This is the fourth part in a series about searching for a therapist while navigating your insurance. You can start at the beginning here.

If your plan only offers in-network coverage, especially if the pool of therapists for your network is small, you may have trouble finding someone who has availability and/or expertise in issues relevant to you and with whom you feel a good fit.  Even if your plan doesn’t offer out of network coverage, you still have options!

Alternately, you may have out-of-network coverage but a very high deductible, or the help from your insurance is not enough to bridge the gap between your desired therapist’s fees and your budget. One of the following options may be of help.

Change plans

Does your employer offer a selection of insurance plans? If you know you want to invest in therapy, consider whether a plan that offers more generous coverage such as a PPO would make financial sense.

Keep your plan, but pay out of pocket

Here’s where you’ll want to crunch some numbers. Even if you have a choice of plans, if the cost for the more generous plan is significantly higher, or if it has a very high deductible, you may be better off keeping a less expensive plan and negotiating an out of pocket fee with the therapist of your choice.

Many therapists are open to some negotiation of their fees; avoiding insurance saves them time and effort as well, so negotiating a self-pay fee with a therapist with whom you have a mutual sense of good fit can be a win-win!

Paying out of pocket comes with the additional benefit of uncoupling your insurance company from your treatment. If you pay out of pocket, your therapist isn’t obligated to give you a diagnosis to justify your treatment to your insurance, and you and your therapist have complete freedom to determine the course of your work together without your insurer weighing in on the hows and whys.

If you do have a choice of HMO and PPO coverage for your health insurance, to make an informed choice you’ll need to estimate the cost of therapy for the year and compare that to your deductible and any difference in premiums between plans. You can get an idea of what therapists in your area charge by checking sites like Psychology Today that list therapist fees.

Use your HSA or FSA account

If your employer offers a Health Savings Account or Flex Spending Account, therapy with a licensed provider is considered a medical expense. You can use the pre-tax dollars from these to pay for therapy. If your provider accepts credit/debit cards you may be able to use your HSA/FSA debit card to pay your fee. If not, you can file for reimbursement from your account administrator.

Ask about sliding-scale, reduced-fee or pro-bono availability

Therapists know how hard navigating the world of insurance can be – it may be why they aren’t in-network! Many therapists are also committed to making therapy available to all people, regardless of need. To that end, some will offer ‘sliding-scale’ fees that are scaled to your income. Others may reserve a few spots in their practice for low-fee or pro-bono patients who otherwise couldn’t afford their services. If you find someone who seems like a great match for you but who isn’t in your network, you can try asking if they are willing to negotiate a reduced fee with you.

Ask about insurance exceptions

Similarly, if the therapist you’d like to see isn’t in-network and you can’t afford their fee, you can ask if they would be willing to request an exception from your insurance plan to treat you. Some insurers will grant exceptions on a case-by-case basis, usually in cases where you couldn’t find a therapist in their network who is appropriate for you. For example, if there are no in-network therapists near you that specialize in LGBTQ mental health, you and your therapist can ask your insurance plan to treat your therapist like an in-network provider just for your treatment only. If granted, your therapist would have to agree to provide treatment to you as though they were in-network. This includes accepting the contracted rate your insurer provides and filling out necessary paperwork, so it is somewhat like asking to be a pro-bono or reduced fee patient.

Try a clinic

Outpatient mental health clinics, such as those attached to the psychiatry departments of hospitals, usually accept more insurance plans than private practitioners, in part because they have a billing staff to manage negotiations with insurance. You might have less choice in terms of identifying the particular therapist you want, and you may be assigned to a trainee, but the trainees in clinics, especially those attached to reputable universities, often have their cases overseen by experienced senior therapists. Seeing them brings you the benefits of the new therapists’ enthusiasm and fresh training along with their supervisors’ wisdom and experience. In the Cambridge area, I recommend Cambridge Health Alliance’s Outpatient Psychiatry Department. In Newburyport, I suggest Harborside Counseling.

Look for research studies relevant to you

Some hospitals or training sites may offer therapy as part of a research study and may have funding to offer treatment at little or no cost. The Center for Anxiety & Related Disorders at Boston University and the Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program at Massachusetts General Hospital are examples.

I hope this guide has been helpful! If you have feedback or questions, please don’t hesitate to reach out over on the contact page.