Expert Advice on Paying for Talk Therapy

How to appeal for mental health coverage
If the request for services is still denied, you have a right to appeal. But listen carefully: According to the Mental Health Legal Advisors Committee, a state-funded advocacy group based in Boston, Mass., your therapist must tell the insurance company's utilization reviewer and doctor that he or she will not accept a denial of services or a reduction in services.

If your therapist does not insist on all the terms of the original request, you won't receive a denial, and you have no basis for appeal. The phone calls to the reviewer and doctor are not part of the appeal process. You must get a denial notice before you can start the appeal.

Once you get the denial notice, you must file an appeal in writing with the insurer. Include your name and policy number, detailed information about the service your therapist requested, the exact dates for which the service is requested, and reasons you think the insurance company should reverse its denial.

Should you pay out of pocket?
If you can afford it, your treatment can continue during this process. If the appeal is denied, you can continue treatment with your therapist, and the two of you negotiate the fee. Goldberg notes that the therapist cannot charge you more than what your insurer was paying if your approved sessions have been used up.

In other words, if the insurance company was paying $50 a visit and you made a $20 co-payment, you will now pay the entire $70. A therapist at a community mental health center may charge from $5 to $50 an hour, depending on your income and other medical expenses if you are not covered by insurance.

Private clinic fees are in the $50 to $100 range, and private therapists typically charge $60 to $125 an hour. Expect to pay a higher hourly rate for a psychiatrist or psychologist than for a social worker, psychiatric nurse, or counselor.