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Making Therapy Successful: Setting Goals for Therapy


Good therapy can seem like magic. You sit in your therapist’s office and talk and things in your life start to get better. You don’t get as upset during conversations with your partner and don’t get as stressed out at work. You finally start dealing with that bad habit that’s been holding you back and are feeling creative again.

While there’s an art to therapy, there’s a science to it, too, and specific things you can do to increase your chances of success. In this article, we explore an often-overlooked element of therapy: setting tangible and measurable goals.

It’s possible to take even the vaguest or most poetic motivations for therapy and set goals based on them that you can use to track your progress. By following these steps, you can come up with a list of personally meaningful goals that can keep your work in therapy focused and productive.

On This Page

  • 1. Start by identifying broad motives, hopes, and dreams.
  • 2. Choose a theme to focus on.
  • 3. Narrow your theme into one or more specific goals.


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Start by identifying broad motives, hopes, and dreams.

At your first therapy session, when your therapist asks, “What brings you to therapy?” the first thing that comes to mind might be a simple, heartfelt statement like, “I just want to be happy,” or “I feel stuck,” or “I’m tired of just going through the motions.”

These statements express deep feelings that are important to connect to and work with in therapy. Just saying them to a therapist can kickstart a process of change, growth, and healing. But they’re too vague to make effective goals.

To help transform these powerful yearnings into more specific goals, ask yourself: What does being happy look like for you? What specific struggles make you feel stuck? Taking time to reflect on these questions can be therapeutic in itself.

One way to develop goals is to brainstorm and write down as many reasons for coming to therapy as you can. Whether you’re writing in paragraphs or making a mind map, the simple process of getting your ideas down on paper (or on a screen) can help you clarify them. It can help to start with a prompt.

Questions to Ask Yourself to Help You Figure Out Your Therapy Goals

If you’re not sure where to start, it can help to use some prompts. Here are a few questions to get you started:

  • What are some things in your life that you’re tired of?
  • What are some things in your life that you love and want more of?
  • What are some things you haven’t done yet that you still want to do?
  • Was there a specific problem that brought you to therapy? How and when did it start?
  • Have you been in therapy before? How did it go? What do you hope will be different or better this time?

If you have a mental health condition, addressing it will probably be your most important goal. However, taking the time to come up with specific goals related to your mental health journey can help you tailor your therapy experience and make it more satisfying.

As you build lists and examine your responses to these or other prompts, you may find that certain motives, hopes, or struggles stand out more than others. Explore these more deeply. What you thought your reason was for coming to therapy might not be the most important change you want to make in your life.

Choose a theme to focus on.

You might come to therapy feeling like your life is a total disaster. Where do you even begin if you’re having serious problems at work and at home and your bad habits are affecting your health, your finances, and your relationships?

How do you pick just one thing to work on if you're having trouble getting on track with anything?

It’s okay to walk into your therapist’s office and say, “I’m a total wreck. Can we fix everything?” Your therapist will be sympathetic, want to help, and be ready to listen to you describe the problems you’re having. But you’ll be more successful if you ask your therapist to help you find specific issues to focus on.

If you’re falling behind at work and snapping at your partner or children, for example, you might be able to connect these issues to a particular habit or behavior you want to change. It might also be related to a specific cause that you can address in therapy, such as stress, depression, or guilt. Your therapist is trained to identify root problems and can help you if you’re overwhelmed or uncertain how to proceed.

Narrow your theme into one or more specific goals.

Sometimes, it’s easy to identify specific goals for therapy. Sometimes it takes a little more work. Often, it’s a matter of finding the right term.

“I want to figure out if I’m depressed” is easier to turn into an effective goal than “Something just seems to be wrong.” Either one is a fine place to start, but it’s easier to identify symptoms of depression than to identify a needle in the emotional haystack of “Something is wrong.

Therapy Goals: A Few Examples

If you’re not sure what a therapy goal might look like, these example goals may give you some ideas:

  • “I want to heal from depression and get my hope and energy back.”
  • “I want to stop having the same fight with my partner over and over again.”
  • “I want to stop overeating when I’m stressed out and find healthier ways to cope.”
  • “I want to be creative like I used to be when I was younger. I want to paint, sing, or write again.”

Keep in mind that these are just examples and that the range of valid therapeutic goals is wide and varied.

One of the most common reasons people seek therapy is that they want to be happy but aren’t. Of course, it’s not your job to figure out exactly why you’re unhappy—therapists wouldn’t have much work to do if everyone could figure that out so easily for themselves. But you can start the process by trusting your instincts and saying what you think the problem might be.

You can share suspicions with your therapist that you’ve been afraid to share with anyone else. When you confess fears like “I think I might be unhappy because I’m in the wrong line of work,” or “I’m not sure I want to be with my partner,” your relationship with your therapist and your work with each other will deepen. Even being able to say, “I don’t know what I want” can help.

Make your goals concrete, measurable, and SMART.

The idea of SMART goals comes from corporate management but is a good frame of reference for any process of goal formation. It helps you avoid the trap of making goals that are too fuzzy to measure.

Of course, it’s okay to have fuzzy therapy goals, especially in the beginning. In fact, your goals are likely to change over the course of therapy, as therapy is a process of gaining self-knowledge. However, having only vague goals can make therapy frustrating, especially if you’re not planning on being in therapy for a long time.

Think of it as “both/and,” not “either/or. ” You can come to therapy to explore deep questions that aren’t concrete or measurable, and enjoy the slow process of getting to know yourself as you change and grow, while also having some specific, concrete things you’re working on.

What's a SMART Goal?

A SMART goal is:

  • Specific
  • Measurable
  • Achievable
  • Relevant
  • Time-bound

These aspects make it easier to know whether you’ve achieved your goal, and they also make it easier to track your progress.

For a goal to be measurable, it has to be specific. Goals that are both measurable and specific are concrete. You can visualize concrete goals and mark exactly when you’ve met them.

For example, “I want to get up every morning by 7:00 AM” is much more concrete than “I want to stop sleeping late.” Saying, “I want to stop binging on Little Debbie and start going to the gym at least twice a week” is more concrete than “I want to be healthier.”

Time is an important factor in any goal-setting process. If you’re not sure how long it should take to achieve a major therapeutic goal, break it up into smaller goals. For example, instead of saying, “I want to cure my social anxiety completely in one year,” you can say, “I want to go to at least two social events in the next month” or “I want to get out of the house at least once a day for the next week.”

It’s okay if you don’t achieve your goals right away; part of the process of growth is learning what didn’t work and trying again when you don’t succeed the first time.

Create an action plan to track and achieve your goals.

Once you’ve identified one or more important goals you want to achieve in therapy, you can work together with your therapist to come up with an action plan.

In fact, many therapists are required to do this as part of the treatment planning process for their agencies. In general, a treatment plan includes major goals, smaller objectives you can use to track your progress toward these goals, and the methods you’ll use to facilitate change.

There are many ways to track progress in therapy, but it helps if you take the time to identify your therapeutic goals first. It's even better if you share your goals with your therapist and use them to develop a formal therapy plan.

In the next “Making Therapy Successful” article, we provide detailed steps for creating an action plan and measuring your progress in therapy. You can read that article here: “How Do You Build a Good Relationship with Your Therapist?”

If you haven’t found a therapist yet, you can use the search feature on OpenCounseling to find affordable counseling in your area or sign up for affordable online therapy at BetterHelp (a sponsor). If you can figure out your goals before you even start therapy, you’re sure to hit the ground running!


Starting therapy can be scary, but we’re here to help

  • No more waiting days, weeks or even months to find a therapist. Sign up with BetterHelp and get matched to a therapist in less than 48 hours.
  • At OpenCounseling we have used BetterHelp and think they are a great option.
  • Get 20% off your first month with the link below.
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How Can Understanding Your Past Help You in the Present?
Why Are We Mysteries to Ourselves?
Why Is Therapy So Hard?
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Making Therapy Successful: How Do You Know When to Quit?

Stephanie Hairston

Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments.

How Much Does Therapy Cost? Our Ultimate Guide

Therapy has a reputation for being expensive, but it doesn’t have to be. In fact, the costs of therapy vary widely.

You can pay as much as $200 an hour—or more—to see a private practice therapist who’s in high demand and who doesn’t accept insurance. But you can pay as little as $25 per session if you use insurance or find a community counseling center with low sliding-scale rates. Sometimes, you can even get therapy for free.

In this guide, we’ll give you a general idea of what you should expect to pay depending on where and how you get therapy. We’ll also share our tips and tricks for finding affordable therapy. Read on to learn how much therapy costs and why it doesn’t necessarily have to be expensive.

On This Page

  • Can You Get Therapy for Free?
  • How Much Does Therapy Cost If You Pay Out of Pocket?
  • How Much Does Therapy Cost If You Use Insurance?


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  • Therapy from your smartphone, tablet or computer
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  • 20% off your first month.

Can You Get Therapy for Free?

Some organizations offer free therapy as a service to members of their communities. You can use the OpenCounseling affordable counseling database and other online tools to research free or low-cost providers where you live.

Note that many programs listed as offering free therapy limit it to people from specific groups, such as veterans or trauma survivors.

Where You Can Sometimes Find Free Therapy

Depending on your area, any of the following programs or provider types may offer therapy for free or for significantly reduced costs:

  • Free clinics
  • Homeless shelters
  • Domestic violence shelters
  • Veterans’ groups and organizations
  • Churches and other spiritual organizations
  • Medical schools with psychiatry departments
  • Community mental health centers and other public mental health programs
  • Colleges or universities with psychology, social work, or counseling departments
  • Non-profit or charitable organizations that are supported by grants and/or donations

There may be therapists in your area who participate in Give an Hour, a national organization that enlists therapists to provide pro bono sessions to veterans and trauma survivors.

Some therapists offer pro bono sessions independently through their own practices. However, they usually limit the number of free sessions they offer each month, and most only offer them to people who meet specific income or clinical criteria. You’ll need to call potential providers to ask if they currently have any pro bono slots open and if you would qualify for one.

How to Get Reduced Rates for Therapy

Many counselors and clinics offer sliding-scale fees based on your income and ability to pay. Many are also willing to negotiate fees even if they don’t already have a sliding scale in place. You’re more likely to be assessed a minimal fee or be able to get counseling for free at a local non-profit or public clinic if your income is at or below the Federal Poverty Level.

If you can’t find or don’t qualify for free therapy, you may still be able to find therapy for a more affordable price than the rates you see private practice therapists charging for your area.

For example, some specialized networks exist to help offset therapy costs. One of them, the Open Path Psychotherapy Collective, offers a lifetime membership for $59, after which you can see any therapist in their network for $30 to $60 per session.

How Much Does Therapy Cost If You Pay Out of Pocket?

On average, out-of-pocket costs for therapy range from $60 to $150 per session. Sites like Thervo and Thumbtack that list rates for local therapists agree on this range, though the true range is even wider.

While the average cost for therapists listed on Thervo is $60 to $120 per session, this means that people who find a therapist through the site pay anywhere from $20 to $250 per hour. The cost range for therapy on Thumbtack changes based on the zip code you enter and may be higher or lower than the national average.

How Low Do Private Practice Rates Really Go?

Note that national therapist directory TherapyDen reports that only 13 percent of private practice therapists charge $60 or less per session—even as a low fee on a sliding scale.

TherapyDen reports a national average low sliding-scale fee of $112 and a national high or full-cost fee of $157. The site acknowledges that these numbers may seem low or high depending on where you live.

Usually, the only way to get a private practice therapy session for $60 or less is to find a therapist who offers a sliding scale or to go through an organization like the Open Path Collective.

A lot really does depend on your location. You’ll pay more for therapy in major metropolitan areas than you will in small towns. In some places, it’s unusual to find therapists charging less than $150 an hour, while in others, it’s unusual to see people charging more than $100.

How Much Does Therapy Cost If You Use Insurance?

For people who have insurance with mental health coverage, the cost of a therapy session with an in-network therapist is usually the same as the average co-pay to see a medical specialist, or about $30 to $50 per session.

Your Insurance Shouldn't Charge More for Therapy

Federal regulations including the Mental Health Parity and Addiction Equity Act (Parity Act) and the Affordable Care Act require insurance companies to charge equitable rates for mental health and medical services. This means they can’t assign higher co-pays to mental health specialists than they assign to medical specialists.

Some plans are exempt from these laws, and others simply don’t follow them. But in many cases, if you know your rights under the Parity Act, you can hold your insurance company accountable. Push back if you find you’re paying more out of pocket for therapy than you’d pay for the same level of medical care.

According to NAMI, your state insurance division and the federal Center for Medicare and Medicaid Services can take action to enforce parity law.

Since they know they can’t simply assign higher co-pays, some insurers try to skirt around the requirements of the Parity Act and Affordable Care Act by finding other ways to limit the number of mental health claims they pay. For example, your insurance company may deny your therapy claims as “medically unnecessary.” When this happens, you have to appeal your denied claims to try to get your insurance provider to pay them. Many people simply give up instead of dealing with the headache.

Beware the Hidden Costs of High-Deductible Plans

If your plan is a grandfathered plan that’s exempt from parity requirements, you may have to pay higher co-pays for mental health care than you do for medical care. You’ll also have to pay more if you have a high deductible plan. Plans with high deductibles require you to pay the deductible before the plan will cover any costs. So, if your deductible is $5000, you’ll be paying a therapist’s standard per-session rate until you’ve paid $5000 toward your deductible for the plan year.

If your plan has out-of-network benefits, you don’t have to see an in-network provider to have your sessions covered by insurance. However, you’ll usually pay significantly more to see an out-of-network therapist than you would to see an in-network therapist.

If your plan doesn’t offer out-of-network coverage, it won’t pay for your therapy sessions unless you find an in-network therapist. Some people believe insurance companies are actively trying to limit the number of therapists in their networks so that people have to pay out-of-pocket or out-of-network rates.

For More Information

For more information on the hidden risks of using out-of-network benefits, you can read our article “Thinking of Seeing an Out-of-Network Therapist? Read This Before You Do.” In this article, you’ll also find tips for how to lower your risks and get the most out of your out-of network benefits.

Why Do Costs for Therapy Vary So Much?

The biggest factor affecting the price of therapy is the cost of living where a therapist works.

Therapists who live in more expensive locations have to pay higher office rents and higher prices for other professional expenses. Therapists who live in more competitive areas have to invest more in marketing than therapists who live in less competitive locations. They may also have stricter requirements for licensure and have to pay higher licensing and continuing education fees.

Another reason for the wide cost range for therapy is that many therapists offer sliding-scale fees, or adjustable session rates based on clients’ incomes. The same therapist may charge some people $75 a session and others $200. This helps them cover their costs while making sure more people can afford to see them.

Some therapists choose not to offer sliding-scale fees out of concern some clients may not feel comfortable paying more or less than others. They may instead provide a certain number of pro bono sessions per week or find other ways to provide lower-cost sessions. For example, some therapists who want to serve clients from a wider range of socioeconomic backgrounds choose to offer some or all of their sessions through a local clinic.

Clinic-based therapists can often charge lower fees than therapists in private practice because they are not responsible for as many costs. Non-profit and public clinics may also receive money from state or federal grants or from charitable donations, which offsets their costs and allows them to charge clients less.

Why Do Some Therapists Charge So Much?

When you see that a local therapist charges $150, $200, or even more per session, it can seem unfair or greedy. A lot of people can’t afford to pay $600-$1000 per month to see a therapist!

However, most therapists don’t want to exclude clients based on income. This is why many choose to use a sliding scale, offer pro bono sessions, or spend some time each week providing therapy at an affordable local clinic.

Still, you might wonder why therapists don’t simply charge everyone less. If they’re so dedicated to helping everyone, why do they insist on charging more per hour than so many other kinds of professionals?

The main reason therapists charge so much is that it costs a lot to maintain a therapy practice.

Therapists in private practice have to shoulder similar costs as people who run small businesses. They have to cover rent for their offices as well as pay for their own insurance. They either have to pay assistants or spend unpaid time attending to various clerical and administrative tasks like filling out insurance paperwork.

After all of these costs are factored in, therapists take in significantly less per hour than what they charge per session.

Another reason therapy costs what it does is the degree of professional investment, training, and study required to become a therapist. Mental health is a demanding field and therapists want to make sure they’re fairly compensated.

Many therapists undergo a similar amount of education as medical doctors who charge even higher fees for their services. Then, for the rest of their careers, they have to pay for the continuing education they’re required to get to maintain a therapy license.

How Much Does Medicare Pay for Mental Health Counseling?

Medicare Part B pays 20 percent of the Medicare-approved amount for therapy sessions after you meet your deductible ($233 in 2022). Medicare-approved amounts tend to be lower than the amount private insurers pay (80 percent lower, according to CNN).

Participating vs. Non-Participating Providers

Therapists who accept Medicare assignment can’t charge more than the Medicare-approved amount, while providers who accept Medicare but don’t accept assignment can charge up to 15 percent more per session.

So while you’re only responsible for 20 percent of the Medicare-approved amount when you see participating providers, you’re responsible for 35 percent of the Medicare-approved amount for non-participating providers.

This means that if the Medicare-approved amount for a therapy session where you live is $150, you’ll pay $30 coinsurance to see a participating provider and $52.50 to see a non-participating provider.

You can search for the Medicare-approved amount for therapy in your area by using the CMS Physician Fee Schedule Look-Up Tool (the HCPCS code for 60 minutes of individual therapy is 90837).

How Much Does Medicaid Pay for Mental Health Counseling?

Medicaid co-pays for therapy are $4.00 or less if your income is at or below the Federal Poverty Level (FPL) and are a little more if your income is up to 150 percent of the FPL. Per Medicaid cost-sharing requirements, Medicaid co-pays aren’t allowed to exceed 5 percent of your individual or family income.

Clinics Are More Likely to Accept Medicaid

Because Medicaid reimbursement rates are relatively low, it’s rare for private practice therapists to accept Medicaid. Clinics, especially those run by non-profit agencies or the public mental health system, are more likely to accept Medicaid than therapists in private practice.

How Much Does TRICARE Pay for Mental Health Counseling?

The cost of therapy with TRICARE is the co-pay for a specialist visit, or about $30. There are some variations in co-pays, deductibles, and premiums based on what type of TRICARE plan you have.

TRICARE publishes a fact sheet listing its costs and fees annually. You can find the 2022 fact sheet here. TRICARE also provides an interactive tool you can use to figure out your co-pay on their “Compare Costs” page.

Note that TRICARE only covers therapy for the treatment of a diagnosed mental health or substance use disorder.

How Much Does Therapy Cost Without Insurance?

In summary, there are many factors that determine how much you’ll pay to see a therapist if you don’t have insurance or if you choose not to use insurance. These are:

  • The average cost of therapy in the surrounding area
  • The cost of living where the therapist’s office is located
  • Whether the therapist you want to see offers a sliding scale
  • Whether you’re eligible for therapy through the public mental health system
  • Whether there are mental health clinics in your area that offer therapy and whether you’re willing to get therapy at a clinic
  • Whether you’re open to receiving pastoral counseling and whether it’s available at your church or another location in the community
  • Whether you have integrated healthcare clinics where you live that allow you to receive medical and mental health care at the same location
  • Whether your state offers financial assistance for mental health services for people who are uninsured and whether you qualify for that assistance

In other words, what you pay depends on the average cost of private practice therapy where you live and whether you have affordable alternatives to private practice therapy. For example, while you might have to pay $115 a session to see a private practice therapist in your area, you may find that you can pay $65 at a local non-profit clinic and $50 at a community mental health center in your state’s public mental health system.

Federally Qualified Health Centers

Federally qualified health centers (FQHCs) often provide affordable therapy alongside affordable primary care. These integrated healthcare clinics are specifically designed to help people in underserved areas access affordable healthcare.

They accept a wide range of insurance plans. One special thing about FQHCs is that they always accept Medicare and Medicaid, while few private practice therapists do.

Even if you don’t have insurance, you can sometimes pay a single fee for all the care you receive each month at an FQHC instead of paying a fee for every service you receive. (This is also true of some other types of integrated clinics.)

You can use the online search tool on the U. S. Department of Health and Human Services website to find out if you have a FQHC near you.

In some areas, costs for therapy may not vary that much between these different care settings, but it’s always worth looking into a wide range of local therapy providers to see if there’s a low-cost option available to you. You can also call therapists you’re researching to find out if they offer sliding-scale fees or other cost-saving methods. You can often negotiate rates with a therapist.


At OpenCounseling, we recognize that our mental health system has serious gaps and that cost is a real and significant barrier to therapy for many Americans. However, we also know that there are more options for affordable therapy than many people realize, and our mission is to make it easier for you to find those options.

Check If You Can Save Online

BetterHelp (a sponsor of OpenCounseling) currently charges $320 a month to see a therapist online through their platform. They also offer financial aid between 10% and 40% for those who qualify. The weekly charge includes live phone or video sessions as well as messaging services. If you’re getting a weekly live session, this may mean that at $80 per session, BetterHelp is more affordable than other out-of-pocket options where you live.

In addition to participating in BetterHelp or other online platforms, some therapists offer online video sessions independently. In many cases, they offer sliding-scale rates for both online and offline sessions. This means you may be able to find a therapist who’s licensed to practice in your state whose sliding-scale rates for online sessions are lower than in-person rates for therapists within driving distance of where you live.

We hope this article has sparked some ideas and helped you locate potential resources for affordable mental health support where you live. Even if it takes a while, don’t give up—you may be closer to finding the help you need than you think.


Starting therapy can be scary, but we’re here to help

  • No more waiting days, weeks or even months to find a therapist. Sign up with BetterHelp and get matched to a therapist in less than 48 hours.
  • At OpenCounseling we have used BetterHelp and think they are a great option.
  • Get 20% off your first month with the link below.
Share article on social media

Related Posts

Deciding How and What to Pay for Therapy
Decoding the Forms of Payment Therapists Accept
Free and Affordable Marriage Counseling for Veterans
Free and Affordable Counseling for Veterans and Active-Duty Military Service Members
Employee Assistance Programs (EAPs) – Are They Right for You?
University Counseling Centers: Open To Their Community

Stephanie Hairston

Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments.

Voluntary health insurance - patient care under VHI in Medica

VHI is a voluntary medical insurance that provides an opportunity to receive medical services in private or public medical institutions in accordance with the insurance program.

How to get a VHI policy?

VHI for individuals:

Call any insurance company in St. Petersburg and find out: what is needed to obtain a VHI policy, find out how to receive medical services under a VHI policy in our clinic.

VHI for legal entities:

1. Contact the personnel department of the organization where you work and specify the possibility of issuing a VHI policy to you;

2. When applying for a job, ask an employee of the personnel department a question about providing a VHI policy. A number of organizations include this type of insurance in their social package.

How to get medical assistance under the VHI policy at the MEDICA Clinic?

Option 1: Call the insurance company at the number specified in your VHI policy and inform the dispatcher about your desire to contact our clinic for medical assistance. In a conversation with the dispatcher, voice the address of the medical center that you would like to visit.

Option 2: When visiting any of our medical centers, inform the administrator that you have a VHI policy of an insurance company (name). The administrator of our clinic will coordinate all the necessary actions with your insurance company and will discuss with you further actions related to receiving medical care.

Documents required for a visit to the clinic "MEDICA":

  • Passport
  • VHI policy

It is advisable to have on hand extracts and certificates from other medical institutions that are related to the disease.

When do you have the right to use the VHI policy?

You can use the VHI policy in the event of an insured event.

An insured event is your contacting our clinic in the event of an acute illness, injury, poisoning, exacerbation of a chronic disease for consultative, diagnostic assistance, as well as in other cases provided for by your insurance program.

Can I reimburse the costs if I submit supporting documents (cash receipt) to the insurance company?

No, when receiving VHI services, you do not participate in the process of mutual settlements, provided that the VHI insurance program does not provide otherwise. The insurance company organizes the treatment and pays for it directly to our clinic.

Why does my policy have exceptions?

In the insurance program, among the exceptions, diseases are indicated, the treatment of which is provided by public funds (that is, they are included in the range of free medical services). This means that no medical institution in our country has the right to provide services for the treatment of these diseases for a fee or through the VHI system.

To make an appointment with a doctor, call your insurance company, the phone number of which is indicated on your VHI card.

List of insurance companies with which contracts for the provision of medical care under VHI policies have been concluded:

  • PJSC IC "Rosgosstrakh"

  • JSC "Sovcombank Insurance"

  • SAO "VSK"

  • JSC "Insurance company "GAIDE"

  • OOO SK "Alliance Life"

  • OOO "Insurance company "Capital-Policy"

  • North-Western branch of OJSC Insurance joint-stock company "Energogarant"

  • North-European branch of JSC Insurance joint-stock company "Energogarant"

  • JSC Renaissance Insurance Group

  • AlfaStrakhovanie JSC

  • CJSC "Medexpress"

  • "North-Western Regional Center" branch of SPAO "Reso-Garantia", St. Petersburg

  • LLC "Absolut Insurance"

  • JSC United Insurance Company

  • LLC "British Insurance House"

  • JSC "IC "PARI" (branch "ADVANT")

  • LLC "SK "Consent"

  • JSC "Insurance Business Group"


  • JSC "Insurance company "SOGAZ-Med"


  • JSC "MAKS"

  • SPAO "Ingosstrakh"

  • OOO "SO "HELP"

  • LLC "SMP-Insurance"

  • LLC SMK "Astra-Metal"

  • JSC "Russian Standard Insurance"

  • LLC "Region-Medservice"

  • Capital Life Life Insurance LLC

  • JSC GSK Yugoria

  • JSC "Insurance company "POLIS-GARANT"

Contact person: Afanasyeva Olga Sergeevna

Phone: +7(812) 775-00-00 ext. 1012,

Mobile phone: +7(931) 351-45-65

E-mail: [email protected]

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Russia is changing the rules for helping cancer patients. Why are some doctors against the new order?

  • Oksana Chizh
  • BBC Russian Service

Photo by Valery Matytsin/TASS

Cancer patients in Russia may be deprived of the opportunity to choose their own medical institution and doctor. The new procedure for providing care for oncological diseases effectively leaves regional officials the right to decide where to refer the patient - to federal medical centers or to local hospitals. Opponents of change believe that when these norms come into force, hundreds of thousands of people will be hostages of the new system.

The order of the Ministry of Health on a new procedure for providing assistance to adult cancer patients will come into force on January 1, 2022. In April, the document was registered by the Ministry of Justice, despite the campaign of patients against its adoption in social networks and attempts by representatives of the medical industry to make their own adjustments.

The BBC Russian service looked into how the cancer treatment system would work and why it raises so many questions in the medical community.

Out of routing - at own expense

With the entry into force of the new rules, the routing of cancer patients in the region will be determined by the state authority - the local ministry of health.

The order stipulates that the regional authorities will now draw up a list of medical organizations that provide assistance to cancer patients, a scheme for the territorial fixing of medical institutions for primary and specialized oncological care, as well as a list of diseases for which telemedicine consultations are held with federal medical centers.

The document still contains a clause on the possibility of an oncologist from the primary office to send a patient to a federal medical center to clarify the diagnosis and determine treatment tactics.

But patients and part of the medical community believe that the order of routing enshrined in the order will violate the patient's right to choose the place of treatment, which is guaranteed to him by the law on the fundamentals of health care.

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"Excuse me, how is it so - routing and "has the right"? This is a violation of the basic principle of functioning of the [health care] system described in the federal law," says oncologist and hematologist Mikhail Laskov, founder of Dr. Laskov's Clinic.

Now - and until 2022 - CHI routing works through the issuance of referrals by the attending physician. Moreover, adds Laskov, for the time being, a doctor of any specialty can write out a referral for examination to the federal center for a cancer patient. The new order narrows these possibilities: from now oncologists of the outpatient cancer care center (CAOP) or primary oncology room will send patients to centers subordinate to the federal authorities.

"That is, we have already taken and limited the basic right of a doctor to refer his patient where he sees fit, because only an oncologist from the CAOP or office [now] can do this," Laskov emphasizes.

According to the current procedure, the attending physician still has the right to refuse a patient requesting to be sent from a regional medical institution to a federal center if he does not consider this request justified. "A referral is always the doctor's consent that it is necessary, and the patient's consent to go there, this is a matter of agreement," recalls Laskov.

But now, the oncologist believes, the regional doctor in this matter becomes completely dependent on officials.

“Even if he quietly issued [a referral to a clinic that is not on the list approved by the local authorities], the problem is that it cannot be used,” says the founder of Dr. Laskov’s Clinic. “The patient will apply with this referral to some organization , which is not included in the routing. And this organization will not take it, because it will not be paid. "

Before the new order, the doctor could neglect the recommendations of the regional Ministry of Health: routing existed in the form of a "local order": "well, they didn’t comply, and that, nowhere in the law is it written that this is a reason not to pay according to compulsory medical insurance rates," the oncologist explains.

Now going beyond the list of medical institutions established by regional officials is a violation of the order and a reason not to pay for the services rendered.

"That is, now, when a medical organization issues an invoice to the [CHI] fund or an insurance company, the insurance company will say, on completely legal grounds: it is written right there in the order that you need to follow the routing, but you didn’t. So, sorry, at his own expense," sums up Laskov.

Councils under strictly defined conditions

The tactics of treating cancer patients are determined by the council. The new order says that it should include oncologists, a radiotherapist, as well as a neurosurgeon when it comes to tumors of the nervous system, and it can only be carried out under certain conditions.

The document defines them as follows: "Treatment tactics are established by a council of doctors ... a medical organization, which includes departments of surgical methods for the treatment of malignant neoplasms, antitumor drug therapy, and radiotherapy."

That is, it turns out that part of the non-state oncological clinics that operate in Moscow and other large Russian cities fall out of the treatment process, emphasizes Ali Mudunov, head of the Russian Society of Head and Neck Tumor Specialists.

Mudunov is a member of the "Onconavigator" project, which developed road maps for cancer patients, and the head of the specialized department of the Lapino Clinical Hospital "Mother and Child". This center participates in the CHI program and, according to the doctor, provides assistance to several hundred patients with cancer from the Moscow region and other Russian regions a month, where it is rare to receive high-tech medical care and follow the necessary treatment tactics.

The new procedure for holding consultations will hit not such institutions as Lapino, but small private clinics that do not formally meet the requirements stated in the order, says Mudunov.

The author of the photo, Vladimir Smirnov/TASS

"We must understand that in making a decision about the treatment or diagnosis of an oncological disease, the main role is played not by machines, not by tools, not by equipment, but by the doctor," says Mudunov, "In this coordinate system you just need to analyze the information that the patient came with. The patient can bring the results of the examination with him and come to the consultation at any private clinic where there are specialists of the required level. In order for him to be diagnosed and prescribed treatment, it is not necessary that this clinic has radiotherapy department, as prescribed in the new order.

As a result, according to Mudunov, quite a lot of institutions will fall out of the total number of medical organizations that accept cancer patients under compulsory medical insurance.

"This, among other things, increases the workload of already busy state institutions - both federal and regional. And in fact, this will lead to an even greater decrease in the effectiveness of aid delivery: to an increase in the load on already loaded institutions, to an increase in queues and an increase in decision-making time, despite the fact that the time intervals for diagnosis and assistance are clearly regulated," Mudunov is sure.

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the format in which this service exists now: in practice, the organization of remote consultations may take not a couple of days, as expected, but from a week or more.

Mudunov's colleague Mikhail Laskov believes that the clause on consultations may have another negative consequence: according to the oncologist, this provision is worded in the order in such a way that it undermines the "basic principle of doctor's autonomy."

The consultation is convened at the initiative of the attending physician, but from the order, according to Laskov, it follows that such consultations are his duty even in cases where they can be dispensed with.

"So it turns out that there is an oncologist at the polyclinic. A man came to him and said: 'My mole is bad, it looks like melanoma.' now he can’t do anything at all. His organization should have an oncologist surgeon and a radiotherapist. He can’t even convene a consultation, because they are not in the clinic, "says Laskov.

"All Russian and international education assumes that if a doctor received a diploma, then he went through a specialization, passed a residency, this means that his role is to receive patients and prescribe treatment or examination for them. Otherwise, why is he actually needed? - he is perplexed doctor. "I'm like an oncologist now, why? Why? To issue a certificate? To take money?"

Invisible patients

It is not clear what tools the patient will have after the entry into force of the new order in order to get a referral to Moscow.

Now, if a cancer patient is dissatisfied with the quality of care in his region and for some reason cannot get a referral to Moscow or St. Petersburg from the attending physician, he still has ways to fight.

"For example, there is an option to write an application addressed to the head physician to issue an official refusal. You can complain to the insurance company, to the local Ministry of Health or the Department of Health, to the Federal Ministry of Health or even to the Prosecutor's Office, thus trying to get into the clinic where you want to be treated,” says Anastasia Kaflanova, director of the Leukemia Foundation.

The Foundation, which helps people with hematological cancers, cooperates with federal centers and a number of regional clinics. The main flow of patients in need of expensive treatment, which is not always fully paid for by compulsory medical insurance, comes from these institutions and from specific doctors.

The author of the photo, AFP

Kaflanova fears that the new procedure will increase the proportion of patients who will not be able to get the help they need in federal clinics at the right time, which means they will not fall into the organization's field of vision.

"It's no secret that the level of equipment and the level of staffing across the country is very heterogeneous and varies greatly. There is also a practice when doctors are simply afraid to ask for help. Because it is believed that we are all in the region, in our "The hospital has everything," says the director of the Leukemia Foundation, "There is also some additional psycho-emotional burden on the doctor. Ultimately, the patient suffers again. For us, as a fund, they will be simply invisible. For the patient, this can be vital, critical."

"Organize the system"

Supporters of the new order, however, believe that it - on the contrary - will streamline the system of assistance.

"Unified requirements have been introduced for medical organizations that provide assistance to cancer patients, including their capacity and structure. It is important that now any medical institution, regardless of the form of ownership, including private ones, providing assistance in the field of oncology, can general grounds to participate in the provision of medical care to the patient. The procedure does not establish prohibitions and does not restrict the rights of citizens to choose a medical organization and a doctor, "Medvestnik quotes Andrei Kaprin, chief freelance specialist-oncologist of the Ministry of Health, director general of the National Medical Research Center for Radiology, Academician of the Russian Academy of Sciences.

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