Why Most Sex Therapists Don’t Take Insurance and What You Need to Know
Sex therapy is great. It can help you identify and get past sexual shame, guilt, and hang-ups that are affecting your sex drive and low libido. It can help you communicate better, boost connection, and have better sex that’s more satisfying, pleasurable, and stress-free.
It’s a great service, though when looking for providers you may notice a lot don’t take insurance. This can be confusing and frustrating. The act of finding a therapist you like can be a daunting task alone because so there are so many out there. And when you factor in wanting to find a therapist with a sex therapy specialty, it can be even more overwhelming. Some people start this process by looking at who’s in-network, but that’s not always the most helpful. This is because many sex therapists are out-of-network providers and may not show up in that search. I’m here to tell you about the real reasons sex therapists don’t take insurance (and some may surprise you).
7 Reasons Sex Therapists Don’t Take Insurance:
Lack of coverage for sex therapy services
Sex therapy services aren’t typically covered by insurance companies. Maybe it’s seen as a luxury service and they prefer to offer coverage for more severe mental health issues? Who knows. I’m just speculating. Regardless of the reason, it communicates a lack of understanding of how important this area is in our lives. Experiencing a lack of connection, sexual pain, stressful sex, low libido, and overall disconnection are significant issues. Anyone who’s ever experienced an issue with their sex drive can tell you just how much of an impact this can have on their day-to-day functioning. And if insurance companies aren’t going to reimburse for these services, sex therapists aren’t going to be in-network with them.
Less confidentiality
While using your benefits may help you save some money, it opens up your insurance company to request your records at any time. This can be an added layer of stress during sex therapy since you’ll typically be discussing things about your sex life that you may not want others to know. Just knowing this information makes it into your record, and knowing others can request access to these, can be a big stressor for clients. This can affect how comfortable and open someone is in the session, which greatly affects progress and outcomes. This, paired with the importance of knowing your information remains as confidential as possible, is why many sex therapists forgo working with insurance panels.
Pro-tip on out-of-network (OON) sex therapists: If you’re seeing an OON provider and submit a superbill (i.e. receipt) to your insurance to reimburse you for the cost of the session, they can still request records. Most people think if they’re seeing an OON provider, their insurance company can’t have access to records. When you submit a superbill, they can request documentation because they’re now involved in the payment process. As soon as this happens, they have a right to see records to justify treatment, and therefore payment.
Treatment restrictions
It can be a long, difficult process for providers to even get credentialed with an insurance company. And that’s only the first step. Once in-network, insurance companies can be overly involved in treatment, which can lead sex therapists to feel restricted in the type of services they provide. For example, some plans will only cover a certain number of sessions, and if treatment exceeds that, the provider may not receive payment. For someone who is working on their desire and sex drive, this work can take time. Knowing there’s a set number of sessions can cause feelings of pressure to progress quickly, and this impacts progress. Some insurance companies have strict time expectations and won’t reimburse for ongoing sessions longer than 60 minutes, despite longer sessions being clinically useful for some clients. Basically, it takes the power away from the sex therapist to provide you with what they believe to be the best service for your individual needs.
Diagnosis requirements
Most insurance companies require a mental health diagnosis for them to reimburse claims. On top of that, they’ll reimburse for some diagnoses, and others they won’t pay for at all. Typically, most sex therapy diagnoses aren’t covered. This can be tricky for sex therapists because people seeking these services don’t always meet the criteria for an approved mental health diagnosis covered by the insurance company. This leaves the sex therapist giving a diagnosis that doesn’t fit so insurance will pay, having to stop services, or providing services and not getting paid. None are great options.
Low reimbursement rates
Therapists only get a portion of what they bill for services through insurance and some of these rates are insulting low. Especially when factoring in all the education, supervised experience, and training required for therapists. This leads to therapists having to maintain large caseloads to ensure adequate pay, which can quickly lead to burnout. This is a crappy situation for the sex therapist, as their passion for helping you with desire and sex drive has now turned into something stressful and draining. But it’s also not fair to you. Because burnout leads therapists to provide sub-optimal services which affect your progress and outcomes in the end.
Lengthy reimbursement process
It can take months once submitting a claim to receive reimbursement. This not only makes it difficult to manage payments and finances, but sometimes insurance companies will reject claims or ask for further information. While this is a pretty standard practice, it can be frustrating and time-consuming to go through this process months after the session was held. This can lead to extra work, stress, and even more burnout for therapists. This is the opposite of what you want because if your sex therapist isn’t at their best, they’re not going to be providing as high of quality services as you deserve.
Telehealth restrictions
Telehealth is a great option for sex therapy. It allows you more flexibility to find a great sex therapist and not be limited to who’s in your geographical region. However, some insurance plans have different coverage for telehealth and in-person services. They may reimburse telehealth sessions at a lower rate than in-person, cover fewer sessions, or may not cover this service at all. This can restrict sex therapists’ ability to provide you with this service.
Sex Therapy Fees
The most important thing you can do in this process is find a sex therapist who’s a good fit for you. This may seem foreign, but it can be helpful to prioritize comfort and fit first, and fees second. Because the thing about sex therapy is: the best outcomes come from the therapeutic relationship you have with your therapist. If you prioritize spending less and end up with a therapist who isn’t a good fit, the process can be longer, harder, and more frustrating. Even spending $20 on a copay for someone in-network is too much to spend on crappy therapy. And it may end up costing more in the long run because you won’t progress as well.
I recognize this may seem daunting, scary, or just plain backward. If you’re like most of us, you try to be conscious of your spending and make sure you’re making the best financial decisions possible. It can help to know more about why you’re investing the amount you are, what the fees are based on, and where this investment is going. Every practice is different, but I’m going to share some behind-the-scenes of my practice and what gets factored into fees.
7 Components Factored Into Sex Therapy Fees
Technology
Anyone who’s ever used technology knows it can be really great, until it isn’t. Being a telehealth-based sex therapy practice, it’s important I maintain technology that’s reliable, up to date, has a good connection/microphone/camera, and is a tool to aid us in feeling connected during our time together.
Electronic Health Record
In my practice, my EHR has many uses. It houses all your consent forms, documentation about your treatment, personal information, and is also the video platform used for all telehealth sex therapy and couples therapy sessions. Due to all the information stored here, and the importance of the platform for sessions, fees go to investing in an EHR that’s reliable, easy to navigate for clients, and HIPAA compliant.
Professional licenses
There are certain mandatory fees all therapists have to pay to maintain their license(s). Part of my therapy fees goes toward licensure renewals. This insuring I keep my licenses active and up to date so I can continue to provide awesome sex therapy services.
Education and training
Ongoing education and training are important to any good therapist. It’s important I continue to learn, grow, and hone my sex therapy and couples therapy skills over time. Without this, therapists can get stuck in a rut or provide the same services over and over, even if they’re not the best fit for clients. Continued training holds me accountable and ensures I keep gaining skills so I can be the best version of myself for my clients.
Professional memberships
Along with continued training, it’s important to stay up to date on what’s going on in the field. There’s always research being done on new techniques, better interventions with couples, more effective modes of treatment for sex therapy, and more that can help clients in different ways. By staying involved with other professionals and organizations, I can stay current on what’s going on in the field so I bring in the best interventions for clients. And by getting to know other professionals and their specialties, we’re able to network to help clients get synced up with a better fit provider earlier, so they can start making progress sooner.
Online platforms
I love the work I do and think it’s beneficial, but it’s not helpful for clients if they can’t find me. Part of my fees goes to online platforms to make this easier for clients. By being listed through different directories, platforms, and having a website, clients can more easily find me, read about my services, get a feel for what it would be like to work with me, and reach out right then and there if they think my sex therapy and couples therapy services would be beneficial.
Targeted caseload
As mentioned above, burnout for therapists is a very real, scary thing that can happen pretty easily. Since I love sex therapy and helping people with desire and sex drive, I want to ensure I’m providing a really good service and decrease my odds of burning out. Instead of working with dozens and dozens of clients, I focus on really intentional work with a smaller group of individuals and couples. This allows me to be more involved in the process with my clients, see them more often, and allows more focus and progress and what’s needed to ensure positive outcomes. This means I’m selective about the clients I work with because the fit between sex therapist and client is the most important predictor of outcomes. I wouldn’t want to make the process any harder and longer for someone who isn’t a good fit with my style or practice, so I’m diligent about pairing with individuals and couples who fit with my style and benefit from the types of services I provide.
It may feel foreign, but I’d encourage you to try shifting your thinking from how much you want to spend on this process to what you want to get out of it. Spending money on yourself, and especially your mental health, and double so to boost your desire and sex life, can be tough. But consider how different your life could be if you felt connected to others, understood and valued in your relationships, confident in your desire, had a great sex drive, and were having sex that you look forward to. The outcomes that can come from sex therapy with a great sex therapist can help make the investment well worth it.
And at the end of the day, if you have your heart set on using insurance benefits, there are a few things you can ask to help set you up for success when seeking a sex therapist. Call the number on the back of your insurance card and ask about the following: telehealth coverage, amount of deductible met this year (if applicable), your out-of-pocket maximum, your out-of-network coverage for mental health benefits, and the reimbursement process for superbills.
Free Sex Therapy call in Philadelphia, PA
If you’re interested in learning more about sex therapy and how to find the best sex therapist for you, click here and we can set up a 15 min phone chat. I’d be happy to learn more about your individual experiences and help you with the process. If you’re interested in individual sex therapy in Philadelphia or couples therapy in Philadelphia, you can read more about how I can help with both by clicking their links.
My specialties include low sex drive, differential desires, communication, managing sexual stress and pressure, and increasing connection.
