Paying for Treatment
Weekly therapy is a commitment and there are several ways to pay for treatment each with their own positives and negatives. When therapists accept insurance they must adhere to the policies and guidelines set forth by the insurance companies. I have described below how what I believe the impact of using insurance vs private pay affects treatment.
Using Insurance
Therapy Within the Medical Model of Health
Therapy through insurance is within the frame of the medical model of mental health. Similar to how you would see your primary care doctor for a medical illness or complaint, insurance companies view psychotherapy in the same way. Insurance companies see treatment as a way to quickly resolve the immediate symptoms. When the symptoms appear to be resolved then treatment is considered completed.
Impairment Focus and Insurance Limitations
Insurance companies focus on the impairment that an individual is suffering from. The impairment has to be significant enough that the individuals work, personal life and hobbies have been negatively impacted causing significant distress. This focus on the severity of impairment can sometimes lead to limitations on the duration or frequency of sessions, as insurers often impose restrictions to control costs. On top of this, insurance companies will only cover treatment that is directly related to interventions addressing an ongoing impairment. For example, if depression or anxiety reduce to a manageable state, and you are scoring low on the required assessments, treatment should be terminated. Self discovery or deepening your interpersonal relationsips outside of the context of a diagnostic disorder is not covered by insurance. These constraints can disrupt the natural flow of therapy and hinder progress for some who desire longer-term therapy working towards deeper change and self discovery when the symptoms related to the DSM diagnosis might have gone into remission.
Diagnostic Pressure and Therapeutic Process
Insurance companies require therapists to diagnose clients with a mental health disorder in order to justify reimbursement. While diagnostic assessments are a standard part of therapy, insurance companies only accept diagnosis from the DSM (Diagnostic and Statistical Manual of Mental Health). DSM diagnosis can be limited in scope and driven by external pressures such as pharmaceutical companies. For therapists, the pressure to assign a diagnosis to someone who does not meet criteria for insurance purposes can potentially contaminate the therapeutic process and alter treatment. Additionally, therapists may feel compelled to focus primarily on symptom management rather than exploring underlying issues or providing holistic support. A focus on treating the diagnosis can limit the available modalities used as well. Insurance companies will typically push for specific modalities that focus on symptom reduction, but do not look to address root cause (The Why).
Reimbursement Challenges
Have you ever wondered why you are having a hard time finding therapists that take your insurance? The reimbursement rates set by insurance companies are typically much lower than that standard private pay rate. As a result, many therapists decide to forego taking insurance as it often is more time intensive with documentation, claims filing and communication with insurance companies. Many providers will overbook themselves to provide the minimum amount of care to offset the lower rates. This is why you only see your primary care doctor for 15 minutes as they attempt to see 30 to 40 patients a day to earn more income as reimbursement drops. On top of all of this, insurance companies can audit documentation. This includes requesting all treatment plan and progress notes to review. If they determine services were not medically necessary they are able to recoup previously paid claims as 'claw backs' which would make patients liable for up to two years of session fees.
Importance of Accessibility
Despite these challenges, accepting insurance remains a vital means of making mental health care accessible to a broader population which is the reason I do reserve a portion of my caseload for insurance clients. I do my best to manage all of these pressures and to provide the best treatment under these circumstances as possible. However, it is important for clients to understand how involving insurance companies can impact your treatment and the ways that it can limit the type of care you receive.
​
I am happy to discuss during a consultation call if using your insurance would be the best option for us to work together.
​
Here are two articles if you would like to learn more
https://www.npr.org/transcripts/nx-s1-5028551
https://projects.propublica.org/why-i-left-the-network/
​
​
What Does That Mean for You?
I believe it is important to the therapeutic process to have an open and honest relationship and the impacts of economics on treatment is a part of that. Utilizing private pay for therapy reduces the impact insurance companies can have on your treatment as well as allowing us to tailor the treatment towards what best suits your needs rather than focusing on meeting criteria from a financial institution.
Using Out of Network Benefits
You do have an alternative to using insurance. Depending on your insurance plan you may be eligible for partial reimbursement for out of pocket expenses. Based on your plan benefits, the annual cost of treatment could be reduced significantly by submitting superbills and getting reimbursed by your insurance plan. You would need to look at your deductible and the OON reimbursement rate. These would be PPO plans not HMO.
​​
Private Pay Rates
I charge $175 per session hour. Session hour is 55 minutes and begins at the scheduled appointment time.
​​
​For standard talk therapy, clients can start to see see significant progress in as little as 6 months, but deeper core issues may take several years to resolve.
​
If you are interested in sliding scale therapy please reach out. I have a short form to complete for clients experiencing financial hardship and have a limited amount of spots open.
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (800) 985-3059.