Some therapists don’t think you have a right to know

Consumerism / By Daniel Sherer / March 4, 2022

Credit: Photo by cottonbro from Pexels

If someone tries to sell you something but can’t, or won’t, tell you how much it will cost… Should you be suspicious?

What if you went to your healthcare provider, had a nice long consultation, allowed them to perform any test their training and experience suggested and even prescribe medications but when asked for an estimate of how long the treatment might take, or how much it would cost, you were told “that’s not something I feel comfortable sharing with you?” Well, that’s exactly what some mental health providers want.

Now sure, some therapists are brand-new and haven’t got any experience helping patients on their own. So, maybe they are nervous that they couldn’t provide an accurate estimate. Or, maybe they will hem and haw and say something like “Every case is different.” or put the blame on the patient with “It really depends on how willing YOU are to be treated.” But the honest answer is probably closer to the admission by Linda Michaels (Co-Chair of the Psychotherapy Action Network). She revealed that “If people see a large dollar amount, they might be intimidated or scared into not getting help at all”. Ya think?

I’m an analytics-guy, so let’s do some math.

According to this story on NPR therapy costs vary from low numbers of $65/hour, up to $250/hour (although I’m sure some practitioners get MUCH more.) In my experience working with claims paid by major insurance companies, I’d say that $85/hour is not an uncommon amount, perhaps a bit on the low-side, for California. And let’s say your therapist recommends they see you once per week. That’s $4,420 per year. Not unreasonable for your mental health, especially if the patient can get some help with that from their insurance. So, why are therapists worried? Well, there’s this law called “The No Surprises Act” that not only helps shield patients from a practice known as “out of network billing” but it also REQUIRES a provider (hospital or doctor) to provide a “good faith estimate” that reveals how much they will charge and how long the treatment might take. If the doc miscalculates by more than $400, the patient may not have to pay… For some therapists, that’s scary as hell.

Treating mental health is not exactly like repairing a knee or performing a coronary bypass. For one thing, the treatment really will be impacted by the patient’s behavior. So, maybe one person can be helped in a matter of months while another might be in for a lifetime of treatments. Then again… performing a knee replacement or heart surgery are ALSO subject to the patient’s willingness and ability to be treated. If you are told to “stay off that knee for the next week” but you try to go for a walk, well then, your doctor’s initial estimate of the duration of treatment is out the window (and it’s all your fault!)

So, back to my earlier price estimate.

If the therapist knows that you will likely need treatment for several years (if not the rest of your life) and they share that fact with you and say “This is going to cost at least $4,420 per year, for the first year and I expect my rates to increase by X%/year over the next TWENTY years, so your actual cost of treatment could easily be $100,000. Should I pencil you in for every Thursday? How about 10:30am?” Would you pause? Should you pause? Therapists think “NO!” They, rightly, think that many people can be helped with psychotherapy and counseling. But the quiet part, that they don’t want to say out loud is: “I’m just ONE of the 100,000 licensed psychologists in the US. I don’t want you asking for hard statistics about my success rate or, God Forbid, comparing my efficacy rates to other providers in the local area!” #PriceTransparency.

Bottom line?

You deserve the best outcome possible for YOU. That doesn’t always mean it’s the “cheapest” but simply charging more hasn’t been linked by reputable studies to the “best outcomes.” In other forms of healthcare, we use “quality scores” to objectively (and also some subjective scores) to rate the performance of medical practitioners. How often do they kill their patients? (hopefully never). How often do they leave a sponge or instrument inside? Do their patients suffer from infections? How often do they need to be re-admitted so the surgery can be repeated? And, thankfully, softer metrics like “How do you feel you were treated by Dr. X?” and “On a scale of 1 to 5, how would you rate the treatment you received?”. These are just a few, general examples of real-world quality metrics. What are the metrics YOUR prospective therapist can share? Are other therapists working in the city where you live? What are THEIR quality scores? How often do their patients suffer adverse outcomes? What are the “risk scores” of their patients?

TL/DR: in healthcare, as with other major purchases, you have a right to know, IN ADVANCE, how much it might cost, how qualified the provider is and what their outcomes usually are. If they say “If you have to ask, you can’t afford it.” or “How can you put a price on your health?” then they might be about to sell you some snake-oil...

Endnotes

NPR, “Therapists say a new law requiring upfront cost estimates could discourage patients”, Feb 3, 2022 https://www.npr.org/sections/health-shots/2022/02/03/1077781031/therapists-say-a-new-law-requiring-upfront-cost-estimates-could-discourage-patie
A Risk Score is a method of grouping patients by the severity of their illness and other conditions. A pediatric podiatrist (children’s foot doctor) may never see a patient with coronary artery disease (CAD) and therefore NEVER have a patient die from a heart attack. Conversely, a psychotherapist who specializes it treating the criminally insane might have a higher number of patients who re-offend or even commit suicide than a High School counselor. We don’t use the same metrics to compare podiatrists with thoracic surgeons, and we shouldn’t use a single metric to compare therapists, but we ABSOLUTELY SHOULD use appropriate metrics and compare them.