Ally pays only $15/session.
Ben pays the full session fee of $100/session for 4 sessions to meet his $400 deductible, and then pays $15/session.
Chris pays the full session fee of $100/session for 40 sessions to meet his $4,000 deductible, and then pays $15/session.
Let's look at some options to make therapy more affordable when you have a high deductible.
What is a sliding scale?
A sliding scale represents the range of fees a therapist typically charges per session.
For example, while a therapist's standard fee may be $150/session, they might list a sliding scale of $80 - $150. This means that they are willing to work flexibly within your budget and offer lower fees based on financial need.
Therapists typically list a lower limit in order to ensure they earn a livable annual salary. Likewise, while they may reserve a few sliding scale slots for clients who would not otherwise be able to seek therapy, these slots are typically limited; not all clients can pay the lowest limit fee at any given time.
When can I ask for it?
You can ask for a sliding scale at any time, but be aware that your request may be declined, depending on how many clients a therapist already has paying low fees.
You might ask about sliding scales on your initial call with a therapist if you know you have a high deductible. It's a good idea to think about your therapy budget and do some research ahead of time. You may want to look at what their standard fee is, as well as what other therapists in the area typically charge to get a sense of what you can reasonably ask.
You can also ask about a sliding scale if you've been seeing a therapist for a period of time and your insurance changes; they might be more likely to work within your budget if they already have an established relationship with you.
What are the pros and cons of sliding scales?
Bypassing insurance entirely ensures greater privacy; information about your sessions won't be reported to the insurance company, which means if you are on your parents' insurance, they won't find out, and future insurers won't have access to your therapy history.
You don't have to meet your deductible before paying reduced fees.
Depending on personal circumstances, some therapists can be very flexible with sliding scale fees.
Therapists typically have a limited number of sliding scale slots, so your request could be declined, or negotiated to more than you want to pay.
Sliding scale fees do not contribute to your deductible, so if you have major medical expenses later in the year, you will have higher upfront costs before your insurance coverage begins.
HSAs and FSAs
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are two ways employees can pay for health-related expenses, including copayments and coinsurances, through a tax-free account.
HSA and FSAs allow you to set aside funds for medical expenses while reducing your taxable income. In most cases, you receive a debit card for your account and use it to pay for qualifying expenses throughout the year. While you can’t enroll in both types of accounts, employers may offer the choice of both options.
HSAs allow you to contribute up to $3,450 per year, roll over unused balances to the next year, and transfer balances you as you change employment; however, there are eligibility requirements, such as having to be enrolled in a high-deductible health plan.
FSAs don't have eligibility requirements; however, they are capped at $2,650 and you forfeit any unused balances in a given year.
This great chart from Nerdwallet outlines the major differences between HSAs and FSAs: