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Decoding the Forms of Payment Therapists Accept

Decoding the Forms of Payment Therapists Accept

It may seem obvious that you have to pay for goods and services, but when it comes to medical care or psychotherapy, it’s not that simple at all. Therapists have many different options for payment, most you will likely already know, but there may be a few things in here that are new to you. Take some time to review payment methods that therapists accept, so that you know all the options you have. It might make things more affordable to you in the long-term.

Private pay. Private pay means you are paying out of pocket yourself. This is just a straight fee for service, no insurance, no discounts. Therapists will usually take cash and checks. Many are able to take credit cards as a form of payment, but discuss that with them first. Credit cards are easier to use today than ever, but not everyone has made the decision to understand how to do it or to accept them.

Health savings accounts. Some employers are offering health savings accounts to their employees. A health savings account (HSA) is a special account that takes money pre-tax out of your check and places it in an account with a credit card attached to it. This is to be used for healthcare expenses, and the benefit is that you do not pay taxes on the amount taken out of your check and placed into the HSA. This can be used for therapy, but check with your benefits provider and the therapist in question first. There are more rules for using it, and the therapist may not be set up to take them.

In network insurance

Insurance or third party coverage is when someone else is paying for the therapist. In network coverage means the insurance provider has a network of doctors, hospitals and therapists that have met certain criteria to become preferred healthcare options for that provider. The therapist has to be set up with the insurance provider to become in network. The benefit for you to use in network therapists is that they take your insurance, and will often cost you less since they are in network. Either way you will likely have a copay for each session. The amount of the copay will vary and check with your coverage to find out that amount. Your insurance provider can give you a list of in network therapists. 

Out of network insurance

If there is in network, then there is an out of network. Out of network means everyone else that has not signed up to be in that specific insurance company’s network of healthcare providers. It is not guaranteed that an insurance company will pay for an out of network therapist. 

What can happen is that a therapist can create what is called a superbill. A superbill is a form created by the therapist reflecting the services and charges for them. Clients will pay the therapist for treatment. Then the client can then send in the superbill to the insurance provider to try to get reimbursed for the services provided.

Other therapists will submit a claim on your behalf. They will try to be paid by the insurance company directly. The insurance company will then decide to honor the bill or reject the bill. They could also give a partial payment and leave you responsible for the rest. Always talk with your therapist about your responsibility when it comes to the bill for services so there are no surprises.

Sliding scale

A sliding scale means that the therapist will charge different fees for different people. This is typically discussed upfront, and should actually be done during that initial phone call for services. Sliding scales are typically based on income or ability to pay. The counselor will likely have a pre-set scale for how much they will charge people that make a certain amount of money. Be clear when you talk with the counselor about what is affordable for you.

Special eligibility

Special eligibility is a specific program that you may qualify for, and may open up new services that are low cost or free. Most of special eligibility programs require you qualify for them, or be disqualified from other services. One example would be if you do not meet criteria to be seen at the local community mental health program, you may be eligible for a low cost alternative at another facility. These special eligibility programs are set up differently, and vary from community to community. Most likely you will be referred to these programs directly, but ask the counselor you are talking with to see if there are any that may help you afford counseling you need.


Medicare and Medicaid are government run insurance options for the elderly, disabled, and those whose earnings are below a certain level. This is the social safety net to protect the most vulnerable in society. Therapists also can accept Medicare and Medicaid. This again requires the therapist to sign up to be a provider for them, so not every therapist will accept them as forms of payments. 

There are many different Medicare and Medicaid programs, so the amount they cover may be different. Please check with your benefits manager to find this out. And find out what counselors are in your area that take your particular plan.

This gives you an idea of some of the forms of payment that therapists accept. If payment is something that is a concern for you, discuss this with the therapist upfront. Learning what options you have, and how the therapist can work with you, will help you plan out your course of treatment. You have more options to pay than ever, and this will help you get the counseling and treatment you need.  

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Jason Simpkins
Posted on 08/24/2018 by Jason Simpkins

Jason Simpkins is a writer at Open Counseling. He is a clinical social worker in Michigan and is dedicated to having quality mental health care available to everyone. And as a University of Michigan graduate, he says a hearty, Go Blue!