Speaker 1: Hey, what's up, everybody? My name is Isaiah. Welcome to Therapy Today. Today we are back in the studio after doing a very involved shoot involving three, maybe four other people, including camera crew, going off-site, answering some questions, eating some hot wings. So that was fun, but we are going back to the simple, tried-and-true formula today, which is just me and Kitty. I know Kitty has been absent from the channel for a little bit, so I wanted to get him back on. Of course, it depends on his schedule. If he's busy while I'm filming, then I can't do much about it, right? So today we are going to be talking about the cost of therapy and how people who need access to services might sometimes be in positions where they can't afford it, the cost might become prohibitive, it might become a financial burden or a stressor by itself in addition to whatever was bringing them to therapy in the first place, and what we can do about that both from the therapist's side as well as from the consumer's side. Before we dig into this topic, please do like and subscribe. That helps the channel to grow. We are closing in on 10,000 subscribers, which again is just such a huge deal for me. I never thought that starting this channel we would ever get to the point where we had even hit a thousand subscribers, much less moving in on that 10,000 mark. So help me get there, help this channel to grow, help us to have dialogues and conversations. You okay? About mental health and how we can navigate the mental healthcare system. And I am interested to hear what kind of stories you all have about financial burdens or cost keeping you from seeking out counseling or whether that's been a stressor for you in the past when it comes to getting the mental health services that you need. Please comment below and let me know what kind of challenges you've run up against, what barriers to seeking services you've run into, and how you got around that or if you didn't. This is a topic that's really important and I do want to learn more about it from you all's experiences. So this This topic came up to me because I was looking through the news and there was an article about a woman who had suffered a home invasion. Someone had broken into her home and she was potentially suffering from PTSD. A friend had encouraged her to reach out to a therapist so that she could get mental health services so that she could deal with the trauma symptoms that she was experiencing. What she found out was even though she was with a prominent insurance company, most of the therapists around her would not treat her because they did not take that insurance even though it was a very common national insurance organization. So apparently what she kept hearing was that this insurance company does not reimburse enough for us to take you on as a client, which translated means that because they don't pay the therapist enough, they don't feel like it's worth taking on clients who have that particular insurance. And a lot of therapists will make this kind of business decision. We can't be paneled with all insurances because there's a process to be paneled with each insurance company. You have to go through an application process with each one, negotiating rates, things like that, understanding how their system works, and so it's time and cost prohibitive to apply for all of those and be universally available to everyone on every insurance. What that means is that therapists will pick and choose which insurances work for their situation. Some are paneled with more insurance companies, some are paneled with fewer, and that just depends on the business decisions that they make about how they do their counseling. What that means is that this lady in the original article ended up going to a therapist and she was paying out-of-pocket $170 per session. And the article continued to talk about, as a launching point from this story, how therapy can become a financial burden and then can be an additional stressor for some people who are participating in therapy, getting therapy in the first place for some other kind of stressor or some other mental health condition, and then And then you add this financial burden on top of it, because I do want to acknowledge that if you are paying out of pocket and you're meeting weekly, you're talking about an extra $170 per session per week, and that adds up to over $500 extra a month if you're meeting that consistently. And for some people, that stretches on for months or years at a time. That's a huge added expense over time. The news article cited a very well-mined survey that surveyed 1,000 adults who are currently in therapy. that a third of them had stopped attending therapy because of the financial burden and half of them were considering stopping because of that same financial burden. So that's a significant number of people who are either choosing not to access services or getting the help that they need because of the cost. And so I do want to talk through some of the concerns that are wrapped up in this particular story as well as just the larger trends about therapy getting more expensive and becoming not affordable for some people who really need it. The first thing I will acknowledge is that $170 based on the other numbers that I saw in the article is actually not that expensive which really blows my mind sometimes. They were listing some therapists who are charging $200, $300 per session out of pocket and what they were saying was that that was what they needed to charge in order for their business to make sense for them to be able to make a living off of it. So that's a conversation that we as therapists need to be having with our clients right off the bat, especially if they are doing self-pay, which means they're not paying through insurance or any other provider, that they are coming up with that money out of pocket and why we have policies about no-shows or late cancellations because that means we are losing some of our income every time a client doesn't show up. And that's where it does get difficult where some personal feelings can get tangled up in the counseling process because what if you have a client who needs help but is is consistently not showing up and that's putting a dent in your bottom line, there could be some personal feelings from the clinician towards the client and we need to own that and we need to recognize that the business aspect can kind of muddy the counseling process and we need to own that and be able to have conversations about that from an objective sense without it becoming personal for us. I'll always encourage clients to have open conversations with their clinicians about what's going on about the process and that includes financial concerns. Definitely it's a red flag if your clinician is ever taking that kind of personally, if they start to get angry or frustrated because you're not able to pay or because financial burden is a concern for you. Again, they need to maintain that professionalism about, yes, they are making a living off of this practice, but also that this is a very real stressor and concern for you as a client. One person who was interviewed for this story said that their clinician, when they talked about the financial burden, said, okay, well, when you're able to financially take on this commitment of counseling, then I'll be here for you." And while that sounds rather professional and rather appropriate, I've got a couple of concerns with therapists who might respond this way. One is that it does sound kind of dismissive of their concerns. Basically, you're saying, oh, you can't pay? Well, all right, well, I'll be here when you can pay, and otherwise I don't have any obligation to you. It's not helpful for the client, as well as potentially making it sound like therapy is just for the well-off, or those who have the insurances that reimburse well enough for it to make it worth your while to see them. And I think if you interview therapists, that's not the impression that we're trying to send, but that's what functionally those kinds of conversations can end up sounding like, saying that, oh well once you have the money then I'll be available for you, is not the message that we want to send about what therapy is about and why we're doing it in the first place. One suggestion that I might have is to engage in in that conversation and say, okay, I understand where you're coming from, that the financial burden is a concern. If you have some policies in place about a sliding scale or something like that, or maybe taking on a pro bono client, that might be a conversation to bring up instead of waiting for the client to bring it up. Or consider making a referral. Hey, I know this clinician here, they take your insurance, and you might be able to work out an arrangement for them. And furthering that conversation to help them bridge the gap to a way that they can access services even if you can't provide that directly for yourself. That's what I would suggest for therapists who maybe have to go through that conversation sometimes and it's a very real concern for both clinicians and clients because there are so many different insurances, different ways that therapists do reimbursement, that sometimes that conversation is gonna come up because it's not uniform across the board. So let's talk about from the client side, how we can manage the financial burden. Because like I said, that cost will add up pretty quickly, especially if you're paying out of pocket. Even when we're talking about maybe having insurance cover it, it can be very confusing sometimes. Some people have deductibles that they have to pay a certain amount, and that can be in the thousands out of pocket before insurance will cover anything. So you're looking at a big financial commitment before your insurance company steps in, or even if you have co-pays, that'll add up as well, an extra $25, an extra $30, or $40 here and there can make a huge difference, especially if you're maybe at a lower-paying job. So if you are in a position where you feel stuck and the therapist that you need to work with or want to work with is not covered by your insurance, one way is to call your insurance and ask about maybe out-of-network benefits. There are some times where I've been reimbursed by insurance companies at a different rate because I was considered out-of-network. I wasn't paneled with that insurance company, but the client was able to ask and they had a policy in place for reimbursing out-of-network clinicians. So that's a possibility that you might be able to bring up with your insurance company. Two other options that I talked about is having conversations with your clinician, with your mental health professional, about policies they have in place for either a sliding scale, which means that they have a reduced rate for people who meet certain income thresholds, or pro bono clients. We are encouraged as therapists to give back to the community by providing services for free for people who are not able to pay or who have other difficulties going on. And so that might be a conversation to have with your therapist if they have any of those spots available, what kind of process you might need to go through in order to be put on as a pro bono client. And this will differ based on whether you're with a larger agency, whether it's a solo private practice or a public mental health agency. Those are all kind of different processes. Most states do have public mental health agencies. I know here in Virginia that's actually mandated by law that every region has a minimal threshold of mental health services that is accessible for anybody regardless of income. And so that might be an option for you to consider if cost is a concern for you or being underinsured is a problem for you. And that's something that you should be able to ask the mental health professional that you're currently seeing to make a referral or to connect you to whatever local public mental health agency is available or whatever maybe nonprofit services are available. Another option to consider is seeking out residents or interns. As we're in our learning process as students, we'll do internships and those are unpaid. As well as after we graduate, we normally have residencies. That depends on the state, but that's a time when you're practicing under somebody else's license and supervision. And so as a resident, you're not working independently yet, and so you can't charge the same rates. And so naturally seeing an intern or a resident would tend to be cheaper. So you might ask if there are any of those working at that particular office, or if your mental health professional happens to know any agencies, companies that employ or have interns or residents on staff, that might be an avenue to consider as well. And so all of this is to say that there are institutional factors that make therapy cost prohibitive sometimes, but that there are also options to lower the cost of therapy, to be able to access services without it breaking the bank. And we don't publicize those as much, and we need to do that as a profession, to connect people with services, to not just say, well, sorry, I can't help you. When you have the money, then you can come back. That is not helpful for people who are going through financial stress, who are maybe going through life challenges or situations where finances are especially difficult or stressful. We might actually be adding to that or exacerbating that. Another option to cut down on costs when it comes to therapy is that I would also encourage any clients, when you are treatment planning with your therapist, Or if you don't, then bring up the idea of a treatment plan or the concept of a treatment plan with your therapist. What are your targets? What are you aiming for in therapy? Be specific, be very measurable about those so that you are aiming for a particular goal and target date, and so that therapy doesn't just stretch on and on. You feel like you're getting value out of what you are paying for. And that can be a way to cut down costs because you're not paying for extraneous services. But in all of this, I think it's the responsibility of both mental health professionals and clients to be able to advocate for the profession, for people who need services to be able to have access to them. I think there are insurance factors, there are governmental factors that could also play a big role, and that's what advocacy is about. But in the meantime, for those people who are struggling with financial burdens when it comes to therapy or access to care, these are some of the ways that you might be able to cut some of the costs associated with therapy. As always, thank you all so much for watching. Please do like and subscribe. that helps the channel to grow and keeps Kitty well-fed. So thank you so much for supporting the channel. We do have a giveaway with Mental Athlete Apparel going on through the entire month of September, 2024. So do check out the Hot Ones video. That is where the giveaway is announced and that's where you can enter the giveaway as well. So please do enter that, check out the video, and I will see you all next time. Hidisay, Thanks again for being on the show and if you've seen this particular episode before, this was one particular audition that the theater staff had to pick and pick, so give that audition a who.