Payment for services is due at the time of the session. For your convenience, we accept cash, checks, Mastercard and VISA debit and credit cards, and American Express. Flexible spending account cards are accepted in the office.
We will file insurance claims as a courtesy to clients. Filing a claim does not guarantee payment. Your insurance benefits reflect the contract between you and your insurance company.
Understanding your benefits coverage including copays, deductibles and coinsurance is your responsibility. We recommend that you contact your insurance company prior to your first session to determine your out-of-pocket responsibility.
Using Insurance for Counseling
Cost is a factor in any major purchase. Most of us pay significantly for our medical insurance benefits. Therefore, often we assume that we should pick a counselor from a provider list or call the insurance company. It is in your best interest to be an informed consumer, and consider the pros and cons of using insurance for counseling.
When you start your provider search on the internet, it won’t be long before you find that many counselors, and a growing number of psychiatrists, are not on insurance panels. You owe it to yourself to consider why some of us avoid managed care.
Whenever there is third party involvement, confidentiality is out of the control of the therapist. Information about the content and progress of treatment is required on every claim. The insurance company does not spell out how they will communicate that information or protect you. Once information enters the company computers, others have access to your personal information.
You almost always have a deductible. This is the amount you are expected to pay out-of-pocket before your insurance covers anything. Know what it is. You might be able to see a therapist for several visits without touching your insurance if the deductible is high.
Your health insurance may not include mental health benefits. If you have coverage, you may have an entirely different policy for mental health or a different insurance provider altogether than you do for your physical health benefits. To get accurate information, get the right company for your questions about counseling.
Every insurance claim must include a diagnostic code. That is like saying everyone who sees their general practitioner must be diagnosed with a cold, at least, when they may or may not have one.
Therapists use the Diagnostic Statistic Manual for diagnosing. Though the DSM provides guidelines for diagnosis, coding by the practitioner is somewhat subjective. I collaborate with my client when giving a diagnostic code, but not all providers discuss the diagnosis with their clients. Since you generally don’t see the complete filing of your claim, you might want to ask about the diagnosis before it becomes part of your permanent record.
Insurance companies often limit the number of sessions they will cover. This may be before you are ready to end therapy. Some folks would feel like there is something wrong with them or their therapist if an issue is not resolved within a certain number of sessions. People are different and they can decide when they are ready to leave therapy or work on another area of concern.
A diagnosis could be less or more severe when managed care is involved than if the client self-paid. Clinicians generally know which diagnostic codes insurance covers and which are more questionable. Though all clinicians use the DSM-IV for diagnosis, the use of a specific code is still somewhat subjective.
Most insurance policies do not cover couples counseling. Couples counseling is considered a V-Code which are generally excluded from the list of covered services. Most of us know that poor relationships contribute to anxiety or depression, but it still is excluded from most policies.
A therapist on an insurance panel is working for both client and the insurance company. This is a potential conflict of interest. If a therapist gets referrals from the company, he/she needs to remain in good standing and work within the parameters of managed care. Occasionally, even out-of-network providers have been asked specific questions about their treatment of their client by insurance companies.
It is difficult for therapists to run a quality practice based on the low reimbursement that insurance companies usually set for counselors. Instead of spending time and energy on the extensive reporting required to file insurance claims, we prefer to be caring for you directly or learning something new.
Hopefully, you now have some things to consider when thinking about insurance. Please call your insurance company so you know the provisions and limitations of your particular policy.
If you are considering using your insurance for psychotherapy, it might be useful to ask your insurance carrier or human resources department to clarify policies regarding managed care, coverage for psychotherapy, treatment reviews, the accessibility of information, and clarification on how confidentiality is preserved.
Psychotherapy is a long-term investment in yourself.
As you weigh the cost of psychotherapy, it is important to consider the life goals you have not yet reached-your goals as they relate to your work, your relationships, or simply the day-to-day quality of your life. Because psychotherapy can help you make choices that will affect your entire future, it might be thought of as an investment in yourself-an investment on a par with education or other forms of self-development. The positive effects of psychotherapy last a lifetime. Only you can decide whether the potential gains will compensate for your investment in money and time.
Managed care companies do prefer for you to work with their “approved providers”; however many managed-care policies will allow you to use an “out of network” provider. Most often managed-care companies reimburse you at a different rate for “approved providers” versus “out of network” providers. So, quite often you will have the option to use a counselor who is not on their providers list, but your reimbursement rate will probably be somewhat less.
Of course, everyone wants to take advantage of their insurance and save some money! But, there are several reasons many people pay for counseling services “out-of-pocket”, rather than using the insurance coverage. (Please also review my reasons for not accepting insurance on my insurance page.) This is especially true with managed-care policies, which have as part of their purpose to limit services to the bare minimum “necessary”. And of course, they determine what is necessary. Some of the reasons you might want to consider paying the cost of counseling out of pocket instead of using insurance include:
1) Confidential and privileged information nearly always must be given to the insurance company in order to have services approved or to be paid for services. This information may be passed on, even without your consent.
2) Counseling services can be delayed and/or interrupted due to insurance denying initial approval or resisting the approval of additional treatment beyond a first few sessions.
3) Insurance companies often initially deny payment for counseling, even when the use is quite legitimate. Insurance companies base their approval for payment on “medical necessity”, which they define and determine. In other words, they make the client and counselor prove to them there is a need for counseling that is directly related to the client’s health. If your claim is denied you do have the right to an appeal process; however the appeal process can be tedious, time-consuming, and stressful for the client.
4) Insurance payments for counseling nearly always requires assigning a diagnosis of a mental health disorder. Many appropriate uses of counseling do not involve an actual pathological condition. Counseling for family problems, marital difficulties, adolescent angst and similar issues quite often are not covered by insurance, unless the behavior becomes serious or it is considered part of a more severe mental health disorder. When a legitimate mental health disorder exists, once the diagnosis is presented to the insurance company it becomes part of the client’s permanent medical record and may have future implications (difficulty changing insurance, ineligibility for certain jobs, denial of life insurance, etc.) This is especially concerning when it involves children or adolescents clients.
5) If you need or want to change insurance companies in the future, your rates may be higher (or you may be denied insurance) due to your medical record showing a history of using insurance for treatment of a mental health disorder.