Paying for Therapy

Therapy access is not as black and white as "either cash or insurance," though this is often a surprise for people. I'm going to share a breakdown of some of the options you have and some of their nuances.

Insurance

Using your insurance benefits to cover some or all of your therapy can be the most simple and affordable option for some.

Insurance Pros

• Little to no direct cost

• Some layer of extra protection (therapists who are credentialed with insurance programs have some layer of accountability to quality, meaning they are licensed and must keep up with basic law and ethics)

Insurance Cons

• Limited choice and flexibility. Your therapy becomes about who can take your insurance rather than finding the best fit, which can actually prolong the therapy process.

• The insurance program dictates a lot about what you will receive. They can steer your therapy based on type, length, frequency, etc. It is very standardized and does not always account for individual needs.

• New telehealth coverage limitations are popping up.

• Less privacy: when working with insurance, therapists are required to provide certain information including diagnosis and CPT codes, and sometimes treatment information. Some individuals prefer to keep their therapy process more private.

  
  

Cash Pay

Most therapists will accept out of pocket payment, and some only accept out of pocket payment.

Cash Pay Pros:

• Flexibility in therapy duration, frequency, and interventions. Flexibility in setting (referring to my note above about some insurance programs moving away from telehealth coverage).

• Can be a cost-effective option if you look at the big picture. Finding the right fit can improve outcomes and reduce length of treatment.

• It simplifies things for everyone. No denied claims to follow up on, no stress about benefits and deductibles.

Cash Pay Cons:

• It may not always be affordable to those who need it

• Less system oversight on the therapist (meaning, you'll just want to verify their credentials and training)

Sliding Scale:

Sliding scale options may be available depending on your provider. This means you pay a reduced fee, sometimes based on your income. For example, my standard rate is $160 for adult sessions. I reserve a couple of sliding scale spots to increase accessibility, and those individuals pay what they can on a scale from $60-120. Sliding scale options are completely dependent on your provider, but many providers do offer this so always be sure to ask if it's something you need.

Out of Network or Superbilling

This is an option for individuals who really care about finding the right fit but still want or need support from their insurance. If you find a therapist who is out of your network or who does not outright work with insurance, often times they will be willing to provide a "superbill." This means they provide a document outlining the services you have been provided (often monthly). Clients then take this document and submit it to their insurance provider. Insurance providers can then reimburse you partially or in full what you paid for those services.

If this is something you plan to do, I recommend calling your insurance provider in advance to talk through what would be covered and what your reimbursement rates would be. For example, different therapist license types may not be covered (I still have an associate license until approximately February 2026, which likely would not be reimbursed for).

Generally speaking, I have heard a lot of people get by okay with this method. It just takes being a little bit more work on your end and some planning.

HSA and FSA

Health Savings Accounts and Flexible Spending Accounts are often lost and forgotten when it comes to considering how to pay for therapy. However, around 37% of Americans report having one of the two (Understanding HSA & FSA Trends in Consumer Spending - Numerator). These accounts are tax advantaged accounts that you get to spend on eligible healthcare expenses. Therapy is a common use for these funds. These funds are accessed through a debit card. Be sure to stay aware of whether or not your employer provides this benefit.

EAP

Employee Assistance Programs are another benefit offered through some workplaces. This covers the cost of brief counseling services through certified EAP providers. This is usually only 3-8 sessions and you are assigned to the provider. For some, that is all that is needed. For others, it can be a good bridge to something longer term.

Other Affordable Therapy Options

Group Therapy

Group therapy can not only be a more cost-effective option, but it can really maximize therapy outcomes as well due to the benefits of the group therapy process, and working through skills and goals in real-time.

Churches

Community Mental Health Centers

Largescale online platforms, such as Better Help, Talkspace, or Open Path

Quality therapy accessibility is a passionate topic for me. I am passionate about ensuring individuals find the right fit and don't end up in care for longer than they need to be. Still have questions about your options for paying for your therapy? Email me: amber@eckertwesttherapy.com

Written from my own head and heart, without the use of AI

Amber Eckert, MSW, LSWAIC

Eckert West Therapy