How to ask your therapist about a sliding scale payment plan
by Nancy Uddin
March 1, 2024
Worrying about how you’re going to pay for the things you need in life can be stressful enough. But when you’re worried about how you’re going to afford your mental health care, which is often necessary to help cope with such stressors, it can sometimes feel doubly scary.
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Rates for a single session of therapy can vary a lot based on where you live, your insurance and whether your chosen provider is in network or out. For example, you could pay an in-network therapist a $20 copay or an out-of-network one more than $200 per hour. A survey by the National Alliance on Mental Illness found that people seeking mental health care often face much higher out-of-pocket costs than they do for other types of specialty medical care.
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Even more, there is a national shortage of qualified mental health professionals, even as demand for these services has surged. Many mental health providers opt out of insurance networks entirely, citing paltry reimbursement rates and a heavy administrative burden of being in these networks.
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But none of this means you should give up on getting therapy. Many providers offer sliding scale rates for patients who meet certain criteria.
What is a sliding scale payment plan?
A sliding scale payment plan is a reduced rate for services, with that rate being based on your economic needs, says Erica Cramer, a therapist at Cobb Psychotherapy in New York City. “People become therapists because they want to help others,” she points out. “That’s why many therapists account for sliding scale clients in their practice.”
Cramer says that therapists figure out how many clients they can afford to see at a reduced rate. “If you’re experiencing financial difficulties, it’s important to be honest with your therapist and tell them your concerns. Therapy shouldn’t make your life more stressful.”
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For people with insurance who are going to an in-network therapist, it may be harder to qualify for a sliding scale payment plan. However, it can still be possible. Cramer explains that every insurance policy is different, and that some clients will have a high deductible they’ll need to meet before their copay kicks in. “Depending on the particular situation, a therapist may be able to reduce a client’s session rate while they are [working toward] meeting their deductible,” she says.
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Even after you’ve met your deductible, however, your copay may still be pretty high. In these cases, a therapist might be able to offer a sliding scale rate that brings the copay amount down. For example, if you can’t afford to see your therapist weekly with an $85/session copay, a therapist may be able to offer you a reduced rate that you can afford. Or, if it’s clinically safe for you to switch from weekly to biweekly sessions, your therapist might also offer that as a solution.
How do you ask your therapist about paying with a sliding scale?
First, you have to recognize that there’s no way to know if your provider can see you on a sliding scale until you ask. That question can feel difficult and even a bit awkward, but you should know that these requests are far from unprecedented.
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“If a client is unable to afford the cost of sessions, either at the outset of starting treatment or later on during the therapeutic relationship, it’s recommended that you simply ask your provider if they are able to work on a sliding scale while explaining the reasons for the request,” says Dr. Dan Peters, a psychologist and executive director of the Summit Center in San Francisco and host of the Parent Footprint podcast.
In other words, chances are, you’re not the first person to bring this up. It can help to go in prepared with a simple script for what you plan to say. You can also ask your therapist outside of your session time so that you don’t spend valuable treatment minutes going over the particulars of your financial need. Email them ahead of time to let them know what you’d like to talk about, or call them on their office phone if that feels easier. Be specific and direct, something like “I can’t afford to pay over X amount for my sessions because of X reason. Since I feel our treatments are helping me, is there a way you can work with me on a sliding scale?” If you think you’ll only need a sliding scale for a brief length of time, say that, too.
Cramer says that if a therapist does give you a sliding scale treatment plan, it might impact the way you discuss your finances in your future sessions. The sliding scale might be a temporary arrangement due to certain circumstances, like if you’ve been laid off and lost your insurance coverage. Keeping an open dialogue about the subject will keep your therapist from feeling like they’re being taken advantage of.
My therapist won’t take a sliding scale payment — now what?
Even if your therapist can’t accommodate your financial need, asking for a sliding scale payment can open the door to finding a therapist who can. If a mental health professional isn’t able to keep treating you, they have an ethical obligation to refer you to someone else who can meet that need.
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“If your provider cannot reduce their fee or reduce it enough [to make it affordable for you], the next part of the conversation is developing a transition plan with your provider to continue care with another provider or organization that is financially accessible,” says Peters.