Payment Questions

I have worked with public and private insurance for years and have come to the conclusion that HMO insurance is a mixed blessing. On one hand, you pay a lot for it and certainly may want to use it when you need care.  However, managed care companies ask for very sensitive clinical information to make their decisions about exactly how much care they will pay for. This can include detailed information about your family history, your diagnosis, any feelings you may have about self-harm, or information related to trauma. Even though your policy may say that you get many sessions per year, they often will not pay for more than a few sessions unless your life or health are seriously at risk, and they may only approve a few sessions at a time.  This makes it difficult to know how much time you have to work with, and they may stop paying rather abruptly. They also make a practice of making clinicians spend a lot of time tracking billing and appealing sessions, which often results in sessions not getting paid for, and I prefer not to spend my time negotiating their systems.   As a professional, I believe the most effective and ethical treatment requires that decisions about your treatment be made by you and me.

I see people for an initial evaluation session, which is usually 90 minutes long and which costs $190.  During that time, we will look at the problems you are having and discuss what is likely to be required to help you with them.  Sometimes people come for a few sessions and then come back later if they need to, some people work on one problem at a time with time off in between, and others come weekly or biweekly to work on more complicated issues.  We will decide together what makes the most sense clinically and in terms of your time and your budget.  Some people have access to "Flexible Spending Accounts" at work, which allow you to save pre-tax money to pay for medical expenses not covered by insurance, including co-payments or the full cost of therapy sessions.  Many people do have an "out of network" provision in their insurance plans, even if it is mainly an HMO policy.  If you use an "out of network" option, the insurance company receives only your diagnosis, dates and kinds of sessions but no other sensitive information.
 

However we decide to manage payment, I ask that people pay their portion of the fee at each session, which prevents people from building up unmanageable bills and reduces my billing expenses.