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July 10, 2024 17 mins

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Can affordable therapy really be within everyone’s reach? Join us as Dr. Tami and Harold tackle the critical issue of making mental health care accessible for individuals with low income. We start by demystifying the process of checking eligibility for insurance, highlighting how many might already qualify without knowing it. Dr. Tami shares her clinic's approach to sliding fee scales, ensuring that therapy costs are adjusted based on income and dependents. We also discuss state programs and human service centers that provide behavioral health services using similar sliding fee scales. Indigenous communities are not left out, as we shine a light on the invaluable resources offered by IHS facilities.

We don't stop there. We delve into the broader issue of mental health care accessibility, emphasizing the glaring disparities faced by many. The conversation underscores the importance of making quality mental health services, including evidence-based treatments, available to everyone regardless of their financial situation or insurance status. We call on clinicians to innovate and find ways to make essential services accessible. And, we invite our listeners to engage with us, share their questions, and suggest topics for future discussions. Prioritizing mental health is crucial, and this episode is jam-packed with insights on how to seek the best possible support on a budget.

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Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
The following is a series of candid conversations.
The content is intended forinformational purposes only and
is not a substitute for seekinghelp from a mental health care
professional.
To learn more info regardingadditional disclaimers, privacy
policies and terms andconditions, please visit
HelloDrTammycom.

Speaker 2 (00:24):
Bonjour, welcome to Psychologist Say, a podcast
where I talk about thepsychology of everyday living.
I'm your host, Dr Tammy, andI'm joined today by my co-host,
Harold.
How are you doing today, Harold?

Speaker 1 (00:36):
I'm doing great.
I'm doing great.

Speaker 2 (00:37):
Wonderful.
So, harold, let us know thatone of our listeners had a
question that was sent to us.
So what was the question,harold?

Speaker 1 (00:46):
He was wondering about how somebody who's low
income or you know, hasdifficulty paying for any kind
of therapy.
Like what are their avenues,what can they do to pay for
therapy?

Speaker 2 (01:00):
Right, great question .
So there are several differentoptions to think about and
really one thing is if they'rean individual has low income,
it's always good to check to seeif you do qualify for any type
of insurance.
Sometimes people assume thatmaybe because they're low income

(01:21):
that they can afford insurance,and so I always do say at least
do your homework in that areato see if there are some options
and if there's not, anothergood thing to do is look for
clinics that have a slidingscale fee scale fee.

(01:50):
So even, for example, my clinic, we offer this.

Speaker 1 (01:53):
And so this is something that will go based off
of your income.
Okay, so like what is it?

Speaker 2 (01:58):
So it's just based off of your annual income and
the number of dependents thatyou have in your home, and so,
whatever that is, then you'recharged a percentage versus the
full fee of attending a session.

Speaker 1 (02:19):
Okay, so if a potential patient comes in with
documents of their income, theirdependents, you'll adjust your
own fee based on that, rightOkay?

Speaker 2 (02:30):
And one thing is not every clinic will do this, so
you want to find a clinic thatoffers a sliding scale fee.

Speaker 1 (02:39):
Okay, so this is nothing mandated.
You have to find a clinicthat's willing to work with you
in that way.

Speaker 2 (02:46):
Yeah, if you want to go to a private practice which
I'm a private practice, so manyprivate practices may not offer
this.
This is something that myclinic offers, and it's a way
this was the whole mission of myclinic was to make sure that
we're inclusive and that we canprovide therapy to everybody who

(03:07):
is in need of therapy.
And I mean, the reality is,when you are running a business,
you do have to be able tocharge.
So it is important you knowthat if there is insurance out
there that people can, that'salways a good route to go to try
to find that and then finding aclinic that offers that they're

(03:29):
able to work with you if you donot qualify for insurance but
you still want these services,and so usually that's what
clinics will require is to bringin some proof of income, and
then we're able to work throughthat, and if your income is at a
certain percentage and you kindof pick that percentage, then

(03:50):
you can qualify for discountedservices.

Speaker 1 (03:53):
So if you want to go to a private practice, you will
have to pay something.

Speaker 2 (03:59):
I imagine that most people will have some kind of
fee for yes, because it's abusiness.

Speaker 1 (04:06):
The purpose is to make money.

Speaker 2 (04:07):
Well, the purpose is to be able to provide services,
and that's the whole way theclinic runs.
It's a job, it's what they'redoing for income.
So there's other things tothink about.
There are state programs thatoffer human service centers.
There are state programs thatoffer human service centers.
So that's another area whereyou can look in your state and

(04:29):
find out what other humanservices at the Department of
Human Services and each areawill have a behavioral health
clinic where you're able toaccess services and they may do
the same thing.

Speaker 1 (04:46):
The sliding fee scale Okay, so even with public
options, there's going to besome kind of payment involved.

Speaker 2 (04:53):
Right, but they'll have that sliding fee.
Yeah, so nobody's paying insaneamounts of money, Right no,
it's more based off of what youcan afford, based off of your
income.

Speaker 1 (05:07):
Okay, so what if somebody came in and they have
no income?

Speaker 2 (05:11):
Oh, that's a good question.
Well, I think through the stateprograms they still that's part
of the program they get statefunds to be able to provide
these services.
So it would be the same thingbe able to provide these
services.
So it would be the same thinglike if you're an Indian country
and you're going to an IHS.
That would be another optionfor our Indigenous people who

(05:31):
are enrolled and they live in anarea near a behavioral health
facility.
That's another great option tothink about.
If you do not have the incomeand you will not get that bill,
so IHS will still bill insurancebut yet you're not stuck with
that co-pay.
But also, if you do not haveinsurance, you're still able to

(05:52):
get those behavioral healthservices.
So that's another great optionfor Indigenous people who are
listening to the podcast.
And we can still look for thosestate programs that are run.
There may be some nonprofitprograms that offer certain

(06:13):
discounts or they may havecertain grant funds that cover
therapy.
I think it depends on how manyresources you have in your area.

Speaker 1 (06:23):
Yeah.

Speaker 2 (06:24):
So here in our smaller rural community I'm not
aware of a nonprofit that offerssomething like that, but I
could imagine, yes, in largercommunities you may be able to
get services if you do not havemoney.
If it was through a nonprofitand they have it set up that way

(06:44):
.
If it was through a nonprofitand they have it set up that way
.
I'm glad you brought that upbecause it's really making me
think of there's probably evenmore ways than I was originally
thinking about.

Speaker 1 (06:52):
Mm-hmm.

Speaker 2 (06:54):
And the other one is looking online.
This has been an option whereyou can look at getting so many
sessions for like a flat rate,so that you know what you're
getting into.
The prices may vary, but thereare a lot of individuals who do
not have insurance who are goingthat route.
They're able to get like apackage deal for so many

(07:16):
sessions and they know exactlyhow much money they're going to
pay for these sessions, and sothat's another great option to
look and do your homework and tostart seeing what's out there.
I think people are going tofind there's a lot more than
they knew existed, especiallywith being able to do therapy

(07:37):
online.

Speaker 1 (07:38):
So are there any options?
In particular, you know about.

Speaker 2 (07:46):
I'm not sure of the name, but I think they're
advertised quite often onBetterHelpcom, maybe one, I
think.
Yeah, that is exactly what oneis called BetterHelp, and I'm
not trying to advertise.
But those are some of the areaswhere you're able to go in and

(08:07):
look for online therapy.
Look for affordable.
You know, in your internetsearch, look for affordable
therapy options.
Your internet search, look foraffordable therapy options.
I think there are supportgroups that you may be even able
to access, where that's notindividual therapy, it's not
therapy, but maybe somebody iswanting to seek support, you

(08:31):
know, looking for family support, looking.
Maybe they have a diagnosis andthey're looking for an online
support group for anxietydisorders.

Speaker 1 (08:42):
Where people can get together and kind of talk about
Chat virtual meetings.

Speaker 2 (08:48):
Those are the other options I think of.
How do we enhance and connectwith other people and get the
support we need?

Speaker 1 (08:55):
Yeah, At least they're not like if someone is
going through a difficult time,at least with those options
they're not alone.

Speaker 2 (09:01):
They don't feel alone .
Yeah, Right, and you knowthere's always crisis lines
where you're able to call in.
You know every state has them.
I believe ours in North Dakota,I think it's 988, a crisis line
.
Yes, 988, help is available.
Those are really good things,Like even if it's, it doesn't

(09:24):
mean you're starting therapy,but it means if I'm in a, in a
tough spot, I can dial thisnumber and and talk to somebody.

Speaker 1 (09:33):
Yeah, If things get really tough.

Speaker 2 (09:51):
If things get really tough.
Every state has these resources.
So those are good ways to sayhow do I maybe develop my own
mental health kind of toolkit?
Maybe you don't need it now,but maybe it's something that in
the moment you won't want tocreate, or maybe somebody in

(10:14):
your home or maybe a friendwould need some of these
resources.
So I think this I'm really gladour listener asked us this
question because it's a greatquestion and locally, like, what
I've done is I try to writegrants.
We try to do contracts withprograms, schools, communities

(10:41):
with programs, schoolscommunities where we can try to
help offer these servicesthrough contract as well.
So whenever you're providingcontract services, then you're
not billing insurance, you don'thave to deal with co-pays.
So there are a lot of thingslike that I think that I do as
an Indigenous clinic to try tohelp individuals get their needs
met.
Also, I have a grant right nowwhere we're able to provide some

(11:03):
therapy while I'm credentialingproviders for insurance.
So sometimes there may beoptions like that where clinics
are working and trying toprovide and get creative on ways
that they can give services.

Speaker 1 (11:20):
That sounds great.
So I guess I have a questionwith that pay scale.
Do you have an idea of what'sthe low end on that scale?
The sliding scale fee, thesliding scale fee, yes.

Speaker 2 (11:36):
So it's looking at different percentages, right,
and the family size, what yourcurrent income is.
So you have to be able toqualify.
If that's what they're using,they'll qualify for a certain
number of sometimes they do evendo a number of sessions at a

(11:57):
certain rate.
It can take what could be asession that could cost $100 or
$200, and it could take it downto like $45, various.

Speaker 1 (12:11):
I mean this really Everyone's situation will be a
little different.

Speaker 2 (12:13):
Everyone and depending on what service,
because every service has itsown fee.
Yeah, so that's one thing thatyou know as a private practice.
This is good to know for ourlisteners that if you are
self-paying and that's where youdon't have insurance and you

(12:33):
want to self-pay, that you gothrough, your provider gives you
a good faith estimate.
So that's another way to try tosay well, how expensive is this
going to be if I self-pay?
It's an estimate of here iswhat our sessions cost and
here's how many sessions I'mproposing that you have.

(12:55):
This is my treatment plan andhere's a good estimate of what
it will cost you before theyfully engage and start to get
those bills.

Speaker 1 (13:05):
So they'll lay out like an individual session cost
and maybe a total cost.
Yes, yep.

Speaker 2 (13:10):
Where it's like.
Well, this would be the cost ofour first visit.
If I don't do testing, I'mplanning on seeing you for six
sessions at this price persession.
So it's a good faith estimate.
So they know after you know.
In total, this is likely whatyou'll be paying out of pocket

(13:32):
if you self-pay.

Speaker 1 (13:33):
Right, but that's an estimate.

Speaker 2 (13:35):
That's an estimate, so that means like we didn't
anticipate that you may have hada crisis session.
And maybe you need more sessionsor well even if you needed more
, we would have to then again,you know, review that with them.
We wouldn't just say like, seeyou next week and it wasn't on,
you know.
So that's part of thattreatment planning where you
want to say, okay, uh, we're,we're rounding, you know, we're

(13:58):
at the almost, you know, in twosessions we're at the end of our
six and I think I would like tosee you four more times and
then again at this rate, youknow, you kind of just keep them
aware because that's where outof pocket, and I and that's
something I do, you know, rightaway when individuals say, well,
I'll just pay out of pocket,and I, even on the telephone, I

(14:21):
said, okay, well, let me like,let me go through what this
could cost you, just even overthe phone, and sometimes people
are surprised and they'rebacking off with, oh OK, wait,
hold on.

Speaker 1 (14:32):
Yeah, this could be expensive.

Speaker 2 (14:34):
Yes, so they may, and that's one you know that's a
downfall of all health care.
It is, it's pricey, it isexpensive.
Yep, so it's something.
These are.
This is really good questions,because we do.
You know, we want people to beable to engage in therapy and
it's really looking at beingcreative and finding what
resources can work with you.
Even talking to your providerabout it or your clinic, like

(14:59):
what we're doing now, it couldbe a really good way for me to
talk to somebody who wants tocome in and see me that I would
go through all these optionswith them, and even you may even
refer them to somewhere else ifyou know that it meets their
needs better.

Speaker 1 (15:17):
Yeah, I think this is a good one, because this is a
topic I don't think I ever heardin psychology before is how do
I pay for this Right?
And there's so many people,especially in our community,
that they just can't afford itand many can't.
They just don't have insurance,they just can't afford it, and
that's all over the nation.

Speaker 2 (15:40):
This is something that and it's one of the highest
need areas.
You know it's an area that isin such need and you know it
shouldn't be a privilege to havegood mental health care and
have quality providers and begetting the best, most
evidence-based treatment.

(16:00):
You know everything that we'retrying to do here at the clinic,
so I think this is really justbringing up a bigger
conversation, you know, for downthe road and looking at just
health care in general and beingable to take care of our needs
and that's for everybody.
You know that inclusivity ofeverybody should have access to

(16:24):
this, and that's where I'mhoping that more and more
clinicians get really creativeon how they can do that.
So, miigwech, thank you.
Great conversation, harold.
Thank you to our listener forbringing this question our way.
If you have any more questionsor topics for us, please don't

(16:46):
hesitate to go to our websiteand go to our link.
Send us a message and we'll behappy to try to do our best to
create a conversation about it.

Speaker 1 (16:58):
You can also send us a text message through Spotify.
There should be an optionwithin our episode menu screens.

Speaker 2 (17:06):
Beautiful Anything you want to leave with Harold.
Any thoughts for the listeners?

Speaker 1 (17:13):
Ask us more questions .
We'd love to hear them.

Speaker 2 (17:17):
Miigwech.
Ps Therapy can be veryexpensive, yet your mental
health is definitely somethingthat we believe is a priority.
Let's look at all the ways thatwe can help you find the right
setup for you.
You.
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