Online Mental Health Services
You’ve probably noticed the recurring ads on TV (including cable and streaming services) for telehealth services, and especially those for mental health services. Well-known companies include BetterHelp, Talkspace, E-Therapy Café, even Thumbtack, among others. The boom in telehealth occurred in the wake of the in-person Covid 19 restrictions beginning in early 2020, though some of these companies launched circa 2015, if not earlier, and telehealth run by traditional providers existed well before then, particularly for patients who lived in remote and rural areas, or who were homebound.
The attraction is clear: You don’t have to get in your car or take public transportation to a session, and you don’t risk embarrassment by sitting in an outer office while awaiting your appointment. For those without insurance, some of these telehealth mental health services may be cheaper than local, in-person therapy.
But there’s no such thing as a free lunch, right? And don’t you get what you pay for anyway?
Well, it’s complicated. What I want to do here is investigate Medicare and private pay insurance reimbursement, and why so many therapists refuse to accept insurance, including Medicare. Shocking (to me) is the fact that 43 percent of all health care providers in the country who refuse to accept Medicare are behavioral health providers.
“We don’t accept insurance.”
Perhaps the best database to find a practicing therapist in your area – someone you can see in person – is the one developed by Psychology Today magazine (here). But be forewarned – many, even most – will not accept insurance. It’s usually about the reimbursement rates.
.Slate Magazine published an essay by a practicing psychologist in 2022 who explained why she didn’t take insurance any longer. She wrote that she began her career by wanting to make a good living but also to help people in need, so early on she not only accepted insurance, but offered a sliding scale fee structure for people with less money. She stopped taking insurance after three or four years, however, because insurance reimbursement was not keeping up with pay raises in other professions, she wrote, plus the burden of filling out a lot of paperwork was taking away time better spent actually seeing patients.
Separately, The Wall Street Journal explained “why it’s so hard to find a therapist who takes insurance” in an article published on October 5, 2021. The article is paywalled, but the gist of it is that reimbursement is low, and it’s a hassle to complete all the forms that insurance demands.
So, what is the average price therapists charge? It varies (you knew I was going to say that) but I picked New York City first. One major health care provider there, Nao Medical, says rates for “psychologists and therapists” can be anywhere from $150 to $300 per hour. In Denver, as another example, the amounts would range from $65 to $250 per hour, according to My Denver Therapy.
I can’t check every private insurance plan, but I could check Medicare reimbursement to see just what the government will pay. I was surprised to learn the national average for reimbursement is $195 per session! I have to make an editorial comment here – isn’t that enough for these healers? (I couldn’t resist being facetious just now.)
On a related note, I must say that the word “therapist” is used very loosely. On the above-mentioned Psychology Today site, anyone from folks with a Master’s Degree in an appropriate field to an LPC (Licensed Professional Counselor) to a Master of Divinity to a Ph.D. clinical psychologist will be called a therapist. Some of the therapists have more letters behind their names than Realtors like to have!
Online cheaper, but …
I’ll mention one online therapy site up front that does make it easy to see if your insurance will pay for your sessions (not counting copays), namely Talkspace. On the same page you can also apply to be a counselor, so make no mistake that the site is in business to take a cut of whatever a counselor or therapist may charge you.
I looked at the BetterHelp site next and I found the issue of insurance reimbursement to be well-hidden, and for good reason. The site operates on a “subscription” basis which allows you one virtual session and some very limited text contact, and it does not accept insurance, according to the reliable website Healthline.
And then there’s Thumbtack, which I’ve used in the past to find “handyman” services for projects around my home. But you can find a therapist or counselor via this site, as well. Who knew! As I scoured through the Thumbtack site, I saw that their therapists rarely listed credentials, and insurance didn’t seem to be an option at all. You just pay them like any “pro” you might hire on the site, PayPal accepted! If you just want someone to talk to, well, maybe, but I’m sticking to handymen who know how to install a faucet or caulk a bathtub properly.
Is telehealth mental health therapy the wave of the future, though? I doubt it, and here’s a statement I found on Medicare.gov that warns the government will stop paying for such services after December 31, 2024 unless you live in a rural area. Some of these websites will go under then, I predict.
Disclaimer!
I’m not a therapist and am not offering any medical advice here. Also, please note that none of these services are suitable for what are the traditionally recognized major psychoses, most notably schizophrenia and Bipolar. Your family physician might prescribe medication for these conditions or refer you to a psychiatrist, who is someone with a medical degree. Except in rare instances no therapist, counselor or psychologist without a medical degree is allowed to prescribe medicine. Yet most psychiatrists these days do not do therapy themselves – they make a diagnosis, prescribe medicine, and may make referrals to someone else to do therapy. But that’s the mental health merry-go-round, perhaps a topic for a future post.
Before you go:
My latest collection of short stories, “Don’t Go,” has received a very positive review from the respected Midwest Book Review, and has been named a Finalist in the Foreword Reviews INDIES awards for 2022. Read more about it here.