Mental health treatment and the self-pay patient

As I mentioned in a post earlier this week, one of the issues I haven’t gotten around to addressing here has been mental health care and how self-pay patients can get the most for their health care dollars. I cover a variety of mental health care options in my book The Self-Pay Patient: Affordable Healthcare Choices in the Age of Obamacare, of course,  (have I mentioned yet that it’s now available in paperback as well as for Kindle and Nook?), but that’s no excuse for not addressing it here on the blog. So here goes.

To begin, an awful lot of mental health care is already self-pay, in that more so than probably any other health care profession a large number of mental health professionals do not accept insurance. For example, a recent New York Times article found that only 55% of psychiatrists accept insurance, compared to about 86% of other medical doctors. The picture for other mental health providers, such as psychologists and licensed therapists, seems to be similar.

So finding a mental health professional who is accustomed to dealing with self-pay patients usually isn’t that difficult. But there are other challenges, of course, such as being able to afford it. 

The blog at Clear Health Costs is in the middle of doing a series on the cost of mental health care, which addresses these challenges and gives an excellent overview of mental health and self-pay patients. Here are some excerpts from the second and fourth installments of the series, which I thought were particularly helpful for self-pay patients:


Paying for mental health care is difficult for many. Even for those who are insured, restrictions on mental health coverage require many Americans to pay  quite a lot out of pocket… According to a survey looking at treatment received between 2005 and 2009, a quarter of the 15.7 million Americans who received mental health care listed themselves as the main payer for the services, paying between $100 and $5,000.   Yet for those who are persistent and direct about stating what they can pay, there are ways of finding more affordable treatment…

While the fees therapists charge vary according to geographic location and levels of training, one standard session (45-55 minutes) of talk therapy generally runs between $80 and $120.  In New York City seeing a psychotherapist runs higher (between $200 and $300), while on the lower end of the scale it is closer to $60. Multiply these rates by one session per week, and the costs can add up faster than patients are able to pay…

A variety of mental health professionals have the training and qualifications to provide psychotherapy, including psychologists, clinical social workers, psychiatric nurses, and mental health counselors.

  • Psychologist. A psychologist has a doctoral degree in psychology, which is the study of the mind and behaviors… Licensed psychologists are qualified to do counseling and psychotherapy and provide treatment for mental disorders.
  • Licensed Clinical Social Worker. A clinical social worker has at least a master’s degree in social work and training to be able to evaluate and treat mental illnesses.
  • Licensed Mental Health Counselor. A psychological counselor is a mental health professional who has a master’s degree (MA) in psychology, counseling, or a related field… 
  • Psychiatric or Mental Health Nurse. Some nurses have special training to provide mental health services. They can evaluate patients for mental illness and provide psychotherapy.

Among mental health professionals, only psychiatrists are able to prescribe medication…  

Psychiatrists who also provide psychotherapy may be a dying breed, but they can still be found. According to a 2010 study, while just 11 percent of psychiatrists provide talk therapy to all of their patients, almost 60 percent provide it to at least some of them. But for those who are paying out of pocket for therapy, seeing a psychiatrist is even more expensive that engaging a different service provider…

The good news is, there are many approaches consumers can take to find affordable therapy. Here are five ways to negotiate a better rate:

1)     Sliding scales. Almost all therapists offer sliding scales for patients who are paying out of pocket, and/or for people with limited resources. If you are already seeing a therapist or interviewing possible candidates, be sure to ask about discounted rates, which can be as much as 30% below the self-pay rate.

2)     Request flexible scheduling. While many patients book weekly sessions with their therapists, those paying out of pocket may prefer to reduce costs by scheduling sessions on alternating weeks. In between sessions, many people engage in online support-type groups such as 7 Cups of Tea, through which users can connect with compassionate listeners for free. is also a go-to website that hosts many forums catering to a variety of audiences. 

3)     Be direct about stating what you can pay. Therapists often have pro bono slots in their practices, enabling them to see a percentage of their clients at no cost.

4)     Inquire about a payment plan. Patients whose financial circumstances have changed drastically may consider asking about a payment plan rather than abandoning therapy altogether. Therapists may accept a plan to receive a portion of their fees at time of treatment, with the balance to follow.

5)     Ask for a referral. Community mental health agencies offer therapy services at far more affordable rates. Local university clinics, where students in training provide low cost therapy, are another low cost option.


Between 1996 and 2010, prescription mental health medication fills rose from 150.3 million to 396.7 million. More than half of these prescriptions (207.9 million) were for antidepressants. In fact, between 2008 and 2010, prescriptions for antidepressants rose by more than 20 million. Prices for these medications fluctuate wildly. According to Consumer Reports Best Buy Drugs, retail prices for commonly prescribed antidepressants range from about $21 to more than $1,000 a month. The report also includes a list of common antidepressants, lists the average cost of a monthly prescription, and identifies whether a generic is available…

Clearhealthcosts offers seven strategies that consumers can follow to save on psychiatric medications. And watch for Part Five in this series, which focuses on Prescription Assistance Programs.

 1)     Compare costs at local pharmacies or at large discount stores: Prices for medication can vary greatly from pharmacy to pharmacy, and some offer discount cards, which carry savings of 10 to 25%. Large discount stores, such as Target and Wal-Mart, sell a 30-day supply of many generic drugs for $4.00. And Costco has a Member Prescription Program offering discounts on many prescription drugs. One great resource: here’s one of our blog posts with links to sites telling what pharmacies actually pay for medications. Online sites such as are useful tools for consumers to use to compare drug prices. A quick search for New York City rates for Seroquel, an antipsychotic drug used to treat bipolar disorder, found rates for the generic varying from $29 at Kmart to $208 at RiteAid – both of which required coupons that can be downloaded from the website. (We have heard frequently that coupons and discount cards do not always work at the named pharmacies, though.)

2)     Switch to a generic: For those who pay a flat co-pay for drugs, the co-pay is lower for generics… But — don’t always assume that a generic is cheaper, or that generic prices are uniform to all providers.

3)     Stick to the formulary: Drugs that are on an insurance plan’s formulary usually cost less than drugs that are not…

 4)     Shop online:  Online shopping is handy for patients who have chronic conditions and limited mobility, as the medications are mailed directly to them. Cost-savings vary, depending on the prescription, but they can sell for 35% or more off the regular price. When shopping online, look for the “VIPPS” seal – which stands for Verified Internet Pharmacy Practice Site. (WebMD has a list of signs that can help consumers ensure an online website is trustworthy.) Some well-known VIPPS pharmacy sites are:,, and

5)     Look for discount cards and coupons: A non-profit information resource devoted to helping people find affordable medications and reduce health care related costs, offers a drug discount card that can be downloaded from their website. While savings vary for prescription medications, they can be as high as 80%… NeedyMeds can also help patients find coupons, rebates and more offers of brand name medicine

6) Be cautious about discount cards and coupons; they may not actually deliver the benefits that they promise: Be a smart shopper. You might ask “What does it cost without the discount? And what does it cost with the discount?” Here’s a blog post with a video from a pharmacist telling how it looks from his end when he gets a discount card.

7. Other resources for buying prescriptions can be found on our “Prescriptions” page: It’s here, and it goes into great detail…

A lot of these options for saving money on mental health treatment will be familiar to regular readers of The Self-Pay Patient blog. I’ve reported on NeedyMeds* and GoodRx in the past, and also discussed the $4 generic offerings that most of the big-box pharmacies offer. And some of them are geared towards people with insurance, and therefore not applicable to all self-pay patients.

But there’s some new items as well, such as the flexible scheduling using online support groups during the week where there is no visit to the mental health provider.

There are a lot of other options for self-pay patients, as always I’m barely scratching the surface in any single blog post and will have to remember to get back to this topic more frequently. If this is an issue you are dealing with now, I highly recommend you click through on some of the links in the Clear Health Costs posts excerpted here for more information, and of course there are more options described in The Self-Pay Patient: Affordable Healthcare Choices in the Age of Obamacare.


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3 Responses to Mental health treatment and the self-pay patient

  1. Pingback: More mental health options for self-pay patients |

  2. I have no health insurance and I am in 200mlg of Zoloft and 2 mpg of cliazeepan daily for severe anxiety. My regular dr suggest I see a liscened phyciatrist due to my depression and anxiety. I moved to Florida 6 years ago and before that I did have health insurance but unfortunately I do not at the moment. I can’t get help from the state because they say my husband is slightly over the pay scale. I know I need a phyciatrist for many reasons. My dr suggested a self pay dr. I have been taking Zoloft for many years and have been hospitalized for my anxiety and other issues. Not in a mental institution but because of other health problems wound up in the hospital where Drs agreed I need to take anxiety medication daily. I can’t seem to think straight without it. I don’t sleep, I pace the floor all night and my mind wanders constantly to the point I can’t work. I want to get help so I can work again.and function normally and I know without medication it is impossible. I have a family history of both depression and anxiety and the last thing I want is to wind up getting rushed to the hospital once again with my anxiety. That has not happened since I started taking clonazapan. The 2 mpg help greatly balance me out. I take one in the morning and one at night along with my other meds. I’m praying it’s not to expensive for cash pay as I need to see a dr within the next few weeks. I have enough meds until then but like I said in the beginning my regular dr suggest I see a phyciatrist as well I do agree. I’m sorry for the length of this message but I was trying to explain my situation. Thankyou and have a nice day!

  3. I live in Port Saint Lucie Florida so I am looking for a dr in a 15-20 mile radius

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