What Is Sliding Scale Therapy And How Does It Work With Health Insurance?

Have you been experiencing mental health concerns but questioning if therapy services are affordable? If so, you're not alone. Not everyone can easily manage therapy costs, which is why many therapists now offer sliding-scale therapy work and sliding-scale fees. Deciding to see a licensed therapist to address your mental health concerns may be one of the most critical decisions you ever make, and session fees don't have to be a barrier to getting help. You can learn more about a therapist’s options and negotiate a set amount for sessions by connecting with sliding-scale therapists in your area or online. Some therapists provide flexible pricing, starting at $80 per session.

What is sliding scale therapy and can it support mental health?

A sliding scale is a type of fee structure therapists sometimes use to offer people with fewer resources reduced fees. This allows therapists to provide affordable care to a wider range of patients, ensuring that those in need can still receive mental health services. The sliding scale many therapists use is also commonly employed in various industries, including legal services and primary care clinics. By considering a customer’s ability to pay based on their overall income, therapists can make their services more accessible, offering rates starting at $80.

How income affects sliding scale fees in mental health services

The therapist sets up one sliding fee scale that is used for any client, whether they’re an insured patient or someone seeking financial assistance. If you have enough resources to cover the full therapy cost, you will be billed at the therapist's standard session fee. If you're underinsured or facing financial challenges that hinder your ability to pay, you'll be provided the option to pay a reduced rate. Sliding scale fees are especially helpful for those with a low income, allowing them to access mental health care at an affordable rate. For example, in a one-on-one practice where the full price is $175 per hour or per session, if you make less than the poverty threshold of $50,000 per year, your fees may be $75 per hour, but if you have an annual income of $120,000 per year, you may pay the full price per session. Therapists can adjust their fees using a sliding scale, with rates as low as $75 to accommodate various financial situations if necessary.

How do sliding scale fees work?

These numbers, or the set fees, take into account the client's pay as well as the therapist's salary. Clients who earn more money may be expected to pay closer to the full session rate compared to those with lower incomes. Sliding scales, of course, can vary for each one-on-one practice, but in the U.S., they are usually dictated by the Federal Poverty Guidelines and the Bureau of Primary Healthcare, a United States department within the Human Services & Resources Administration (HSRA). Therapists use these guidelines to develop fair fee structures that balance the needs of their clients and their practice.

Who benefits from sliding scale therapy and how does health insurance factor in?

The sliding scale rates are a reasonable request for determining how much you pay for your chosen therapy options. Clients with limited financial resources can greatly benefit from sliding scale therapy, as it allows them to access necessary care at a reduced cost. In most cases, the in-network therapist's office personnel will apply the scale to your situation and take care of the paperwork to provide affordable counseling services for you and/or your family once you pay the minimum fee towards a therapist.

Will it make a difference in your treatment?

Whether you pay the full cost of your sessions or a reduced fee, the providers at your chosen therapy center follow ethical guidelines to give you the same standard of high-quality care as clients who pay full price. They make no difference in the way they treat you or the time they spend in pro bono sessions. Many therapists who offer sliding scale rates do not even know who benefits from the financial break. The sliding scales and billing are often handled by the accounting personnel of the one-on-one practice rather than the mental health professionals themselves.

How sliding scale fee structures are determined in mental health services

Sliding scale fees are not unique to mental health services; many healthcare providers and educational institutions offer a reduced rate or different rates for their services. Doctors may also offer sliding-scale consultations if you require a mental health referral from your primary care provider. Sliding scale consultations can also be used for services like measuring blood sugar content, getting insulin therapy, receiving intensive insulin consultation, and blood glucose support. Talk to your primary care provider to learn more about accessing affordable mental health services. The cost of therapy sessions can vary, but they often range around $120 per session depending on the therapist and location.

Do you qualify for sliding scale therapy?

If you do not believe you can afford the full price, you can present your income information and number of dependents to a provider who can offer sliding scale rates. Determining how much you'll pay is a straightforward process for the therapist's office staff. If you meet the sliding fee scale criteria to receive affordable therapy, you'll pay reduced rates or lower fees based on your level of need. To receive this option, you must find a provider to offer a sliding scale option, as some providers do not offer one.

Sliding scales are designed for people who are paying for the service themselves directly to a one-on-one practice, therapy center, social worker, or other mental health professional rather than those who are paying through an insurance company. With those who offer sliding scale fees, you don't typically get a reduced fee for your copays or deductibles. Also, even though a practice may accept insurance, many insurance companies do not cover most mental health care, or they only cover a small percentage. In many cases, it's less expensive to pay out of pocket with a sliding scale fee than to use your health insurance. Some therapists may reduce their fees to $60-$75 in special circumstances, depending on the client’s financial situation.

Guidelines of sliding fee therapy 

Not every practice with a sliding fee scale has the same rules or code of conduct. A sliding scale may require you to verify income with a pay stub to prevent insurance fraud. Others may take your word for your income and set sliding scale fees based on that. Some require that you notify the office within a certain amount of time if your financial situation changes. In some cases, you may need to provide proof of taxes or pay stubs to verify your income level for sliding scale eligibility. The sliding scale rules, which determine how sliding scales work in that specific practice, may be listed on an agreement that you sign with the therapist or their staff. If you don't qualify for the low fees, there are other mental health resources, such as community mental health clinics and online therapy platforms.

Online counseling

While seeing a therapist face-to-face at a one-on-one practice may be the more traditional way to have counseling, it tends to be more expensive. The therapist must pay for the building they are in, utilities for that building, salaries for employees, business and office supplies, and possibly even insurance for employees. They also have to spend money on transportation to get back and forth to work. Nowadays, many therapists choose to practice remotely because of the benefits it offers them and their clients, promoting a fair trade between services and expenses.

Online therapy has been proven to be just as effective as in-person therapy, offering a wider range of flexibility and availability. In addition, it may save both you and the therapist time because you can see each other whenever you're free. While many online therapy platforms don’t accept insurance, they tend to offer affordable monthly subscription plans. Some platforms, such as BetterHelp, offer financial aid to those who qualify.

This new flexible form of online counseling breaks the barriers of typical Monday through Friday appointment times and allows clients and therapists to connect on their own time. Getting started with affordable online therapy is as easy as completing a quick registration process, providing contact information, and selecting a therapist that meets your needs. Payment plans are usually based on a subscription model, allowing more people to afford essential therapy.

The individual therapy and counseling services you get online, often provided by participants of the American Counseling Association, are the same as you would get in a more traditional setting. This type of therapy may be especially helpful for individuals experiencing social anxiety or depression, as they don't have to sit in a waiting room or interact with anyone but the therapist. To find sliding scale therapy or free sessions, you can search online platforms or contact local mental health providers.

Alternative support options

In addition to individual therapy sessions, there are other options that offer mental health support. Some include therapy at community centers, schools, teaching hospitals, employee programs, and chat rooms. Some therapists may also work pro bono or offer services through moderated online forums or chat platforms.

• Group therapy: One of the most popular types of therapy is group therapy, which can be found in many areas at local churches or community centers. Most of the time, the sessions are free or very low cost, and you would meet with a group of people and a therapist or clergy member who moderates the session. The therapist typically does not provide individual care in a group setting, but in some cases, sessions may be co-facilitated by two or more therapists to offer additional support and perspectives.

• Schools or teaching hospitals: You may also be able to get counseling from a local school or teaching hospital. If you're a student, you should be able to get free sessions from your school. Teaching hospitals and clinics usually offer free therapy or low-cost counseling in a teaching situation where you'd be seeing both the therapist and an intern who is receiving training through continuing education courses. Not everyone may be eligible for these services, as they may have a limited number of slots available. However, if these services are not available, the therapist at these facilities can often refer you to other affordable therapists in your area.

• Employer assistance programs: Some employers offer employee assistance programs that may have free or low-cost mental health care. This is usually separate from your health insurance and is a resource to help employees manage life challenges like divorce, grief, and other major concerns. Through these programs, you might find a therapist who collaborates with other therapists to provide comprehensive support.

• Online chat rooms: There are also online chat rooms where you can talk to others who have similar concerns. You can intimately chat online with others who want to open up about their experiences and offer help to those who need it. While less structured than traditional therapy, some therapist-moderated forums offer a safer and more supportive environment. A therapist might recommend specific forums that align with your needs.

Although chat rooms can provide support, they have some potential downfalls. Without a therapist to facilitate communication, the process can be unorthodox. It is different from going to a therapist personally, wherein you'll get to see the therapy room design and experience the entire interaction face-to-face. However, all you must do is click one button to get out of that room, and there are a lot of options. Some chat rooms are specifically designed for certain subjects like depression or anxiety, while others are more general.

It's important to note that therapy and chat rooms are intended for non-emergency situations only. Visit your nearest emergency room if your issue is an emergency or you're facing a life-threatening situation.

If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.