Why is ERP So Expensive?

Article reviewers:
– Dr. Jamie Feusner
– Dr. Patrick McGrath

Can you relate to this story?

You finally figure out that the hell you are going through is OCD: an unwanted thought, image, and/or urge that violates your character and cripples you from the time you wake up until the time you go to sleep, mixed with mental and physical actions taken to make the fear and relentless anxiety stop. You learn that many people with OCD get better by doing a very specific type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP)- where the core teaching is focused on accepting, not suppressing, your OCD fear. You see that you need to find a licensed therapist that specializes in ERP to help you do the treatment, given the personalization and complexities that come with both building and navigating your treatment plan. Yet, you realize that accessing an ERP specialist therapist often takes several months of time on a waitlist and also hundreds of dollars per visit..  Sound familiar? 

I’m sure it does, and you’re not alone. Personally, I’d rather be punched in the gut by Mike Tyson than to have that feeling again, and I’m sure many would agree. It’s awful, and it’s why my team and I at NOCD are committed to fixing the broken OCD treatment system. ERP is the gold-standard treatment for OCD, but it has never been very accessible. Here’s the step-by-step reason as to why, in case you’ve ever wondered: 

1. Most health insurance companies misattribute costs caused by untreated OCD to other conditions, since many providers misdiagnose OCD. A staggering 38% of mental health professionals misdiagnose OCD and nearly 50% of primary care physicians.  
   • Every time you go to an in-network doctor and you use your insurance, your doctor will bill 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. Then, over time, they will cohort their data to identify the conditions that require the most service, and focus on treating those conditions to lower costs.. 
   • When a condition is misdiagnosed by an “in-network provider,” (a doctor that serves patients from a specific insurance plan), it is also miscoded, causing the health insurance company to attribute the service offered by the doctor to the wrong condition. For example, millions of people with untreated OCD today are currently getting misdiagnosed and miscoded by in-network providers, causing health insurers to view the patients as having conditions like “generalized anxiety disorder” and “panic disorder,” not OCD. 
   • The misdiagnosis and miscoding issues have masked the true prevalence and cost of untreated OCD on health insurers globally.
2. Many health insurers don’t pay ERP therapists specialty rates, given their disconnected data prevents them from seeing the true cost savings opportunity in treating OCD effectively. 
   • Health insurers don’t see the amount of services utilized by people with untreated OCD as well as the true number of people with OCD that they cover, due to the misdiagnosis and miscoding issue mentioned above. When untreated, patients may spend a high number of sessions in therapy, and may utilize high dosages of medication, and will sometimes need ER  or residential treatment. Therefore, most insurers don’t prioritize running OCD awareness campaigns, training therapists, and paying ERP therapists the specialty rates that they deserve. 
   • When people with OCD get better and manage their OCD thoughts, images, and urges, they often don’t use as many healthcare services since they’ve regained their life and feel mentally healthy
3. Most licensed therapists who are trained in ERP don’t take “talk therapy” rates given by health insurance companies, go out of network and charge high cash rates.
   • Given the extensive training and work needed to treat a condition like OCD, the number of licensed clinicians falls far short of what is needed, and the revolutionary impact ERP Therapy can have on your life, licensed therapists trained in ERP are worth more than several hundred per hour. 
   • Because health insurers don’t see the true size and need for OCD specialty care in their population, again given the data disconnection issue, they let their ERP therapists leave without losing a wink of sleep. 

I’m sure you are fed up with this problem, and I can rest assured that my team and I at NOCD are fed up too. That’s why we are solving it. We are attacking the problem at its core: training licensed therapists to specialize in ERP, using technology to supervise them and to make their care efficient, and bringing them in-network with payers. Ultimately this will offer people with OCD affordable ERP therapy, payers the viability needed to see the true, positive, impact of treating OCD, and providers the opportunity to receive reimbursement equal to their impact. 

If you are someone with OCD and you want to access a NOCD Therapist you can do so here. Also, if you are a therapist and you want to join our cause you can learn more on this page.

About the reviewers:

Jamie Feusner, MD is the Chief Medical Officer at NOCD and is Professor of Psychiatry and Biobehavioral Sciences at UCLA where he is the Director of the UCLA Adult OCD Program. Dr. Feusner is a member of the Board of Directors of the International College of Obsessive Compulsive Spectrum Disorders and is a member of the International OCD Foundation Scientific and Clinical Advisory Board.

Dr. McGrath is Assistant Vice President of Residential Services for AMITA Health and Director of the Foglia Family Foundation Residential Treatment Center and the Alexian Brothers Center for Anxiety and OCD. He is President of OCD Midwest, President of Anxiety Centers of Illinois, Scientific Advisor at IOCDF, and author of The OCD Answer Book.