If you’re reading this, then you already know that mental health care is essential. Yet, navigating insurance to access it is an uphill battle, especially when seeking a clinical psychologist. Of the non-physician medical providers, clinical psychologists have the most lengthy and rigorous training, and as a result charge the most for their time.
However, insurance reimbursement rates are typically far below standard fees for clinical psychologists, resulting in most psychologists deciding not to participate as in-network providers. For example, psychologists in the Newport Beach area charge $250-350 per session, whereas insurance may reimburse an in-network provider for less than half that amount. For clients to see an out of network psychologist, they may get reimbursed less than $100 per session, leaving them to pay over $200 per session. This differential underscores why so many individuals are unable to receive necessary care.
Barriers to Finding Any Therapist
Locating an in-network therapist is frustrating and often impossible to achieve. While California requires in-network providers to offer appointments within 10 business days, many listed on insurance directories are unavailable, a well-studied phenomenon known as “ghost networks.” Moreover, most in-network options are either master's-level therapists or relatively newly-licensed ones, which may not align with every client's needs for specialized care. Lastly, don’t expect that therapist to be practicing near you, or to have an office. Virtual care is the norm for in-network therapist care.
Affordable Alternatives with Trade-Offs
Platforms like Alma and Headway offer an alternative, negotiating better rates from insurance companies. These arrangements allow some clinical psychologists to accept a limited number of reduced-rate clients, often at fees about 50% of their private rates. However, psychologists can only offer a few slots at these rates, so availability remains limited. Another option is available to people with a health savings account (HSA) as the cost of out of network care can be reimbursed out of the HSA.
Psychological and Neuropsychological Testing: An Added Challenge
Psychological and neuropsychological testing presents its own set of hurdles. These evaluations, often essential for diagnosing conditions like ADHD or Autism Spectrum Disorder in high-functioning adults, typically require preauthorization from insurance companies. Even when approved, reimbursement rates remain low. Insurance companies frequently deny coverage, claiming the testing is not medically necessary. In practice, expect psychological and neuropsychological testing to be provided only by an out-of-network psychologist.
The Path to Advocacy
Clients have the option in California to ask their insurance company to cover the full out-of-network fee when in-network care is inaccessible. This process requires patience and persistence, but it can make quality care more attainable. For additional help, platforms like the DMHC Help Center provide resources for navigating California insurance challenges and ensuring timely care. The DMHC Help Center also is the place to file formal complaints with the state.
Balancing Skepticism with Hope
While the system has flaws, the drive to generate accessible, quality mental health care is strong. Advocacy organizations like the California Psychological Association and American Psychological Association continue their efforts. For many people, virtual care by a master's level therapist will be more than sufficient and effective. If you are unable to find a clinical psychologist on Headway or on Alma, don’t be afraid to ask an out of network psychologist if they offer a sliding scale. They usually do. If they tell you they lack low-fee availability, ask when they think this might change. Ultimately, persistence in seeking help can lead to the support and resources needed for your mental well-being.
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