis. Honestly, I believe it insurance would get their head out of the sand and quit allowing this cycle to continue then more people may be healed or at least in a place of non-crisis.

 

I could go on and on but we all know it. Insurance doesn't want you to get well or else we wouldn't need them as much. They make big bucks on having people stay sick.

[Melissa in Australia]

Uninsured here, we paid $50/session for DD.  Those of you that are paying $100 or more... we just couldn't afford that and would have had to do without.  It makes me sad for people who are in desperate need but prevented by finances.

 

My desire when eventually returning to school would be to pursue counseling.  I've read enough about it not to be doing it for the money.  :glare:

we couldn't afford it either , but we are not paying. DHS funds all the twins extra medical and they particularly want to fund psychology etc.

[heartlikealion]

Uninsured here, we paid $50/session for DD.  Those of you that are paying $100 or more... we just couldn't afford that and would have had to do without.  It makes me sad for people who are in desperate need but prevented by finances.

 

My desire when eventually returning to school would be to pursue counseling.  I've read enough about it not to be doing it for the money.  :glare:

 

Yeah, I just don't think I could swing it. I have a therapist I have seen once recently. I literally just went over finances tonight to see what we can afford and I'm not sure if/when I should make my next appointment to see her because even with a co-pay that's $25 or $30 a visit + gas to drive 90 min. round trip. I'm thankful for that rate, don't get me wrong. I'm annoyed that our ins. doesn't cover marital counseling at all so dh and I will have to pay out of pocket + a babysitter fee if we go. I do think the system is flawed and would like to see changes. I don't know the logic here and I'm not trying to be rude by saying this, but I wish more practices had non-traditional hours to see patients (evenings/weekends). I have to drive 45 min. to see my therapist and she luckily sees patients in the evening, but only with limited availability. When dh's fall hours begin I will probably have to stop seeing her all together due to scheduling conflicts and I have barely just begun.

 

[GoodGrief]

It's a broken system.

 

We are paying OOP, $200/hr weekly for private therapy, and $90/hr weekly for group therapy for my daughter in the Seattle area. We resorted to OOP out of desperation, and unsatisfactory care over the years by providers who would accept our (military) insurance. We've been doing this for the last year. And we waited over 6 months on a list for access to these providers. We are still using insurance for the psychiatrist. He has little interest in our daughter, honestly, but she's getting the basics, and we really can't afford anything more at this point.

 

I'm not complaining, really. I don't know how to make things different. Mental illness is exceptionally complicated, the population is difficult to deal with, high liability. Things cost what they cost. But I do know that "getting help" is no simple task.

 

[Joanne]

May I share your post with my dd, she is thinking of changing her major from elementary education to counseling...her probable fiancee wants to be a social worker....I foresee them living on ramen noodles the rest of their lives.

Sure and I would be happy to "talk" with them

Via PM also.

 

I love my job. But I encourage new students to be informed.