What is the Cost of Therapy in NYC?

The Big Picture.

During one of the biggest mental health and unemployment crises in modern history, the average cost of a 9-month course of therapy in New York City is $7,500. Consumers, many of whom often pay for sessions via credit card, are now more likely to incur debt to cover the costs of their mental health care costs. Nirvana Health is partnering with RIP Medical Debt to help eliminate patient healthcare debt.

How much does a therapy session cost?

The cost of mental health care is a significant, yet often overlooked, contributor to peoples’ medical debt. The average therapy session in New York City costs $194, according to Nirvana Health's internal data on over 5,500 clinicians. For the 9.6% of New Yorkers without insurance coverage, a typical 9-month treatment plan would cost roughly $7,500 before tax. For scale, treatment in New York City can eat up 12% of the median household income and cost three times the median monthly rent for a studio apartment.

For those lucky enough to have an insurance plan that covers a portion of mental health care, benefits may not kick in until after they hit their deductible, which can take months and cost thousands of dollars out of pocket. The average deductible of plans reviewed by Nirvana Health is $2,200, but the plans with the most affordable monthly premiums on the New York state insurance marketplace have deductibles over $4,000.

What is involved with insurance verification?

When billing staff receives your insurance card information and date of birth in our Simple Practice system, they will assist in establishing an expected cost of services with the practice. In some cases, insurance will cover 100% of the cost. More often, there will be a copayment (i.e., $20 per session), a cost share with the insurance plan. Another possibility is your insurance may have a deductible. This means that the initial $X cost for health services each plan year (usually January, June, or July, depending on your plan) is considered out of pocket. Some plans exclude mental health costs from the deductible.

What if I have primary and secondary insurance?

When you have two forms of health insurance coverage, your primary insurance pays the first portion of the claim up to your coverage limits. Your secondary insurance may pick up some or all of the remaining costs. For instance, if you have a hospitalization, the first plan may pay up to $20K (i.e. for a surgery visit). Then the secondary may pick up the remaining amount the secondary insurance allows.

However, you will still likely be responsible for some cost-sharing. For example, it’s a mistake to think your secondary insurance will kick in and cover the deductible attached to your primary insurance. Instead, you likely will be responsible for protecting the deductible.

You also may be responsible for copay and coinsurance fees.

It depends on more than that.

Looking for a therapist can be incredibly stressful, particularly in New York City. One of the most complex parts of the process is finding out how much you would pay out of pocket with your particular insurance plan.

It is sometimes hard to determine the cost of psychotherapy in NYC. First, look at the data for out-of-pocket expenses for therapy in NYC when you have no insurance. The latest data shows that treatment in NYC averages between $175 and 450 out of pocket. LSP offers a competitive $175-200 per session rate (with a sliding scale available).

What if you have insurance? At LSP, we try to eliminate the guesswork before matching you with a quality therapist. We currently have contracts with Aetna, Blue Cross Blue Shield, and Cigna.

With that said, here are some tips and terms you might expect to learn more about how insurance works when seeing a therapist:

For example, just because you have a Blue Cross Blue Shield plan doesn't necessarily mean you are covered. Some marketplace plans through Blue Cross Blue Shield do not cover therapy.

Allowed Amount - The highest amount insurance will cover (pay) for a service.

Benefit Period - When services are covered under your plan. It also defines when benefit maximums, deductibles, and coinsurance limits build up. It has a start and end date. It is often one calendar year for health insurance plans.

Example: You may have a plan with a benefit period of January 1 through December 31 that covers ten physical therapy visits. The 11th or more sessions will not be covered.

Coinsurance - A certain percent you must pay each benefit period after you have paid your deductible. This payment is for covered services only. You may still have to pay a copay.

Example: Your plan might cover 80 percent of your medical bill. You will have to pay the other 20 percent. The 20 percent is the coinsurance.

Coinsurance Limit (or Maximum) - The most you will pay in coinsurance costs during a benefit period.

Copayment (Copay) - The amount you pay to a healthcare provider when you receive services. Depending on your plan, you may have to pay a copay for each covered visit to your doctor. Not all plans have a copay.

Covered Charges - Charges for covered services that your health plan paid for. There may be a limit on covered charges if you receive services from providers outside your plan's network of providers.

Covered Person - Any person covered under the plan.

Deductible - The amount you pay for your healthcare services before your health insurer pays. Deductibles are based on your benefit period (typically a year at a time). Learn about deductibles here.

Example: If your plan has a $2,000 annual deductible, you will be expected to pay the first $2,000 toward your healthcare services. After you reach $2,000, your health insurer will cover the rest of the costs.

Dependent Coverage - Coverage for your dependents who qualify.

FSA (Flexible Spending Account) - An FSA is often set up through an employer plan. It lets you set aside pre-tax money for expected medical costs and dependent care. FSA funds must be used by the end of the term year. If you don't use it, it will be sent back to the employer. Check with your employer's Human Resources team.

HMO (Health Maintenance Organization) - Offers healthcare services only with specific HMO providers. Under an HMO plan, you might have to choose a primary care doctor. This doctor will be your main healthcare provider. The doctor will refer you to other HMO specialists when needed. Services from providers outside the HMO plan are hardly ever covered except for emergencies.

HSA (Health Savings Account) - An account lets you save for future medical costs. When deposited, money put in the account is not subject to federal income tax. Funds can build up and be used year to year. They are not required to be spent in a single year. HSAs must be paired with certain high-deductible health insurance plans (HDHP).

Medicare is a federal program for people 65 or older that pays for certain healthcare expenses.

Network Provider/In-network Provider - A healthcare provider part of a plan's network.

Out-of-pocket Cost - Cost you must pay. Out-of-pocket costs vary by plan, and each plan has a maximum out-of-pocket (MOOP) cost. Consult your program for more information.

PPO (Preferred Provider Organization) - A type of insurance plan that offers more extensive coverage for the services of healthcare providers who are part of the plan's network but still offers some range for providers not part of the plan's network. PPO plans offer more flexibility than HMO plans, but premiums tend to be higher.

If you are interested in finding the best therapist in NYC (for your needs) who accepts your insurance, feel free to complete the form HERE.