What Is Sliding Scale Therapy: Do You Qualify?

By Toni Hoy

Updated September 10, 2019

Reviewer Wendy Boring-Bray, DBH, LPC

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Deciding to see a therapist to address your emotional problems and/or mental health concerns may be one of the most important decisions you will make in your lifetime. It is a hard-enough decision to make for many people without also having to worry about how they are going to pay for it. Yet, professional fees can be a burden if you do not have adequate income to pay them and keep your household running at the same time. Many people do not seek treatment because they cannot afford treatment and this is a big problem in our society. Even those with health insurance are having this problem because many do not cover mental health care at all. One solution offered by many counselors is sliding scale fee therapy. If you qualify, this type of fee structure can make it possible for you to get the help you need without making you bankrupt.

What Is Sliding Scale Therapy?

A sliding scale is a type of fee structure therapists sometimes use to give people with fewer resources a lower fee. In fact, the sliding scale fee is commonly used in many types of industries including legal service or dental care. It is not a "sale" or a "discount" that can change over time. The amount you pay goes by your income, period. The less income you bring in each month, the less you pay for your therapy sessions. The therapist sets up one sliding scale that is used for all of their patients. If you have enough money to pay the full cost of therapy, you will be billed at the therapist's standard fee. But, if you are facing financial challenges that decrease your ability to pay, you will be billed at a reduced fee. For example, in an office where the full price is $175 per hour, if you make less than $70,000 per year, your fees may be $75 per hour but if you make $120,000 per year, you may pay $100 per hour.

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Does Everyone Get the Same Level of Care?

The sliding scale is just a way of determining how you pay. In most cases, the therapist's office personnel will apply the scale to your situation and take care of the paperwork. Whether you pay the full cost of your sessions or a reduced fee, the therapist gives you the same high-quality care. They make no difference in the way they treat you or the time they spend in each session. In fact, most therapists do not even know who pays what. Their billing is done by the accounting personnel rather than the therapist.

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Do You Qualify?

If you feel you cannot pay the full price, you can present your income information and number of dependents. Deciding how much you will pay is a very straightforward process for the therapist's office staff. If you meet the criteria, you will pay lower fees based on your level of need. The amount you pay is usually adjusted by the United States Federal Poverty Guidelines and the usual and customary fee for mental health in the geographical area where you live.

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What about Insurance?

Sliding scales are designed for people who are paying for the service themselves rather than those who are paying through an insurance company. You do not typically get a reduced fee for your copays or deductibles. Unfortunately, many insurance companies do not cover most mental health care anyway or they only cover a small percentage. In many cases, it is cheaper for you to pay out of pocket with a sliding scale fee rather than using your health insurance.

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Making Sure You Know the Rules

Not every sliding scale has the same rules. Some may require you to verify income with a pay stub. Others may take your word for your income. Some require that you notify the office within a certain amount of time if your financial situation changes. The rules should be listed on an agreement that you sign with the therapist or their staff. You should always be very careful to read the agreement before signing anything and if you have any questions, be sure to ask them to clarify. If you do not qualify for the low fees you would prefer to pay, there are other mental health resources, such as a community mental health clinics and online therapy.

Why is Online Therapy Cheaper?

While seeing a therapist face to face may be the more traditional way to have therapy, it is also more expensive. This is because the therapist has to pay for the building they are in, utilities for that building, salaries for employees, business and office supplies, and some even have to pay for health insurance for employees. Not only that, but they also have to spend money on transportation to get back and forth to work. Online therapy is so much cheaper because the therapist can work from anywhere so they do not have to pay for all that overhead such as rent, utilities, and travel expenses. The therapist does not have to pay employees in most cases and there is the added benefit of time saved because you and your therapist can "see" each other when you have time.

Does Online Therapy Work?

The therapy you get online is the same as you would get in a more traditional setting. In fact, this type of therapy may be even more effective because it is so convenient for both of you. Those who have depression or anxiety disorders may find online therapy even more beneficial because they have a hard time going out in public sometimes. With depression, you may not even feel like getting out of bed so how are you supposed to get dressed and go to an appointment with a therapist? This is another reason why many people with mental health disorders do not get help. The added stress of looking for a therapist, setting an appointment, and actually making it to that appointment is enough to make many individuals change their mind about going. With online therapy, all you have to do is get on your smartphone or other electronic device and you can do that from anywhere.

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Other Choices

There are other options as well. Some of these include group therapy, schools, teaching hospitals, employee programs, and chat rooms.

  • Group therapy: One option is group therapy, which can be found in many areas at local churches or community centers. Most of the time, the sessions are free or very low cost and you would meet with a group of people and a therapist or clergy who mediates the session. The therapist does not usually give you individual care but will help keep the conversation going and under control.
  • Schools or teaching hospitals: You may also be able to get counseling from a local school or teaching hospital. If you are a student, you should be able to get counseling from your school at no charge. Teaching hospitals and clinics usually offer free or low-cost therapy in a teaching situation where you would be seeing both the therapist and an intern who is learning similar to on the job training.
  • Employer assistance programs: Some employers offer employee assistance programs that may have free or low cost mental health care. This is usually separate from your health insurance and is a setup to help employees deal with life issues like divorce, grief, and other major problems.

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Online Chat Rooms

There are also online chat rooms where you can talk to others who have similar issues. You will be able to anonymously chat online with others who want to share their experiences and offer help to those that need it. Some people do not like the idea of talking to random strangers about their problems but others like this better than talking to a therapist. There is something freeing about chatting with people who have no idea who you are and cannot see you.

Of course, there are downfalls to this as well. Without a therapist or other professional to mediate, things can be unorthodox so you have to be prepared. But, all you have to do is click one button to get out of that room when you want to. And there are a lot of different chat rooms. Some are specifically for certain subjects like depression or anxiety but others are just general. The best part is that they are all free of charge.

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