Fees for a 50-minute hour

Psychotherapy / Counseling / Coaching —$120

Hypnothearpy — $150

Clients are giving away control of their therapy when they rely on insurance coverage - to a company that has profit as its only motivation. Money guides every coverage decision. Clients often wonder why it would be better to pay out of pocket for psychotherapy. After all, they are already paying for the health insurance - clients are paying but not controlling. That impacts you in important ways and here’s how.

Control of your therapeutic journey.

Insurance companies can and do arbitrarily make a new rule, change a rule, change the amount of each session that they will pay for and thus increase your co-pay. For example, Vermont Medicaid just decided to cut therapist rates from $101 to $88, a $13 pay cut for me. Really? Sometimes they make mistakes, pay the provider the full fee, then months and months later say, ooops, they are going to charge you for their mistake. Sometimes a client does well, improves and meets goals quickly, so that is the end of their coverage and the end of therapy because the company says so. And some companies allot only a set number of visits per year. It isn't possible to just have on-going support via a therapist in the insurance company system - managed care by them, not you.

Research shows that it is not specifically what therapists actually DO that makes a difference and helps people grow and change when they come for help – it is the relationship therapists BUILD with their clients that makes it happen. Good rapport is magical. But from the insurance company perspective, one therapist is as good as any other, switcho-chango, no big deal. If you and your therapist have built up a rapport that helps move your life forward, it doesn't matter to the insurance company. If that’s the end of their willingness to pay, you are done.

I have seen this happen in my own practice: a major insurance company made a new rule and some of my clients suddenly had to make the choice of being referred out or self-pay. Two had just had relationship break-ups, one just changed her job - really bad timing. Continuity of care is meaningless to them. For insurance companies, that is irrelevant. I was given 2 weeks to help them figure out how they were going to pay for therapy, including moving from weekly to biweekly sessions, or help them find someone new in a very limited market. There just aren't that many of us out there able to take on new clients.

Same thing if you change jobs and the new job doesn't offer the same insurance company and your therapist doesn't take the new one. Stuck again – everyone controlling your health care options but you.

That is why therapists offer fee for service self-pay care. In this scenario you say when you start and end therapy, period. The care you get is decided by you and your therapist, not a managed care administrator.

Control of your information.

Mental health is stigmatized in this country, especially some diagnoses like my own specialty, Borderline Personality Disorder. (People are often labeled 'Borderlines' as if it were their identity.) When you allow the insurance company to decide your therapy options, you also give them the ability to limit your privacy. Your provider has to give a diagnosis code in order to get paid and that is sent to the provider with every claim billed. When they audit your therapist for compliance, they can read all the notes your therapists has written about your personal care. They decide if you really need it; if not the provider has to pay the company back and you have to cover that anyway.

With self-pay your information is stored in your therapist’s HIPAA-compliant system with you in control of who sees what. Yet another way of becoming the heroine of your own life.

Out of Network Benefits.

Help with getting whatever Out of Network Benefits are available. Most fee-for-service therapists will offer a ‘superbill’ at the end of the month which is like a receipt for the payments you have made, and you submit it to your insurance company for reimbursement if you have Out of Network Benefits. I can do a bit more: I will take the reimbursement application (‘superbill’) off your hands and submit it from my office and you wait for your reimbursement.

A bit of advice, too. If you have an FSA, HRA, or HSA, you can put aside pre-tax funds toward covering therapy. These two things can help you save a penny.