Fees, Payments & Insurance

What you Will Find in This Section:

"Cost Effective Treatment?"

    I am a fee-for-service provider. This means that I do NOT accept insurance for my services. This may sound a little strange to you if you have never obtained health care by paying out of pocket for it, but there is a good reason why I have chosen to practice this way. As managed care providers continue to demand more out of providers, we are left in a position that makes providing effective mental health services difficult. Managed care companies are asking therapist to limit their services to the most "cost effective approaches." This sounds reasonable right? It is absolutely reasonable, unless you happen to be one of those people who needs therapy to help you with issues that are more serious than a phobia of transitory depression. "Quick Fix Therapies", as I call them, are appropriate for some clients, but most people who seek out therapy are not looking for the quick fix.

    Many people go to therapy because they are suffering and want the type of help that requires more time and more in-depth psychological services than is allowed under most health insurances. In this case, most people start therapy, use their allotted number of sessions and then decide if they want to continue to see their therapist by paying out of pocket. If you have a good relationship with your therapist. This is very common, however, what if you cannot afford to pay the new higher rate? Your therapist may not be able to afford to do this for you. You end up being referred to another therapist or your therapist has to take a big pay cut to continue to see you, and most of us cannot afford to do this. Unlike doctors and other medical providers, there is a limited number of clients that I can see and remain effective. Thus the $85.00 fee to see your doctor for 15 minutes or less is something he can afford. Losing this fee for therapists is too much of a financial loss. When you pay for therapy, you pay for your time. A therapy hour is a therapy hour. Thus, I opt to set my fee with a client from the start so that we both know what to expect from the beginning. I won't suffer a major financial loss and you won't get hit with the payment shock.

Service and Treatment Choices

   In addition, I also chose not allow an insurance company to dictate the type of therapy I provide and the length of time needed to help someone. Some clients may only need a few sessions, while others truly need several months and sometimes years. Paying a fee-for-service fee gives me the freedom to offer you a wider range of services and remain true to the quality of service I can offer. It gives both of us options.

    It is my belief that the restrictions placed upon providers by insurance companies have so interfered in the practice of therapy that clients are poorly served overall, despite our best efforts. Patient's well-being is not prioritized by insurance companies. There are large numbers of therapists who are taking a stand against severely restricted insurance companies and their practices by offering fee-for-service therapy only, like I am. In order to do this, therapists have had to use sliding scale fees to ensure that patients can afford their treatment.

Negotiable Fee

    I offer a negotiable fee so that money doesn't have to be an obstacle to obtaining therapy from me. Please note that I do have a limit as to the lowest payment I may offer clients. I also have to survive and pay my bills so that I can continue offering high quality therapy services to my clients. You and I will negotiate a fee during the first session. If we cannot agree upon a fee that is reasonable for both of us, I will refer you to a therapist who will be able to help you.

Patient Privacy - The Heart of Things

   Another reason that I have chosen not to take insurance is privacy concerns. The more an insurance company wants justification for therapy services, the more they want to know about your mental health. This requires that I give you a diagnosis that meets their standards of "medical necessity," that I provide them with a report of your progress and they may expect a treatment plan. In addition, therapist files are audited by insurance companies, to ensure that the patients are being treated the way therapists report and to be sure that the records are in-keeping with their standards. Your mental health records become a part of your overall medical records, and the information contained becomes a permanent part of your records.

    The honest truth about "medical necessity" criteria - In order for a therapist to get paid, you have to be ill. You have to have a diagnosable psychiatric mental illness, according to the standard psychiatric diagnostic criteria found within the Diagnosis and Statistical Manual (DSM-IV T-R).  In reality, most people who go see a therapist are not mentally ill, per say, but see out therapy to help them cope with difficult, temporary life crises or relational problems. Even if a person who attends therapy does have a mental illness, the reason for seeking out therapy typically is NOT for treatment of the illness.

    For example, lets say that you are breaking up with your spouse or life partner. The two of you have been together for 8+ years or longer, and the end of the relationship along with all the struggles of dividing up a married life is excruciating! You have a lot of moodiness, depression, trouble sleeping, anxiety, nightmares and sometimes you just don't want to get out of bed in the morning. The diagnosis that is appropriate for you, if you do not have a history of mental illness, is an adjustment disorder. You are going through a hard time and seeing a therapist will help you through this difficult transition. Well, many insurance companies will not pay for adjustment disorders, or limit the type of services that a therapist can offer for you. You may not be able to have more than 10 sessions. In truth, most people take a good 6 months to 2 years to come back after a major break-up. Two and a half months of therapy, while helpful, is not nearly enough time for this type of issue. You really may benefit from having the extra support for the full 6 months to a year. But, if your insurance company doesn't pay for adjustment disorders or severely limits the number of sessions, then I have to diagnose you with another disorder, like Major Depressive Disorder or Depressive Disorder NOS, or an anxiety disorder. All the sudden, you have a psychiatric illness on your medical record. This is known as "upcoding." The opposite also happens when  client is being treated for a serious psychiatric disorder, but insurance won't cover certain diagnoses, so the client's diagnosis is downgraded to what insurance will cover.

    The required "medical necessity" criteria has left many therapist giving diagnoses that are not accurate to what their patient actually is struggling with. While this is not an ethical practice, it is done routinely to qualify clients for their insurance payments. These diagnoses become a permanent part of your medical records. The diagnosis is recorded in your insurance company records and will be revealed as they deem appropriate. This can have very damaging consequences to patients. A mental illness diagnosis can disqualify you for future insurance coverage, as an existing condition, and be revealed to other entities who request your medical records. In refusing to accept insurance, I eliminate the need to diagnose clients for insurance purposes. You never have to inform anyone that you ever went to therapy. It allows me to protect your interests as much as possible under the law. And believe me, many people inquire about your health history.

    Under current law, your mental health records are only disclosed under certain circumstances, however, there are many instances when we, as providers, or insurance companies are not required to obtain your permission to provide your records to third parties. Thus your records can be accessed without your knowledge, and not necessarily for your benefit.

    Without insurance company records, the only records to worry about are my records. This severely limits who can access your records. There are no audits of my files. I am solely responsible for your records. No other healthcare provider, insurance company, or other entity can access your files without your written permission. This is the best safeguard of your privacy. It leaves you in control 100%.

    There is only one exception to this, and it has to do with court proceedings. A judge can order me to produce your mental health records if they are absolutely necessary in a legal case. No one but the court can do this. Your attorney cannot obtain your records without your permission, an attorney of someone else cannot obtain your records, and no police or anyone else can have access to your files without a court order from a judge directly ordering me as a therapist to produce your records. Because of this, I am very careful in how I keep your records. What I do is focus on the services that I provide to you and the reasons why I provide them. Thus your confidentiality is protected in all ways.

Diagnosing

    Because I do not need to use a diagnosis for your health insurance doesn't mean that I do not document a diagnosis in my therapy records; I do. The good news is that I will give a diagnosis that fits your situation and is practical for my use; it won't necessarily be a psychiatric diagnosis, unless you already have one. My diagnoses fit the type of issue you bring to therapy. I won't evaluate you for a mental health diagnosis unless we discuss this. Practical diagnoses are used for the purpose of planning the most effective treatment for your needs. I am very careful about the type of diagnosis I give to my clients. You are always welcome to inquire about my diagnoses. This way you are never left guessing and wondering. You and I also will develop a "treatment plan" together so you always know what to expect and the type of service I am giving you.

Payment Options and Financial Policies

    Your first appointment is free. I do not charge for an initial consultation. I offer this so that you can meet with me, see if I am the type of therapist you would be comfortable with and then we can establish a fee if you decide you would like to continue seeing me. It gives you a chance to shop around for the right therapist for you. While I have a lot of experience, I do specialize and may not be the right person for your particular needs. Because of this, I believe an initial consultation is the best way for both you and I to determine this.

    If we do agree to enter into a business relationship, we will establish a fee at that time. I am able to take checks, cash, money orders, e-checks and credit cards. Most of my clients opt to pay for therapy using e-checks or their debit cards. I utilize a service called Therapy Partners who enable me to accept payments transferred from your bank to mine! It is an excellent and safer method of payment and you will always have access to your statement on-line. If you chose to pay by check, cash or money order, then your payment is expected at the time of service. I prefer to be paid at the beginning of the session to prevent the end of therapy discomfort that many people experience when trying to write a check at the end of a therapy session. This can be awkward especially if we have an emotional session. Paying at the start of a session tends to be much more comfortable for clients because it allows a natural transition at the end of the session.

   If something happens to change your financial status during our therapy, please let me know right away so that we can work out something to accommodate your needs as they change. If for some reason you lose the ability to pay for therapy, inform me of this right away. I may be able to work out something with you. If we do arrange for a payment plan in this circumstance, I have a maximum amount of $1,000 to be carried, unless we make other arrangements. This is for ethical reasons. If we need to make additional adjustments to help you, we will. It doesn't necessarily mean you will have to stop treatment. It depends on your individual situation and my ability to accommodate it as a business professional at that time.

    If you are unable to attend a session, I will charge you for the missed session unless you are able to make up the session later during the same week. If you are out because of a major illness or extended vacation, an exception can be made at my discretion. I am not going to be unreasonable about this, but what you are paying for in therapy is both my time and my services.

    I do not charge for emergency crisis calls, unless the call lasts over 20 minutes. I will then charge you for the call in increments. So, if you call me during an emergency and we spend an hour on the phone, I will charge you the full fee for the time. However, if we are on the phone for 30 minutes, I will only charge you for a half a session.

    I do not charge for messages left or referrals. If you request a copy of your mental health records for some reason, I will charge you for my time and the cost of the materials. If you would like a copy of your mental health records, for personal information, I can offer you a summary of your records, which I will type and is less expensive than providing you with an entire copy of the chart.

Links

For more information on therapy and managed care, go to Dr. John Riolo's webpage and click on the Psychinsiders "The Insider" link. He has several articles in his website that are aimed at educating consumers about therapy, the practice of therapy, and insurance companies, along with many other articles about the practice of psychotherapy. Due to his copyright, I cannot directly link you to his articles.

Insurance Payments for Therapy         Insurance and Therapy         Advantages of Paying for Therapy "Out of Pocket"

Therapist Reports to Managed Care Companies Destroy Privacy          Lost Confidence and Confidentiality in Psychotherapy

What You Should Know About Using Health Insurance for Psychotherapy          Confidentiality of Records and Managed Care