How do you find the money when therapy's not a luxury?

What therapies do you/your family need? How often do you go? What is covered and what is out of pocket?

None right now. At some point one our kids needed speech therapy weekly for about six months because of vocal polyps. We paid out of pocket.

—Brachi Silver

Baruch Hashem, no one needs therapy. We do go to nutritionists, which aren’t covered under insurance, and we pay anywhere from $150 to $250 a month.

—Heshy and Chanie Michaels

My husband and I are in weekly marital therapy, at a cost of $80/hour. One child is getting psychotherapy that is completely covered by his insurance. Another child is getting ABA therapy, CBT, speech, and OT — all of which is completely covered by his insurance, after we pay the $7,000 deductible…

—Miriam Y.

At the moment, psychotherapy and speech therapy. At one point we were also doing occupational therapy and vision therapy.

The psychotherapy is once every two weeks for one person. Another family member was also going twice a month, which moved to once a month, and is now on hold indefinitely. We’ve only begun speech therapy now, so we’re unsure what we’ll need. Our older kids who needed it went once a week. Most of the psychotherapy was covered by Medicare through mental health plans, and we paid maybe $20 out of pocket per session. Speech therapy here is incredibly expensive, though.

—Leah Lowy

One teenager goes to regular psychotherapy. When my kids were younger, I took them to occupational therapy, speech and other early intervention therapies, sometimes as much as every day, sometimes even twice a day. Most of those therapies were covered by insurance or by the state’s early intervention program, and I had no out of pocket costs.

—Baily W.

Various family members are in psychotherapy, usually once a week for different people. In the past, some kids needed OT and speech. Baruch Hashem, Medicaid covers it. Sometimes in the past we had to pay for therapy out of pocket because certain therapists didn’t take Medicaid, but it’s been a long time since then, and I don’t even remember how much it was anymore.

—Yechiel and Shifra Jacobson

One of our kids gets physical therapy and psychotherapy. Even with a top insurance, we pay over $100 per 45-minute session out of pocket. We’re always paying it off, but we feel it’s worth it. (We also pay a lot out of pocket for better, expensive pediatric dentists.) Hopefully one day it will all pay off.

As a family, we’re also very into naturopathic treatments and visit a chiropractor regularly. He doesn’t charge for a kid up to age 5 but after that it’s $45 per visit, always out of pocket.

—Chaim Stein

How much do you pay for health insurance?

Nothing, my husband’s company pays for it.

—Brachi Silver

We pay $850 through Obamacare, and the kids are eligible for Jersey Care.

—Heshy and Chanie Michaels

We’re all eligible for the state Medicaid insurance, but we pay an extra $500 for our child with special needs so he can access the best therapists he needs.

—Miriam Y.

We pay $580 per month.

—Leah Lowy

I didn’t pay for it. It was through my ex-husband’s job, and we had Medicaid as a secondary insurance. One of my kids has serious medical conditions, and she even has a third medical insurance.

—Baily W.

We’re eligible for free Medicaid, so it’s not an issue for now.

—Yechiel and Shifra Jacobson

My wife has a private arrangement with her employer under which he covers a good portion of our family’s health insurance, sometimes even instead of my wife getting raises or bonuses. On top of that, we still pay quite a lot (in the thousands) because we want top coverage and believe it’s a lifelong investment for our kids’ health. I also get private health insurance for myself, for a few hundred bucks.

—Chaim Stein

Do you think it’s worth it get a pricey, private health insurance that will get you better therapies, or do you make do with state Medicaid (or a more basic plan) and just take whichever therapists come with that plan?

I think it’s better to get the best insurance you can afford, so you have the necessary coverage in case of emergency.

—Brachi Silver

Baruch Hashem, we don’t need therapy, but theoretically, we would take whichever therapists come with our plan. If we didn’t see progress, or the problem was very severe, then we would pay out of pocket.

—Heshy and Chanie Michaels

Depends on the person. For our child with special needs, we do have a more expensive plan. But the rest of us are fine with the state Medicaid.

—Miriam Y.

I have private health insurance, and it can get you into necessary therapies faster. That said, I didn’t choose my health insurance simply based on therapies, there were other factors involved. We chose to have hospitalization and other extras covered. Unfortunately, our plan does not give back very much for therapies.

—Leah Lowy

I do believe you get better therapists if you have better insurance. Medicaid just doesn’t have the same quality therapists. At one point, my ex lost his job and concurrently we lost our health insurance. I had to scramble to find new Medicaid doctors and therapists. Baruch Hashem, at that point my kids were doing well, but if they had been really struggling and I felt that these new therapists and doctors weren’t helping them reach their goals, I would have been prepared to do something drastic, like maybe even move out of state.

—Baily W.

For now, we’re on Medicaid, and it’s working. I don’t know if it always will in the long run. I think it becomes a bigger issue as people grow older. I know my parents would never be happy with Medicaid because they need specialists; at that age their lives depend on it.

—Yechiel and Shifra Jacobson

Our income is borderline; we earn just over the maximum amount to be eligible for the state insurance. In any case, we believe it’s worth it to go private and have access to better networks.

—Chaim Stein

Have you ever had to cancel therapies because you couldn’t afford it? Did you work out a payment plan?

We came up with a different solution — we spaced out my visits more. For example, instead of going to the nutritionist every week, I would go every 12 days.

—Heshy and Chanie Michaels

Early in our marriage, I always wanted to cancel marital therapy because it was so expensive. The therapist we were seeing at the time agreed to let our fees accumulate and then we paid him when we received our tax refund many months later. If an appointment was just for me, I’d be more likely to cancel, but if it were for my kids I’d work out a payment plan.

—Miriam Y.

When it comes to speech therapy, I usually adopt a “wait a see” approach, because of the cost. Usually it’s a teacher who suggests it, but if I understand the kid’s speech, I’m okay waiting. But psychotherapy is a different story. If my kid is willing to go and do the work, I’d be willing to pay almost any price. If they don’t want to go, though, I wouldn’t bother paying for it. It would be a waste of money.

—Leah Lowy

We ran into an issue with one office’s cancellation policy. At one point we had Covid exposure, and then one of my kids got Covid, and we had to cancel a few sessions in a row… and they charged us $100/per kid’s canceled appointment! They understand I’m a single mom with no income, so they said they don’t expect it right now, but they have been very clear that when I go back to work, they do expect to be paid.

—Baily W.

At one point we were seeing an expensive out-of-pocket therapist and were limited in how often we could afford to go. We probably didn’t go as often as we should have for it to be very beneficial. Psychiatrists generally don’t take Medicaid, and that has been a huge issue in the past.

—Yechiel and Shifra Jacobson

No way. We’d sooner borrow the money or accumulate credit card debt. If it was necessary for the health of our child, we would figure out a way to do it, whatever the cost. We look at it as a long-term investment.

—Chaim Stein

(Originally featured in Mishpacha, Issue 923)