Understanding Sliding Scale Therapy

Medically reviewed by Elizabeth Erban, LMFT, IMH-E
Updated May 24, 2024by BetterHelp Editorial Team

Have you been experiencing mental health concerns but questioning if therapy services are affordable? If so, you're not alone. Not everyone can easily manage therapy costs, which is why many therapists now offer sliding-scale therapy work and sliding-scale fees. Deciding to see a licensed therapist to address your mental health concerns may be one of the most critical decisions you ever make, and session fees don't have to be a barrier to getting help. You can learn more about a therapist’s options and negotiate a set amount for sessions by connecting with sliding-scale therapists in your area or online.

What is sliding scale therapy?

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A sliding scale is a type of fee structure therapists sometimes use to offer people with fewer resources reduced fees. The sliding scale many therapists use is also commonly employed in various industries, including legal services and primary care clinics. By considering a customer’s ability to pay based on their overall income, professionals can make their services more readily available to those in need.

Affordable sliding-scale therapy is not a "sale" or a "discount" on regular rates that can change over time. The amount you pay for sliding scale therapy is calculated by your income. The less income you bring in each month, the less you pay in fees for your therapy session. This method can help ensure that such fees are fair and reasonable. 

The therapist sets up one sliding fee scale that is used for any client, whether they’re an insured patient or someone seeking financial assistance. If you have enough resources to cover the full therapy cost, you will be billed at the therapist's standard session fee. If you're underinsured or facing financial challenges that hinder your ability to pay, you'll be provided the option to pay a reduced rate. For example, in a one-on-one practice where the full price is $175 per hour or per session, if you make less than the poverty threshold of $50,000 per year, your fees may be $75 per hour, but if you have an annual income of $120,000 per year, you may pay the full price per session.

These numbers, or the set fees, take into account the client's pay as well as the therapist's salary. Sliding scales, of course, can vary for each one-on-one practice, but in the U.S., they are usually dictated by the Federal Poverty Guidelines and the Bureau of Primary Healthcare, a United States department within the Human Services & Resources Administration (HSRA).

Sliding scale rates

The sliding scale rates are a reasonable request for determining how much you pay for your chosen therapy options. In most cases, the in-network therapist's office personnel will apply the scale to your situation and take care of the paperwork to provide affordable counseling services for you and/or your family once you pay the minimum fee.

Whether you pay the full cost of your sessions or a reduced fee, the providers at your chosen therapy center follow ethical guidelines to give you the same standard of high-quality care as clients who pay full price. They make no difference in the way they treat you or the time they spend in pro bono sessions. Many therapists who offer sliding scale rates do not even know who benefits from the financial break. The sliding scales and billing are often handled by the accounting personnel of the one-on-one practice rather than the mental health professionals themselves.

Sliding scale fees are not unique to mental health services; many healthcare providers and educational institutions offer a reduced rate or different rates for their services. Doctors may also offer sliding-scale consultations if you require a mental health referral from your primary care provider. Sliding scale consultations can also be used for services like measuring blood sugar content, getting insulin therapy, receiving intensive insulin consultation, and blood glucose support. Talk to your primary care provider to learn more about affording these types of services.

Do you qualify for sliding scale therapy?

If you feel you can't pay the full price, you can present your income information and number of dependents to a provider who can offer sliding scale rates. Determining how much you'll pay is a straightforward process for the therapist's office staff. If you meet the sliding fee scale criteria to receive affordable therapy, you'll pay reduced rates or lower fees based on your level of need. To receive this option, you must find a provider to offer a sliding scale option, as some providers do not offer one.

Sliding scales are designed for people who are paying for the service themselves directly to a one-on-one practice, therapy center, social worker, or other mental health professional rather than those who are paying through an insurance company. With those who offer sliding scale fees, you don't typically get a reduced fee for your copays or deductibles. Also, even though a practice may accept insurance, many insurance companies do not cover most mental health care, or they only cover a small percentage. In many cases, it's less expensive to pay out of pocket with a sliding scale fee than to use your health insurance.

Guidelines of sliding scale therapy 

Not every practice with a sliding fee scale has the same rules or code of conduct. A sliding scale may require you to verify income with a pay stub to prevent insurance fraud. Others may take your word for your income and set sliding scale fees based on that. Some require that you notify the office within a certain amount of time if your financial situation changes. The sliding scale rules, which determine how sliding scales work in that specific practice, may be listed on an agreement that you sign with the therapist or their staff. If you don't qualify for the low fees, there are other mental health resources, such as community mental health clinics and online therapy platforms.

Online counseling

While seeing a therapist face-to-face at a one-on-one practice may be the more traditional way to have counseling, it tends to be more expensive. The therapist must pay for the building they are in, utilities for that building, salaries for employees, business and office supplies, and possibly even insurance for employees. They also have to spend money on transportation to get back and forth to work. Nowadays, many therapists choose to practice remotely because of the benefits it offers them and their clients, promoting a fair trade between services and expenses.

Online therapy has been proven to be just as effective as in-person therapy, offering a wider range of flexibility and availability. In addition, it may save both you and the therapist time because you can see each other whenever you're free. While many online therapy platforms don’t accept insurance, they tend to offer affordable monthly subscription plans. Some platforms, such as BetterHelp, offer financial aid to those who qualify.

This new flexible form of online counseling breaks the barriers of typical Monday through Friday appointment times and allows clients and therapists to connect on their own time. Getting started with affordable online therapy is as easy as completing a quick registration process, providing contact information, and selecting a therapist that meets your needs. Payment plans are usually based on a subscription model, allowing more people to afford essential therapy.

The individual therapy and counseling services you get online, often provided by participants of the American Counseling Association, are the same as you would get in a more traditional setting. This type of therapy may be especially helpful for individuals experiencing social anxiety or depression, as they don't have to sit in a waiting room or interact with anyone but the therapist. To find sliding scale therapy or free sessions, you can search online platforms or contact local mental health providers.

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Alternative support options

In addition to individual therapy sessions, there are other options that offer mental health support. Some include therapy at community centers, schools, teaching hospitals, employee programs, and chat rooms.

  • Group therapy: One of the most popular therapy types 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 member who moderates the session. The therapist does not usually give you individual care but may help keep the conversation focused.
  • Schools or teaching hospitals: You may also be able to get counseling from a local school or teaching hospital. If you're a student, you should be able to get free sessions from your school. Teaching hospitals and clinics usually offer free therapy or low-cost counseling in a teaching situation where you'd be seeing both the therapist and an intern who is receiving training through continuing education courses. Not everyone may be eligible for these services, as they may have a limited number of slots available.
  • 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 resource to help employees manage life challenges like divorce, grief, and other major problems.
  • Online chat rooms: There are also online chat rooms where you can talk to others who have similar concerns. You can innominately chat online with others who want to open up about their experiences and offer help to those who need it.

Although chat rooms can provide support, they have some potential downfalls. Without a therapist to facilitate communication, the process can be unorthodox. It is different from going to a therapist personally, wherein you'll get to see the therapy room design and experience the entire interaction face-to-face. However, all you must do is click one button to get out of that room, and there are a lot of options. Some chat rooms are specifically designed for certain subjects like depression or anxiety, while others are more general.

It's important to note that therapy and chat rooms are intended for non-emergency situations only. Visit your nearest emergency room if your issue is an emergency or you're facing a life-threatening situation.

If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.

If you are experiencing anxiety, depression, or other mental health concerns and don’t know if you can afford therapy, you are not alone. Whether you find a therapist who will work with you on a sliding scale or you choose affordable online therapy at BetterHelp, you can get the support you need. Take the first step and contact BetterHelp when you're ready to start treatment.
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