I am writing to address a disturbing and deeply troubling reality within our community—the unethical and exploitative practices of certain mental health professionals who refuse to accept insurance, forcing desperate patients to pay exorbitant out-of-pocket fees.
While we frequently hear about the importance of mental health awareness, why do we not speak about the financial barriers that prevent people from accessing care? In nearly every other field of medicine, doctors work within the insurance system to ensure patients receive treatment without financial ruin. Yet, in our heimishe community, mental health providers actively avoid insurance, knowing full well that their patients—due to cultural and religious sensitivities—will not seek help outside the community.
This is not just a financial issue—it is an abuse of power. Vulnerable individuals in crisis should not have to choose between getting the help they desperately need or plunging their families into debt. Yet, many professionals exploit the stigma surrounding mental health, knowing their heimishe patients will not report them for demanding untraceable cash payments.
Even more concerning, some organizations that claim to assist struggling individuals are profiting from this crisis, steering people toward select providers who charge astronomical fees. Where is the accountability? Who is ensuring that mental health services remain accessible to those who need them most?
This situation is unacceptable and unsustainable. We must demand transparency, affordability, and ethical responsibility from our mental health providers. We cannot afford to stay silent while so many suffer—financially, emotionally, and psychologically.
It is time to demand accountability from those who claim to be healers but have instead turned mental health care into a business of exploitation.
Sincerely,
Name Withheld
The views expressed in this letter are those of the author and do not necessarily represent those of YWN. Have an opinion you would like to share? Send it to us for review.
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44 Responses
This seems very one sided.
Doctors can see dozens of patience at once, spending seconds with each if even that. And yes they accept insurance, But the pennies they recieve adds up when they see so many simultaneously.
Therapists have to spend a minimum of 40 minutes per patient. If they accepted insurance as you “Demand” they would walk away with far less than minimum wage.
Have you decided they are not worthy of earning a living?
Your anger should be directed towards insurance companies, but of course it’s not, because they don’t care what you think.
The frum therpaists in our community are a much easier target.
Here’s a thoughtful and balanced response to the concerns raised in the letter:
I understand and appreciate the frustration expressed in your letter. Mental health care should be accessible and affordable for all, and financial barriers can indeed prevent people from receiving the help they need. However, having stepped into the field myself, I now see a side of this issue that is often overlooked.
While it may seem like mental health professionals who do not accept insurance are simply prioritizing profits, the reality is far more complex. The cost of becoming a qualified mental health provider is significant—between a Bachelor’s and Master’s degree, training expenses often range from $50,000 to $100,000, requiring six years of study, followed by two years of low-paid or even unpaid internships. During this time, clinicians work long hours while maintaining the emotional and mental energy required to help clients effectively.
Once licensed, the financial burden does not end. Office rent, liability insurance, supervision, continuing education, and administrative costs can add up to $5,000 to $6,000 a month, before even considering personal expenses such as housing, daily living costs, and tuition for one’s own family.
On top of this, insurance companies make it incredibly difficult for providers to sustain a practice. Reimbursement rates are often shockingly low, sometimes barely covering costs, and the administrative hurdles to get paid can be overwhelming. Many insurance companies delay or deny payments, leaving clinicians stuck in bureaucratic battles instead of focusing on their patients. This creates an unsustainable model, especially for those who strive to provide high-quality care.
It is understandable that from the outside, this looks like a case of providers exploiting a captive audience, but in reality, many therapists would love to take insurance—if only the system were designed to fairly compensate them. The unfortunate result is that some professionals are forced to choose between staying in the field they love or being unable to provide for their own families.
That said, your concerns about accessibility and financial strain on patients are valid. We need systemic change—both within our community and in the broader healthcare system—to ensure fair compensation for providers and affordable care for patients. Advocacy should focus not only on demanding providers take insurance but also on pushing for better reimbursement rates, reducing administrative red tape, and encouraging community initiatives to subsidize therapy for those in need.
I also recognize that behind your words is pain—pain from those who feel unheard, unsupported, and financially strained in their search for help. That is truly heartbreaking. Mental health care should not feel like an impossible luxury, and as a community, we need to work together to find sustainable solutions that respect both the needs of patients and the realities of providers.
I hope this helps open a more nuanced discussion—one that acknowledges the struggles on both sides and seeks to create meaningful, long-term change.
How about the mental health “experts” finding illnesses where there is no illnesses and then that makes an actual mental illness? I am a quiet woman but since women are stereotyped to be talkers, I was forced into therapy in high school to talk for the sake of talking and then if I did not talk enough I got criticized and if I said something whatever I said was nitpicked. I don’t have that many similar interests like most other girls/women so this was stressful experience.
These mental health “experts” turned my parents against me. I did all my chores, endured beatings and screaming but I kept my grades up as I will be punished harshly for low grades. Now I have to socialize as well. I have to make a fool out of myself to socialize as I really have nothing to say most of the time.
I learned bad habits and took it to work with me. I was fired from one job and nearly got fired from the second because I was attempting to “yenta” by complaining about my job even though I actually am a hard worker. I saved my job through the skin of my teeth. I did everything the opposite of the forced therapy and I rebuilt my reputation. But now I shut down and refuse to talk with most people except my direct family.
When I say my story all I get is “not all therapists are good,” find another therapist,” etc. The point is I would not have this issue in the first place if the therapy was not shoved down my throat. I am now dealing with craziness but I am such anger against therapy that when i go to any therapist it goes in one ear and out the other.
I have no interest in therapy to undo the damage of the bad therapy. I pull myself by the bootstraps and I am resentful for this overrated profession loved by nearly everyone. I still have bouts of craziness but I just have to endure them. I reached out to my high school principal and she apologized for what was done to me and asked for Mechila and a few back and forth emails later she then said that she has no time for me “we only had good intentions” and cut off all contact with me. Plenty of time to nearly ruin me but no time to help my healing process. I hate therapy as much as an antivaxxer hates vaccines.
I hate how therapists and all related professions are the arbitrators of what is considered normal. A teenage girl not interested in typical teenage girl stuff and therefore does not socialize as much even though she does talk when she wants to is considered a flaw and forced into the therapy pipeline. We are not allowed to have differences and unique quirks outside the stereotype.
I’ve had an extremely disappointing and exploitative experience with a therapist. Over the course of a year and a half, I invested approximately $15,000, only to feel taken advantage of and betrayed.
This therapist consistently postponed addressing my trauma, promising to ‘deal with it later.’ Meanwhile, he asked me to recommend him to others, praising him as the ‘best therapist in town.’ I later discovered that he had misrepresented discussions with my doctor, further eroding my trust.
To make matters worse, he frequently used foul language during our sessions. I’m sharing my story to highlight the need for greater accountability in our community, particularly in the mental health profession. Vulnerable individuals seeking help deserve better.
It’s horrendous. The prices are through the roof. Parents, who would do anything to help their kids, pay the price because they have no choice. I know I know – they have expenses too… sorry, I don’t buy it. No one needs to charge $400 an hour to make a decent living. Off the backs of desperate people that just need help.
The issue is a real one that many struggle with financially, although a quick google search shows that this problem is not unique to the frum community. If there is a demand for out of pocket, why would a therapist want to deal with insurance.
A few points from someone in the mental health world
1)Professionals have 50-150k of student debt plus years of not making a salary in crummy internships
2) there are plenty of cheaper therapists that take insurance
3) every industry works this way…you pay more for better services
4) the burnout rate for therapist is incredibly high…you are paying from him/her to carry many people pain around 24/7
5) therapist make a lot per hour but do not work 9-5 and are limited to how many clients they can take and treat effectively
6) Most therapists that I know are far from rich
7) We pay thousands of dollars a year for trainings and our own therapy.
I honestly take offence at your tone.
You make assumptions based on little information and are accusing us of being extortive and evil.
You want to talk about abuse of power?
Look at what insurance companies demand of clinicians. It is simply unsustainable. They pay very little and dictate exactly what kind of care can be provided, for what, and for what length of time. They do not pay enough for clinicians to make a living. If they did, more clinicians would accept insurance. This will continue to be a problem until some improvements are made to our insurance system. Until then, providers will charge what they are worth because insurance won’t pay it.
So sorry that you’re in this predicament. It is a painful reality. There are many services that are out of reach for most people. Let’s be honest, no one is working for chessed. Not the grocer, the administrator or nor the therapist. Not the mental health provider either.
That said, as a Speech therapist in private practice, I haven’t raised my prices in too many years. I accept some insurances and let me tell you, for every hour I spend with a client, I spend another hour on the phone with the insurance company. There’s eligibility, authorizations, billing and more. It sounds simple to say its a scam or grab, but far from it. There’s good reason therapists don’t want to take it.
Again, I’m not speaking from the mental health provider experience, and I commiserate with you, understandably you’re frustrated and in need of help. But exploitation sounds extreme from my business perspective.
Mental health. I wish it was so simple.
There’s only one organization that helps financially and it’s only if someone is seeking help due to molestation.
If anyone knows an organization that assists others with mental health expenses then by all means please let me know.
Some places out of NY/NJ have special funds set up to help out.
Therapists can charge what they want because people pay it and they are professionals who have done years of schooling.
Some do lower the price they charge if they see it’s tough financially. But in my experience most will not reduce their rates. They will suck you dry.
A few points:
1) There certainly are medical doctors who do not accept insurance and provide a higher level of care for people who can afford it.
2) There are plenty of mental health clinics for people who can’t afford to pay out of pocket
3) The cost of therapy is determined by supply and demand, just like any other product or service. Why should mental health professionals be expected to do a chessed that is not expected of any other business proprietor?
I hear the pain and frustration in your words, and there is no doubt that access to affordable mental health care is a serious concern. No one should feel that financial barriers stand in the way of getting the help they need, especially when they are struggling. Mental health care is as essential as any other form of medical treatment, and it is heartbreaking when individuals feel they cannot afford the support they so desperately seek.
That said, it is important to understand why many therapists in our community do not take insurance. The unfortunate reality is that insurance companies reimburse mental health providers at rates that are often far below what is sustainable. Unlike hospitals or large medical practices, most therapists are in private practice, without the ability to offset losses with other revenue streams. Insurance companies also impose burdensome paperwork and delayed payments, sometimes taking months to reimburse for a session—if they approve it at all. In the meantime, therapists must cover office rent, malpractice insurance, continuing education, and, most importantly, support their families.
Many therapists enter this field with a true desire to help, but they also need to earn a livelihood. They, too, experience the financial pressures of tuition, rent, and groceries—just like the people they serve. It is a difficult balance: wanting to be available to those in need while also being able to sustain a practice.
That being said, there is room for improvement in the system. More effort should be made to connect patients with providers who do accept insurance or offer sliding-scale fees. Organizations that assist with referrals should do so with full transparency, ensuring that financial realities are considered alongside clinical needs.
Your concerns about affordability and access are valid, and they deserve thoughtful discussion. However, it is important to recognize that this issue is not about greed or exploitation—it is about a deeply flawed insurance system that fails to adequately support both patients and providers.
The whole premise here is ridiculous. Who are you to dare demand that people work for the price you want them to accept? If you cannot afford a private therapist there are frum mental health centers/ clinics that work through insurances.
The whole frum system is a scandal
Shidduch crisis
Acceptance crisis
Mental health crisis
Shtellar crisis
Housing crisis
Babysitter crisis
Meatboard crisis
Private jet crisis
And its all BMG monopolization THEY caused it THEY should stop it
To all therapists attributing the issue solely to low insurance reimbursement rates, let’s consider the facts. Insurance companies like Fidelis offer reimbursement rates comparable to those of medical doctors who undergo significantly more years of training. For example, a 40-minute session may be reimbursed at $200—an amount that many physicians find acceptable. If this rate is sufficient for them, why should therapists require more?
Moreover, the lack of accountability in private therapy has caused far more harm to patients than is widely recognized. Without the oversight that comes with insurance audits, there is little assurance that proper documentation, progress tracking, and ethical standards are being upheld. Too often, patients invest months in treatment only to discover that private therapists, who operate outside insurance oversight, cannot be held accountable. This is an issue we cannot afford to ignore.
There are many rotten therapist who are not “paying off they’re student debt” nor do they carry the burden of their clients. We need a platform to rate therapist without Lashon hara, so people can know who’s good and looking to help their clients, and who are just money leeches. (I had a therapist who told me repeatedly that the only thing he likes more then money is kavod)
The importance of Mental Health?
Sorry freind, the whole industry is a scam!
We also once believed that everything doctors do is ironclad, scientifically speaking. only after the covid debacle did we start realizing how much comes down to opinion and judgement, and how that leaves so much room for abuse.
Its 100 times worse in the “mental health field”. The line between scientific evidentiary care, and “holistic/alternative” approaches, are so vague as to be non-existent.
Go buy a book like “coddling of the American mind” which literally has a section in the back showing how to do CBT on your own. (its taken from another book, of which name i cant recall right now).
The point is, the only scientific truism regarding therapy, is you do not need a therapist to help you do the exercises. Although a truly good therapist may be of assistance, many times its actually a detraction.
@itchik you know as well as I do that any decent therapist will not work in a clinic, they only start off in a clinic as interns since they know the real money is made by being private.
It’s the same for psychiatrist they are all in it to make it big and that a real shame no other specialty is like this, none.
Yankle why did you keep seeing him if you weren’t happy?
The writer might be correct as far as whom the frum referral agencies refer people to, generally to very expensive therapists when less expensive ones, even agencies or private ones who accept insurance would be more beneficial, especially considering the added financial stress that the fees of expensive therapists cause.
As for insurance paying less than minimum wage, I would point out that many non-frum therapists do accept insurance, so I can only be skeptical as to whether the fees amount to minimum wage.
It seems to me that for many people, frum mental health clinics and non-frum therapists that take insurance are a real option.
Maybe we should put into place what Yisro suggested in this parsha.
Please don’t blame therapists for this. They are not a chessed organization. At the same time, it’s true that therapy, and good therapy, should be more accessible to those who need it. Organizations should be started to fund this by community leaders. I also feel for Giraffe, who was burnt by therapy and by her principle who took no achrayus for forcing therapy on her. I too, was burnt in therapy. Vulnerable people are the ones who go to therapy and the same patterns in their outside relationships get repeated in therapy unless if the therapist knows how to guide them in breaking their negative patterns, but most feel happy to have someone to dump their life experience and advice on instead of strengthening the client to believe in themselves and empower them. At least that was my experience. BH I was eventually led to therapy and healing models whose goal is teaching tools to release emotions and empower the client–like somatic processing and IFS, for example.
Did it occur to anyone that many of the sincere comments supporting the therapist’s side seem to be from the same commenter using different screen names?
Similar to a person who does stitches and charges exorbitant prices and takes no insurance. When my kids needed stitches I just went to the ER. My doctor said it looked just as good as that person’s. Other people get ripped off.
YWN
Please stop posting letters that show bad middos!! It’s a chillul Hashem and adding to the pollution of our society!
Heaven forbid I suggest that the current US presidental administration actually investigate the US Healthcare industry and its deceitful practices instead of renaming the gulf of Mexico/USA and trying to purchase Greenland.
DOGE is apparently saving the taxpayer so much money from excessive spending but why do I sense that savings will be turned into some tax benefit for the ultra-wealthy. I could only imagine if the Healthcare industry gets its way and next thing we know, mental health/therapy is not covered at all because it costs them too much money.
Unethical? Exploitative? Demanding untraceable cash payments? Abuse of power?
These are some disgusting allegations. The letter reeks of entitlement
The problem I see with therapy is that A. It’s a lot less effective than we think, and takes a ridiculous amount of time before people see changes , if they see changes B. Price by the hour is pretty insane.
Most of the highly recommended therapists take well over $300 a session.
Obviously therapy is a choice, but I agree with the letter writer that people turn to these mental health agencies for a solution and in turn are directed to the people most qualified to help them- and it’s simply unaffordable. And they may not even see resolution of their issue because therapy is not magic.
A friend of mine is actively pursuing her social work degree because she did a lot of self help and inner growth over the years to help herself overcome her own issues and she told me she is getting a degree specifically to help people BE THEIR OWN THERAPIST. And she wants people to take her seriously. She said there are many methods where people learn to treat their own issues, but nobody teaches it. She intends to start courses where people learn self help instead of relying on overpriced professionals. I can’t wait to see where she goes with this!
Itching, Please get me a list for the Brooklyn area of health centers/ clinics that work through insurances. Is it more than a handful? I don’t think it is the rates some policies pay well. It’s the paperwork involved. They are not forced to take insurance and paperwork is time consuming. Usually need to hire some help for paperwork. The flip side there are available some insurance that pay for out of network providers by providing a receipt of services.
I am living through this exact situation. Have been paying through the nose for care when Insurances don’t or won’t cover.
I have tried private ($$$) and clinics (covered). The care we got varies greatly. Maybe some of the private clinicians, therapists and doctors etc. Can volunteer some of their time in a clinic for those of us not made of money. I don’t know what else there is to say from the providers side. I agree they are entitled to make a living and pay their bills.
One of the biggest gripes I have is when they put the money first and foremost. One even said to me before I walked in the door, “cash or Zelle only”. I get that they are worried about being stiffed but if we are coming to you, at least show some understanding.
I had one Rov tell me that when it comes to mental health, we are far behind in taking care of the klal. We are still keep it a secret. Have a physical disease and organizations will throw money at the doctors, insurance etc.
Changes need to be made
Consider:
A close relative was (still is) a licensed therapist. Insurance was paying as little as $15 for a visit. It was simply uneconomic and a successful practice was closed up after 20 years to take an institutional job.
@Pashut Jew, I kept seeing him because I was in a very vulnerable state and had put my trust in him. He kept reassuring me that we were in a “hand holding” phase and claimed my doctor agreed, which I later found out wasn’t true. He also attempted to scare me by saying he had clients who became suicidal when working on trauma without learning meditation first. It took me a year and a half to say enough was enough we are not getting anywhere. The biggest lesson I learned from this experience is to put my trust only in Hashem, not people.”
cant afford a service, forgo it, do you go to wolf and lamb and demand they give you a discount because you cant afford their prices?
2024 Medicare NY reimbursement rate for CPT code 90837, the most common individual psychotherapy session, => 53 minutes, was $149.64.
I know and understand the difficulty expressed in this letter, because I suffer from anxiety for many many years. I have been around the block. It is very tough paying for it out of pocket. Having said that, here are a few points.
You make some very strong and, honestly, pretty insulting, accusations. They are not true at all, IMHO.
This is not at all an issue only in the Frum community. Noone is “exploiting” our community because of any stigmas. This is just how it is. Many good professionals don’t accept insurance. There are loads of mental health professionals that do accept insurance, in fact there are loads of them that even accept Medicaid. So I think your accusation here is very unfair and not true. As in many areas; if you want the best therapists or doctors, it may be out of pocket. That is not called exploiting! I know of physicians that do not accept insurance, few and far in between but they do exist.
For the record – Over the past 20 years, I myself saw frum and non frum professionals, as well as a non Jewish therapist at one point. The non frum doctor did NOT accept insurance. The non Jewish therapist did NOT accept insurance. One of the frum therapists DID accept insurance and one did not. So there go your accusations.
To accuse the organizations is truly shameful on your part. I don’t believe for one second that ANY frum organization is profiting by steering people to specific professionals. How can you even make such an accusation? Do you have access to their books?
Mental health is an extremely challenging situation for all involved, trust me I know it good and well! To bad mouth good people and organizations is not the answer. We need to daven to Hashem that He remove this terrible plague from our community and send us bountiful parnassah to afford whatever expenses we may incur.
Firstly; as mentioned in my prior comment – there are loads of professionals who DO accept insurance. They are found in every major frum community, at least in the NYC and NJ areas. MANY even accept Medicaid.
I’d add another point. Many times, patients avoid going to the professionals who do accept insurance, thinking the ones who do not must be better. Sometimes it may be true. But, I have been told that some of the professional at the clinics are actually very good.
sariray ,
I’ll believe it when I see it. I think she is in fantasy land.
Mental health is VERY challenging. I’ve been to therapists and doctors (aka as psychiatrists) over the past 20+ years. I still suffer with the anxiety but have learned to live with it somewhat. It’s extremely debilitating though, like working with half a body and affects all around you, family, friends etc.
The complaint is not just the insurance rates, but also “untraceable cash payments’ – presumably to avoid taxes. The second part cannot be excused by a need to repay student loans.
So, as R Moshe writes not to go to non-observant therapists, so maybe one should not go to therapists who are not ehriche.
As to “therapist is not chesed”, Gemora Taanis 21 describes a doctor who was visited by Eliahu (while Abaye only once a week). One of his zechuyos was having a payment box outside his view, so that he would treat patients without knowing how much, or whether, they paid … I guess these modern therapists have something in common – they also accept only cash.
As a professional in the medical field with experience in insurance, I strongly uphold ethical standards in every aspect of my work. The paperwork required by insurance serves an essential purpose—to ensure that patient wellness is not overlooked. While I agree that insurance companies should improve their adjudication processes, when providers comply with all billing standards, claims are not denied without justified reason.
Also, while healthcare providers have the right to choose which insurance plans they accept, completely rejecting the insurance process altogether seems unreasonable, self-serving, and unfair. Patient welfare is just as crucial as the income we earn. If financial gain becomes the sole focus, how can we truly sustain our profession?
Treating patients with dignity and fairness is a fundamental responsibility of all medical and behavioral health providers. Manipulating the system at the expense of vulnerable patients and societal needs is not only unjust but also unethical.
To Mr. Mailbag: You should never try to disrupt nature’s capitalism. Every provider should set his fee as high as he could, and every consumer (patient) should try to pay as little as possible. The beautiful laws of supply and demand will actually determine the price.
As a therapist I have a few thoughts .
A. Taxes on business owners are extremely high.
B. Supervision and courses are very expensive.
C. You can not do it too many hours per week. My max is 18 clients. More than that I feel that I am not emotionally present enough for any of them.
D. People generally come to therapy after they and those around them have tried (often for years) to work on these issues. They’ve thought about it, tried behavioral changes, rewards, punishments etc. It is unreasonable to expect that such difficult and deep challenges will take a few months to uproot. It is also often not possible to change them completely but enough that is livable and hopefully even better than just manageable.
E. All of that being said, I do believe that therapists overcharge and that for many, it is kavod and prestigious to be a high charger. From a business model, charging more makes you more desirable. I know therapists that charge buckets of money and they are not good, I would never refer people to them, but they have lines of people waiting to see them.
F. I charge on the low end of the going rate even though I have 15 years of experience. I do it because I feel it is the right thing to do and that it should be affordable(even though the low end isn’t really affordable). If I think someone can benefit from therapy only once every two weeks, I do that regardless if I will have open slots the other two weeks. BH I have been zoche to help many people over the years but I don’t have a big “name”. I do think that if I upped my prices I would. If I charged less than I do, I would have less clients because everyone would wonder what is wrong with me.
Put your money where your mouth (or pen) is. List these so-called therapists by name and let the public decide for themselves. This stupid nonsense of making wild accusations without any evidence whatsoever only harms the community that is already fragile.
I would encourage people to only see a therapist when there is an acute need to do so. Otherwise get yourself a mentor, self help book and learn sifrei musar to help you through the situation. This process worked for centuries and there is no reason for people to go to therapy as a matter of course when the method and outcome is often dubious.
If you follow the above the best therapists would be there to treat acute problems and the rest will earn gainful employment elsewhere.
Don’t go down the slippery slope to therapy until you have exhausted all other reasonable options and taken careful and measured advice from someone outside of the therapy world like a Rov, Rebbetzin or mechaneches.
We have to stop this crazy cycle.