It’s important to us that psychotherapy and psychoanalysis be affordable and accessible. We are out-of-network providers – we don’t maintain relationships with any insurers (see more, below). We can, however, work with you to obtain any out-of-network benefits to which you may be entitled. If we decide to work together, we will set a fee, together, in a conversation in which we discuss, among other things, your ability to pay and your commitment to therapy. If we can’t reach an agreement on a fee, we will do our best to refer you to someone who can see you at a rate that works for you.
On using insurance to select your therapist
You need therapy. You’re depressed. Or anxious. Or you struggle with an intractable behavior problem. Or addiction.
You have insurance through your work and reasonably assume that your insurance should cover the cost of your therapy.
You’re right. It should. Mental health care is health care. And almost certainly, your insurance plan will cover some therapy with some therapists.
Prospective patients often ask us if we accept their insurance. We don’t. We are out-of-network providers. We’ve written this to explain why we’re out-of-network providers, why we don’t accept insurance – and how, notwithstanding that, you might well be able to get some or all of the cost of your treatment reimbursed by your insurance company. We hope it also explains why we believe it’s a bad idea to limit your selection to therapists who accept your insurance.
The difference between “in-network” and “out-of-network”
Every insurance company has a “panel” – therapists who have agreed to see patients insured by that company. Insurance companies pay panel members directly, and patients usually have a co-pay – a contribution they make to the total cost. Panel therapists agree to accept the rate established by the insurance company – in New York City, generally about $80/session in 2019 – for patients covered by that company. If you go to your insurance company’s web site, you can see a list of therapists who are “in network.”
In addition, many insurance policies provide “out-of-network” benefits – partial or full reimbursement of patients’ costs for treatment by therapists who are not “in network.” Generally speaking, out-of-network reimbursement is subject to some combination of a deductible – an amount you have to pay before being eligible for any reimbursement by your insurance company – and “co-insurance” or a “co-pay” – a proportion of the cost of each session thereafter for which patients are responsible. Many policies also feature an “out-of-pocket maximum” – an amount after which their rate of reimbursement increases to up to 100% of a rate that the insurance company sets (not necessarily the rate you are paying).
For both patients and therapists, the differences between in-network and out-of-network are stark. A patient seeing an in-network therapist might pay $5 or $10 per session. And her/his therapist typically receives about $80 per session. In contrast to that, until s/he’s met her deductible, a patient seeing an out-of-network therapist will pay 100% of the therapist’s fee. And after meeting the deductible, s/he’ll continue to pay 100% of the fee, but will be entitled to reimbursement of some or all of what s/he’s paid by the insurance company. An in-network therapist, meanwhile, will receive something in the neighborhood of $80 for each session, which s/he will have to collect from an insurance company. An out-of-network therapist will receive whatever fee s/he and the patient have established, and the patient pays the therapist directly.
We are out-of-network providers. We are not in any insurance networks. We provide our patients with statements suitable for submission to insurance companies for reimbursement, and many of our patients obtain partial or, in some cases, complete, reimbursement of the cost of therapy with us.
Why we don’t participate in any insurance panels
If you see a therapist at Union Square Psychotherapy, you will do so because – together with your therapist – you will choose to work together. You and your therapist will have a relationship. That relationship will be the primary tool you use to address the problems bringing you into treatment. Insurance companies intrude on that relationship in any number of ways, including by establishing the fee. We are protective of your therapist’s relationship with you, and we try hard to minimize intrusion by third parties, because such intrusions distort your work together.
Setting the fee is an important part of your work with your therapist. Early on, your therapist will tell you their fee, and you will react. Perhaps it will seem reasonable, or manageable. Or you’ll be pleasantly surprised at its affordability. Or you’ll be outraged by how unaffordable it is. Or you’ll feel torn. One thing is certain: you’ll have a reaction. And that reaction itself will become part of your relationship, and your work together. It will help your therapist learn about you – about the ways the world feels to you.
Perhaps you and your therapist will agree that you should work together at a rate different than her or his full fee – lower or higher. We feel strongly that you should pay a fee that both feels manageable to you and allows your therapist to make a reasonable income.
If we allow an insurance company to set the fee, we lose out on all the information about your experience of the world this fee-setting process can provide. We subject you and your therapist both to a “one-size-fits-all” model of a highly individualized process. Insurance companies allow no flexibility with fee-setting. If a therapist joins a panel, s/he agrees to see any patient with that insurance for the same fee. If we joined a panel, we would give up the flexibility to arrive at the right fee for you, with you. Which brings us to….
Why you shouldn’t limit yourself to in-network providers
The choice of a therapist is a very personal decision. You shouldn’t let anyone – friend, relative, or insurance company – make, or constrain, that decision for you.
Insurance companies pay therapists about $80 per session. In New York, the average fee per session is $220 (according to ZenCare). If you limit yourself to panel providers, you limit yourself to therapists who limit their highest fees to less than half of most of their peers’ average fees. Therapists who are not on panels are free to see people for fees of $150-200 per session, or more – and to see people for $80 or less. Insurance companies deprive practitioners of this flexibility.
Therapy is an investment in yourself. You choose the gym you belong to, the trainer you see. You select who cuts your hair, what restaurants you eat in. Why wouldn’t you choose at least as carefully – and maximize your options – when it comes to your therapist?
And one final thought…
Many high-quality therapists accept insurance. Many patients receive high-quality therapy with in-network providers. We don’t argue that you shouldn’t use an in-network therapist; rather, we argue that you shouldn’t limit yourself to in-network treatment. Investigate. Explore. Meet with several therapists. See who’s right for you. And then, as we have suggested, don’t sell yourself short: invest in treatment with the person with whom you feel the best fit.