this post was submitted on 02 Feb 2025
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It's common for the people who can afford it. Health insurance will fight you on covering it and most therapists try to operate with as little overhead as possible because it is not as reliable as primary care, for example. In other words, therapists generally don't like dealing with health insurers on the patient's behalf. It costs too much for them. This means that most end up paying out of pocket and it does not go against their deductible. I would put a rough estimate that really only the top 40% of earners in America have realistic, reliable access to it. And it will be a significant financial burden for those below top 20% of earners. Which means they will be unlikely to stick with it long-term.
I've never heard of anyone paying out of pocket for therapy instead of going through insurance. I've had several different insurance providers over the past 15+ years and never had an issue getting therapy covered.
I have had to pay for therapy out of pocket, and it's increasingly common for therapists to not accept insurance. There is a higher demand for therapy than a supply of therapists to meet that demand (esp. since the pandemic, but even before then), so many therapists realized they can just operate a practice without the hassle of dealing with insurance.
Well, for instance, BetterHelp is not covered by any insurance, and that's probably the most accessible therapy for everyone. It has more to do with your therapist than the insurance. You probably have dealt with providers that work with insurance. I'm telling you there are a lot that don't for the reasons I outlined.
I also think you're lucky or either the insurers are getting more bold about denying coverage. I've had to fight insurer's on two separate occasions regarding therapy.
The easiest method is probably to get your insurance to direct you to therapists that accept your plan instead of vice versa. That's what I always did.
Ah, yeah, and this highlights another issue. Therapists are in short supply in most of the country. If you're in a major city, you'll have a lot of options, but in a 2nd or 3rd tier city you will have limited options, at least in my area.
Is telehealth permitted for therapists in your state? My state made it easier during the pandemic so I'm able to see a trans-specialized therapist whose office is an hour drive away.