Insurance acceptance and cash pay rates for psychotherapy in the US.
Jane M ZhuAine HuntingtonSimon F HaederCourtney Benjamin WolkK John McConnellPublished in: Health affairs scholar (2024)
Cost and insurance coverage remain important barriers to mental health care, including psychotherapy and mental health counseling services ("psychotherapy"). While data are scant, psychotherapy services are often delivered in private practice settings, where providers frequently do not take insurance and instead rely on direct pay. In this cross-sectional analysis, we use a large national online directory of 175 083 psychotherapy providers to describe characteristics of private practice psychotherapy providers who accept and do not accept insurance, and assess self-reported private pay rates. Overall, about one-third of private practice psychotherapists did not accept insurance, with insurance acceptance varying substantially across states. We also found significant session rate differentials, with Medicaid rates being on average 40% lower than reported cash pay rates, which averaged $143.26 a session. Taken together, low insurance acceptance across a broad swath of mental health provider types means that access to care is disproportionately reliant on patients' ability to afford out-of-pocket payments-even when covered by insurance. While our findings are descriptive and may not be representative of all US psychotherapists, they add to scant existing knowledge about the cash pay market for an important mental health service that has experienced increased use and demand over time.
Keyphrases
- health insurance
- affordable care act
- mental health
- healthcare
- primary care
- cross sectional
- quality improvement
- borderline personality disorder
- end stage renal disease
- chronic kidney disease
- newly diagnosed
- human immunodeficiency virus
- palliative care
- social media
- mental illness
- high intensity
- machine learning
- artificial intelligence
- long term care
- hiv infected
- data analysis
- chronic pain
- patient reported outcomes