Why is ERP So Expensive?

By Stephen SmithReviewed by Patrick McGrath, PhD6 min read
why is ERP so expensive

Can you relate to this story?

You finally figure out that what you are going through is OCD: an unwanted thought, image, or urge that violates your character and debilitates you. From the time you wake up until the time you go to sleep, you’re undergoing a mix of mental and/or physical actions to make the fear and relentless anxiety stop. 

You then learn that most people with OCD get better by doing a specific type of therapy called Exposure and Response Prevention (ERP), where the core teaching is focused on accepting – not suppressing – your OCD fears. You realize that there are licensed therapists who specialize in ERP, and that working with one is critical to overcoming OCD, given the personalization and complexities that come with both building and navigating your treatment plan. 

You’re starting to gain hope about the possibility of getting better and begin searching for an ERP specialist near you, but then a curveball is thrown at you. You discover that accessing ERP not only takes several months of time on a specialist’s waitlist, but it also costs hundreds of dollars out-of-pocket per visit. For many people, these exorbitant costs are simply out-of-reach.

Sound familiar? I’m sure it does, and you’re not alone. ERP is the gold-standard treatment for OCD, but it has never been very affordable in the past. 

Here’s why it’s so expensive:

Most health insurance companies misattribute costs caused by untreated OCD to other conditions, since many providers misdiagnose OCD. In fact, a staggering 96% of people with OCD don’t surface in claims data due to misdiagnosis and mistreatment.  

When OCD is misidentified, patients receive the wrong care and don’t address the root condition, making it nearly impossible for them to get better. This alone is a major and unacceptable problem – but on top of that, misdiagnoses mean that incidences of OCD are strikingly underreported. That means that insurance companies aren’t seeing the true scope of the problem or the significant number of people affected.

The way it works is that every time you go to an “in-network provider” (a doctor that serves patients from your specific insurance plan), the doctor bills your insurance. When billing your insurance, your doctor will connect your visit to specific codes that label your condition and the service offered. Your health insurance company will then pay the doctor based on the type of service that you were offered. 

Over time, insurance companies will cohort their data to identify the conditions that have required the most services among their members, and they’ll focus on treatment for those conditions to lower costs since they are considered the services that their members need most.  

However, when a condition is misdiagnosed by an in-network provider, it is also miscoded, causing the health insurance company to attribute the service offered by the doctor to the wrong condition. That leads to the true condition not being seen as one that needs to be addressed.

For example, millions of people with untreated OCD today are currently getting misdiagnosed and miscoded by in-network providers as conditions like “generalized anxiety disorder” and “panic disorder,” not OCD. 

What that means is that OCD is not a focus for the insurance companies, which in turn limits them from offering specialty treatment for OCD. OCD is instead seen as more of a rare condition that doesn’t affect their population much – which we know is inaccurate because OCD affects an estimated 1 in 40 people in the US alone.

Essentially, these misdiagnosis and miscoding issues have masked the true prevalence and cost of untreated OCD on health insurers globally.

What’s the result?

The consequences of misdiagnosed and misidentified OCD are enormous. Many health insurers don’t pay for the specialty rates required from ERP therapists, given their disconnected data prevents them from seeing the real need for OCD treatment or the true cost savings opportunity in treating OCD effectively. They instead offer ERP specialists much lower “talk therapy” rates. 

The reason ERP therapists need specialty rates in the first place is because specializing in ERP requires extensive training far beyond what’s received to practice most other methods of therapy. Deep knowledge and understanding of OCD are also required because of the complexities of the condition.

Due to this extensive training and the work needed to treat OCD, the number of licensed clinicians falls far short of what is needed – meaning there are a limited number of providers who qualify as legitimate OCD specialists. Meanwhile, the need for their services is high.

Given the massive positive, life-changing impact ERP therapy has on a person with OCD, licensed therapists trained in ERP are truly worth more than several hundred dollars per hour. But, because health insurers have historically not been able to see the true size and need for OCD specialty care in their populations, they have let their ERP therapists leave rather than adjust their rates. 

The lack of in-network ERP specialists leads people with OCD to turn to other methods of care that are covered by their insurance, meaning they often don’t address OCD at all.

When untreated, patients may spend a high number of sessions in non-specialized therapy that’s not meant for OCD (and can actually make their OCD worse). They may also use high dosages of medication, and many need to visit the ER or be placed in residential treatment centers, resulting in increased healthcare costs at a macro level. 

The reality is, when people with OCD get better and manage their OCD thoughts, images, and urges, they often don’t need to use as many healthcare services, since they’ve regained their life and feel mentally healthy. The key to getting better is ERP, and the key to ERP is working with a licensed and trained specialist.

Yet again, since health insurers don’t see the prevalence of people with OCD in their populations – due to the misdiagnosis and miscoding issue mentioned previously – they don’t connect the amount of services utilized as a result of untreated OCD. Therefore, most insurers don’t prioritize running OCD awareness campaigns, training therapists, or paying ERP therapists the specialty rates that they deserve. 

This disconnect has led ERP therapists to go out-of-network and charge higher cash-pay rates that are commensurate with the specialized treatment they offer. The cost of working with an ERP-trained therapist is around $350 (or more – even upwards of $500) per session, and most often, these costs are paid fully out-of-pocket. That’s why ERP has typically been extremely expensive and inaccessible. 

How is NOCD addressing this issue?

I’m sure you are fed up with this problem, and my team and I at NOCD are fed up, too. That’s why we are solving it and are committed to fixing the broken OCD treatment system. 

We are attacking the problem at its core, starting by connecting the data that allows us to show the returns of effectively treating OCD at a population level to insurance plans nationwide. Our goal is to show the large need for effective OCD treatment, so that people don’t have to pay out-of-pocket costs for necessary care.

This has led us to partner with some of the nation’s leading insurance plans – including UnitedHealthcare, Cigna, Humana, many Blue Cross Blue Shield plans, and more – so members can receive OCD treatment through their behavioral health plan benefits. It’s one of the first times that ERP therapy has ever been insurance-backed.

As a result, most of our members using insurance only pay a small copay of $0 to $50 a session.

Even for those not using insurance, we are committed to helping more people receive ERP from a qualified OCD specialist. Our members find that their out-of-pocket costs are significantly less than what specialists charge in their area, and we work with members paying out-of-pocket to manage costs in a way that meets their needs. 

In fact, ERP therapy for our members is typically less than half the price of standard, in-person ERP therapy you’ll find outside of NOCD, even though we offer more service than most ERP therapists.

We’re also addressing the need to have more specialists by training licensed therapists to specialize in ERP, giving more people the opportunity to receive much-needed treatment, despite the lower costs. Our therapists work side-by-side with world-renowned OCD leaders who have designed some of the world’s top OCD treatment programs. These leaders build our protocols at NOCD and actively manage them today, and they conduct rigorous training in OCD and ERP – evidence-based therapy that’s been proven to be the most effective treatment for OCD. All of this ensures that our members get the best care.

Ultimately, our revolutionary process may offer more people with OCD the chance to access ERP therapy without any barriers to treatment; give payers the viability needed to see the true impact of treating OCD; and allow providers the opportunity to receive reimbursement equal to their impact. 

How can you access affordable, convenient, and effective OCD treatment?

If you or someone you know is struggling with OCD, you can schedule a free call with our care team to learn more about how working with a licensed therapist at NOCD can help you. 

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Stephen Smith
WRITTEN BYStephen Smith
Patrick McGrath, PhD
Reviewed byPatrick McGrath, PhD