Tips for Affording Mental Health Care

Many mental health providers are willing to work on a sliding fee scale. Don't be shy about asking.(FOTOLIA/HEALTH)

No matter how depressed, sleepless, or anxious you feel, the high price of professional mental health help can seem prohibitive—who can afford $100 or $200 an hour for therapy? Even if you have insurance, mental health costs can quickly add up with long-term treatment. Plus, mental health benefits often come with separate deductibles to meet, co-payments, and annual caps. For some tips on lowering the cost of therapy—with or without insurance—we consulted Ruth Montag, director of the Resource Center at Mental Health America, a national nonprofit group that helped nearly 10,000 people find resources for mental health care in 2008.

Q: What do you recommend for people with mental health problems who have maxed out their insurance coverage, or are losing their insurance?

A: When someone is already in treatment, we suggest they start by asking their therapist about the possibility of reducing the fee or working out a payment plan. Another strategy that we use is to tell people to try to get at least an initial consultation or a couple of visits with a private therapist, someone recommended in the Depression and Bipolar Support Alliances directory, even if you know you cant afford treatment on an ongoing basis. Especially if you've had trouble getting treatment that works, that provider might be able to get to the heart of the matter in just a couple of visits—such as finding the right mix of medication. Then you stand a better chance when you go into maintenance treatment with someone who is more affordable.

Q: Where can I find the more affordable options for maintenance therapy?

A: Community mental health centers operated by the county or local nonprofit organizations generally operate on a sliding scale where the fee charged is based on income. The Substance Abuse and Mental Health Services Administration maintains an online mental health services locator where you can search for these centers in your area. In addition, you can contact the psychiatry or psychology department of a local medical school or university. Ask whether there are clinics where social work interns or graduate students provide services for a reduced fee. Primary care physicians can also be a resource for those who don't have mental health benefits as part of their insurance. Another valuable resource that we link to on our website is a database assembled by Psychology Today. It's a therapist directory that you search geographically, with a profile of each therapist, including his or her specific area of practice interest. The listings detail what insurance therapists take, what their fees are, and whether they have a sliding scale

Q: What do I do if Im having trouble getting my insurance company to pay for care?

A: First, its extremely important to be familiar with the extent of your coverage; second, we encourage people not to take "no" for an answer. If you are being denied for a treatment that you feel should be covered, enlist the help of your treating professional in the appeals process. We had one situation last year where a mom called us, saying that even though the psychiatrists were recommending residential treatment for her child, the insurance company was refusing to pay. We were able to get the number of the ombudsman for her insurance program, who made the argument very strongly, and the company reversed its decision and approved the treatment.

Q: What if my insurer refuses to pay?

A: Find out if your state has an external appeal process where the treatment denial can be reviewed. Part of convincing insurance companies to pay is giving demonstrable arguments of how bad the consequences could be if they refuse treatment. So that, for them, it becomes a risk management situation. The Mental Health America fact sheet "How To Overturn Managed Care Treatment Denials" and the Kaiser Family Foundations "Consumer Guide to Handling Disputes with Your Employer or Private Health Plan" can be helpful tools for facing treatment denials.

Q: Whats the first place you'd direct people to go if they don't have any insurance coverage?

A: For the most affordable care, you can rely on community mental health centers. Many employers also offer excellent Employee Assistance Programs (EAPs), which can help you (or your family members) locate affordable mental health providers in the community. Many EAPs also provide short-term counseling and support groups. Most states also have programs and benefits for individuals with no health insurance that can help cover the cost of therapy, medications, and other treatment. We encourage callers who don't have insurance to see if they are eligible for health coverage through Medicaid or other state programs for people who are uninsured.