How Much Does OCD Therapy Cost?
Obsessive Compulsive Disorder (OCD) is a disorder marked by intrusive, disturbing, and highly unwanted thoughts and the rituals sufferers engage in as a way to regulate the anxiety these thoughts cause. It’s also one of the mental illnesses gaining traction in terms of recognizing its devastating toll. People are striving to better understand it and science is searching for solutions. Society is learning to view OCD for the monster it is instead of casting it off as an anal-retentive but not terribly troublesome quirk.
OCD is distressing and debilitating and it can feel like a high cost to pay for being born with, well, a brain. However, this cost doesn’t just exist in the metaphorical sense; OCD can be extraordinarily expensive due to treatment, medication, lost wages, co-occurring conditions, and the collateral damage the disorder causes.
In fact, research suggests that the financial burden of OCD can be much higher than the financial burden of depression. In one study, researchers discovered that those with OCD spent $25,666 on overall healthcare in the two years after their diagnosis. Those with depression, by comparison, spent $7,832, making the cost of OCD approximately three times more expensive.
There are several variables as to why this may be, including any co-existing physical disorders the OCD participants had that led to higher overall healthcare spending as well as the challenge of treating OCD due to the many ways it can manifest and the misunderstanding that runs rampant among laypeople and professionals alike.
Whatever the reason, those of us with OCD don’t need to look at a study to know how expensive the disorder is; we only need to look at our bank accounts. OCD can wreak havoc on health and wealth and everything in between.
So, let’s explore this a little more and dig into the reasons why OCD comes with such a hefty price tag.
The Importance of Finding the Right Provider
Finding the right provider is key to keeping your costs as low as possible; the wrong provider will waste your time and your money. But, while financial aspects are necessary considerations when looking for mental health care or any type of healthcare, basing your therapy on monetary factors alone is—at best—putting the cart before the horse and—at worst—potentially damaging to your well-being.
The reason for this lies in the fact that some therapists are treating OCD without proper training in OCD. They may know the basics and may be able to help people with the more common types (such as Contamination OCD) but fail to recognize or properly care for the less frequent manifestations. Or they may be unfamiliar with CBT, ACT, and ERP and opt to treat OCD with less effective modalities because they are the modalities they’re most educated in.
A non-expert provider is especially dangerous for people who have Harm OCD or Pedophilia OCD, as untrained therapists may jump to the incorrect conclusion that OCD intrusive thoughts represent fantasies or desires rather than unwanted intrusions that cause great stress, shame, and fear in the sufferer. Therapists treating OCD outside their wheelhouse have been known to report or threaten to report Harm OCD or Pedophilia OCD sufferers because they misunderstand the disease so dramatically.
The best way to avoid the above, and the subsequent trauma and drama it causes, is to avoid anyone who is not specifically trained in OCD. Being trained in general mental illness is not enough; you need to find a specialist.
Unfortunately, that may present an additional obstacle: Finding an OCD expert is so tricky because of the way mental health care tends to be set up. Often, clinicians treat mental illness as if it’s all one disease rather than acknowledging that bipolar disorder, schizophrenia, OCD, PTSD, and the like are individual diseases that require different knowledge, different treatments, and different medications. While mental illnesses might all involve the brain, the commonalities can end there.
In essence, going to a mental health clinician who is treating you outside their professional training is like going to an orthopedist who plans to replace your bum knee……and offers to perform a bonus triple bypass while you’re under anesthesia. In short, going to a physical health doctor who is treating you out of their area of expertise would require you to get a new doctor….or a great malpractice attorney.
Mental health care should be no different and yet it is; some mental health care clinicians assume a PHD or LPC means they’re qualified to treat all mental health conditions despite not having specific, issue-based training. This tends to happen a lot with OCD.
Unfairly, this puts pressure on the sufferer to sort through providers, sifting the true experts from the novices. It’s certainly not right that this responsibility lands on the OCD sufferer’s shoulders, but until OCD is totally understood by society and the mental health community, and until there are more rigid rules around who can treat individual mental health conditions, it’s reality.
Getting OCD Help Through Insurance
Due to the death and tragedy it brought, it’s difficult to find any silver lining in the COVID-19 Pandemic. But if we have to begrudgingly pay it a compliment, we can acknowledge the much-needed attention it brought to mental health. Not only did it shine a light on the need for mental health care and how common and debilitating mental health struggles are but it forced us to take note of the inequities perpetuated within the system; in far too many cases, therapy has been limited to the affluent who can afford the steep out-of-pocket expenses.
As a result of the above, more health insurance companies have stepped up to address the global mental health crisis. They’re now covering more mental health services, including telehealth, which has dramatically increased access to care by removing the barriers of transportation, childcare, and taking time off work to commute. Importantly, telehealth has removed the need to find a provider nearby; you can now see a provider halfway across the state with the help of technology and a wi-fi connection.
Despite the above, there is still an unwillingness to take insurance in a large portion of providers. While some don’t take insurance due to wanting to protect their patients’ confidentiality, many don’t take it because of the hassle it presents: Insurance companies are nothing if not bureaucratic businesses that seem to manufacture red tape in-house.
In California, for instance, it’s estimated that around 42% of providers don’t accept insurance; in other states, it may be higher. This anomaly is really only found in the mental health care industry; even psychiatrists, who are medical doctors, are far less likely to take insurance than medical doctors in other specialties. There may be a handful of cardiologists, orthopedists, dermatologists, primary care doctors, gastroenterologists, and other types of physical health doctors who only allow self-pay, but they’re the exception, not the norm. Not taking insurance, in the physical health world, means not having patients.
No matter where you live, finding a mental health provider who takes insurance and, specifically, your insurance, can be a challenge. But there is quite a bit of hope coming down the pike: As more people become willing and able to address their mental health challenges, the demand for providers will skyrocket in order to meet community needs. And many providers will have to take insurance or risk losing clients who simply can’t afford to pay them out of their own pockets.
The High-Deductible Caveat
So, you’ve found a provider who takes insurance and takes your insurance; everything should be affordable from here, right? Unfortunately, that’s not the case: Even OCD sufferers who find a provider who takes their HMO or PPO may not experience smooth sailing when it comes to their financial fallout. This is because of the popularity of high-deductible plans many insurance companies now offer to individuals and companies alike.
High-deductible plans focus heavily on preventative care and offer lower premiums in exchange for higher deductibles when you go to specialists and/or a doctor orders diagnostics. They’re a wonderful money-saving option….until you have a preexisting condition. Then they’re a slap in the face.
High-deductible plans tend to harm people with OCD just as they harm people with any chronic illness. Some deductible plans pay for visits to specialists without requiring the deductible to be met, reserving the deductible for diagnostic procedures like x-rays or EKGs. Other plans won’t pay for anything that’s not preventative until the deductible is met; these plans can be financial nightmares for those with OCD and any other mental illness because of the weekly therapy and intense treatment these diseases warrant.
If you have another health condition in addition to OCD, such as a heart condition or diabetes, then a high deductible might be easily met. You’ll likely meet your deductible due to imaging studies or lab tests, ultimately forcing your insurance company to pay for OCD treatment in full or at least a significant portion of it.
The kind of plan you end up with isn’t always in your control. If you’re on your company’s insurance, they may opt to go with a high-deductible insurance plan whether you like it or not. If you’re searching for your own insurance, the only plans offered may be high-deductible options, depending on the area where you live. If high-deductible plans are all that’s available and you’re in the market for insurance, the best thing you can do is opt for the one with the lowest deductible. This will increase your premiums but it still tends to save you money in the long run.
If you can choose a plan without a high deductible, that’s likely the best option. These are financially fairer for those with chronic conditions; a high-deductible plan, conversely, is only good insurance for those who never have to use insurance.
Getting OCD Care Without Insurance
It’s not always possible to use insurance for OCD treatment. Some providers don’t take insurance (as mentioned above) while others take it but only contract with a small number of insurance companies. Some OCD sufferers don’t have insurance because, like OCD treatment, health insurance is extraordinarily expensive. Some do have insurance but prefer not to use it because of high deductibles, high copays, or high co-insurance rates. Some have insurance through an obscure, uncommon company whose size limits the number of providers they can choose from. Others don’t opt to bill insurance because they don’t want Blue Cross butting in to their mental health.
If you don’t have or don’t want to use insurance, you’re not out of luck. Therapists, psychologists, and psychiatrists tend to offer lower rates to those who don’t use insurance than the rates offered to those who do. This is similar to physical healthcare—if you go in for a CT scan of your ankle, the hospital might charge your insurance company $2000. If you opt to self-pay, they may only charge you $700. If you have a high-deductible plan, going with the latter may save you money even though it’s out of pocket.
The best way to find out if a clinician is willing to offer lower rates if you sidestep insurance is to discuss their fees with them before you make an appointment or during the complimentary consultation call most clinicians offer.
The Cost of ERP Therapy
Exposure Response Prevention (ERP) therapy is considered the gold standard for OCD treatment. In this type of therapy, the OCD sufferer is asked to expose themselves (or become exposed organically) to their obsessive thoughts and then refrain from engaging in their anxiety-reducing compulsions or rituals.
For example, if you suffer from Contamination OCD, one of the most straightforward ERPs involves touching something that elicits feelings of germ-filled angst, such as a trash can or door handle, and then refraining from washing your hands.
On paper, ERPs sound simple but they’re extraordinarily hard for OCD sufferers to do, most potently in the beginning of treatment when not engaging in a ritual can cause anxiety to soar. It is this sky-rocketing distress that makes ERPs so hard……but it’s what makes them so effective, too. The more OCD sufferers engage in ERPs, the more they see that their thoughts are just thoughts, their anxiety is not based on actuality, and their OCD has no bearing on reality. This type of insight is the ultimate goal of OCD treatment.
Although ERP is so effective, it’s not always easy to find; as mentioned above, some therapists are treating OCD without expertise in it, which can leave them unfamiliar with ERP or how to properly facilitate a session. ERP may be quite expensive as well. While it’s impossible to know what a provider will charge unless they actually tell you, some ERP sessions can run $300 or more depending on location and the person offering their services. ERP is not a one-and-done thing, either; it takes several sessions to see results.
If you can’t afford to see an ERP provider because of their rates, going to someone in training might be a better option. Because they’re new to the modality, they don’t have a great deal of experience but their rates are generally worlds more affordable. They’re also supervised by seasoned clinicians well-versed in ERP, assuring you get the proper care and they follow the proper protocol.
The Cost of Inpatient OCD Treatment
Inpatient psychiatric care for OCD and other illnesses isn’t cheap; there are reports of short-term psychiatric stays costing tens of thousands of dollars. Fortunately, most insurance companies cover these costs, at least in part, but the high deductibles mentioned above and copays apply.
Not only that, but some insurance plans tend to cap just how frequently the patients they insure can stay in psychiatric facilities. Medicare, for example, limits people to 190 days per lifetime. Private US insurers may be prevented from doing this, however, due to a 2010 law that requires companies to offer mental health benefits on par with physical health benefits. While insurance companies were once notorious for ignoring mental health and offering lackluster benefits (if they offered benefits at all), the laws passed in the states over the past decade have changed care for the better.
The Cost of OCD Medication
About 70% of people with OCD will benefit from medication, although this is largely dictated by genetics and how genes metabolize drugs. One sliver of good news in a disorder that desperately needs something coming up roses is that OCD medication is generally not uber-expensive, particularly when compared to other medications (whether or not you’re not using insurance). This is truest when you’re empowered with the knowledge that allows you to avoid excess costs.
For example, one of the most financially-friendly things you can do in regard to OCD medication is to request generic medications rather than name brands. This can make hundreds of dollars of difference each month if you’re not going through your insurer. For instance, according to Healthline, Prozac can cost as much as $490 out-of-pocket a month; fluoxetine, the generic to Prozac, costs around $4. Similarly, Zoloft can cost $329 a month while its generic (sertraline) costs around $7, and Cymbala can cost $261 a month while its generic (duloxetine) costs around $10. Ordering a three-month supply rather than a 30-day supply may make the medications more affordable, too.
Another option is to sign up with GoodRx if you live in the United States. For 9.99/month GoodRx allows you to compare drug prices at more than 60,000 pharmacies across the nation. It gives you access to major discounts and coupons as well, which can dramatically cut a medication’s cost. The downside to GoodRx is that you can only use it without insurance.
Still, those with solid prescription benefits may opt to use GoodRx as an alternative because the self-pay prices are similar to co-pays but without the sticky red insurance tape. For example, if you have a prescription for Tramadol, which is sometimes used as an off-label OCD medication, and your insurance only charges you $1.75 for seven pills but dictates that you can only get a week’s supply at a time, you may opt to access your medications without their rules. Through GoodRx, you can fill a 30-day Tramadol prescription for $11.89, which is five dollars more expensive each month when compared to going through insurance, but it comes with way more convenience.
If the cost of medication is still too high, you’re on a unique medication that’s more expensive than the most commonly prescribed, or you’re taking several medications at once, many pharmacies offer patient assistance programs that help patients access their medication regardless of their abilities to pay in full.
The Cost of TMS Therapy
Transcranial Magnetic Stimulation (TMS) is a relatively new treatment for OCD. While it’s more typically used for major depressive disorder, it was approved by the FDA for obsessive compulsive disorder in 2018. Despite this, most US insurance companies don’t cover the cost, justifying this lack of coverage with the claim that TMS for OCD is still in its investigational stages. This leaves people who want TMS to self-pay, something that takes a huge financial commitment.
Although the cost of TMS varies depending on the provider, all signs lead us to one conclusion: It’s extremely expensive. Some providers charge approximately $12K while others charge as much as $16K.
It’s highly likely that insurance companies will cover TMS for OCD eventually; most presently cover it for major depressive disorder, something that took a while for insurers to allow. But until that happens, out-of-pocket TMS will be out-of-reach care for many OCD sufferers…..unless we win the lottery.
The Indirect Costs of OCD
When it comes to healthcare, we often think of the direct costs: The copays, the out-of-pocket expenses, the drugs that cost plenty of pretty pennies. But OCD comes with heaps of indirect costs as well, costing you money in ways you might not realize.
Regardless of the type of OCD you have, the disorder can be extraordinarily disabling, leading to lost wages, repeated tardiness, missed workdays, and lost productivity. People with severe OCD may be unable to join the workforce at all. Others may experience too much anxiety to pursue higher-paying jobs or seek promotions. Compulsions may get in the way of climbing the corporate ladder over and over again.
OCD, because it causes such chaos in the mind of the sufferer, can lead to other financially-costly habits, including substance use or smoking cigarettes and unhealthy lifestyle behaviors (including the failure to get a good night’s rest) that can increase the risks of physical health conditions and cost more money.
On the flip side, people with OCD may embrace natural health and self-care in an effort to help get their symptoms under control. This may lead them to buy supplements, sign up for yoga classes, join a gym, get massages, or buy self-help books, all things that add up cost-wise.
As it usually does, the subtype of OCD factors into indirect costs. Depending on what your obsessions are about, OCD can cost you in unique ways.
For example, if you have Contamination OCD, you may spend tons of money on cleaning supplies, bleach, Lysol, or professional cleaning services, hoping to keep your house as sterile and germ-free as possible. If you have Harm OCD, you may spend tons of money on gas, driving back and forth to make sure you haven’t hit a pedestrian or caused a fatal accident. If you have Relationship OCD, you may spend tons of money on romantic outings or gifts for your partner, hoping to keep the flame sparked. If you have Just Right OCD, you may spend tons of money on making sure things in your home are perfect, replacing your couch at the first sign of fading or getting new hardwood floors because one slat is warped. If you have Health Anxiety OCD, you may see doctors without cause and request expensive imaging tests you don’t need, hoping to rule out a physical illness your OCD has tricked you into believing you have.
Indirect costs usually don’t matter to people in the midst of an OCD cycle; when your anxiety spikes, checking is more important than your checkbook. Nonetheless, the spending adds up, both literally and metaphorically. In other words, engaging in compulsions always costs you in the long run.
Saving Money on OCD Treatment
Getting OCD symptoms under control may save you money in terms of indirect OCD costs but it’s harder to control the direct cost of care. In truth, healthcare is expensive and for those of us who need it, the odds are high that medical bills will always be a burden. Even so, there are things that may help you decrease costs as much as possible, including the following:
- Shop around for an insurance plan that has a low deductible or one that pays specialists without requiring that you meet the deductible first
- Go to a therapist who is an in-network provider for your insurance and one who specializes in OCD
- If you don’t have insurance or can’t find a provider who takes your insurance, go to one who determines fees based on a sliding scale
- If you can’t afford weekly therapy, consider going every other week or once a month
- Look into grants that allow OCD sufferers to find outpatient treatment without the applicable costs
- Join support groups that are offered either online or in person (while many support groups are free, some charge a fee (especially in-person groups); however, the fee is smaller than the cost of individual, one-on-one therapy)
- Consider alternatives to traditional therapy, such as online courses and self-help programs that teach you practical ways to manage OCD, arm you with applicable tools, and help you successfully engage in ERPs
- Join OCD pages on social media sites, such as Reddit or Facebook, to find support from people who suffer from the same subtype of OCD that you do, share practical tips, normalize your thoughts, and encourage each other to resist compulsions
- If you’re taking medication, ask your doctor to prescribe you generic versions of the drug and consider joining GoodRx for access to coupons, discounts, and lower prices
- Buy medications in 90-day supplies, which can cut costs by as much as 30%
- Shop around at different pharmacies—the prices of the exact same prescription can vary dramatically among pharmacies that are in close proximity to each other as well as those across town
- Talk to your pharmacy about a prescription assistance program if needed
- Engage in self-care practices that are free of charge (such as doing yoga in your living room or taking a hike in the woods); these activities won’t cure OCD but they can help make symptoms more manageable, thus decreasing the disorder’s financial burden
When all is said and done, the cost of healthcare, any healthcare, is steep and prices continue to rise. A large part of this is due to the aging population; as people live longer, they require more medical intervention. But part of it is also because science is finally giving mental health the attention it deserves; treatments, cures, and novel drugs are continuously in development with the goal of helping the matters of the mind.
OCD, in particular, is a monster with expensive tastes; having OCD can cost an arm and leg and leave us wanting to give it the middle finger. It does this through the price of direct care and indirect financial damage.
Naturally, OCD is the world’s biggest time-suck as well, with its complicated rituals and hours-long compulsions. Thus, from the medical bills to the idea that “time is money,” there’s no way around it: OCD simply costs us a fortune.