A Few Words About Insurance Coverage

Learning What Coverage You Have

As you likely already know, insurance coverage for psychotherapy has become more complicated over the past ten years or so. With HMO, PPO, POS, traditional indemnity plans, mental health carve outs, and a host of other arrangements, it’s impossible to know what your coverage is without making a phone call or two. Even then, you're not likely to get any guarantees of payment.

I have put together a list of questions to ask when you call your insurance company to find out about your "mental health" coverage. It should be helpful in getting the information you need.

Out of Network Benefits

Over the years, I have been on a number of insurance company panels as a "preferred provider." Increasing restrictions and demand for detailed reporting of client issues for authorization of additional sessions combined with shrinking reimbursement, led me to terminate all of my direct associations with insurance companies.

Even though I’ll not be a "preferred provider" for your insurance plan, if you have "out of network benefits," a significant portion of my fee may be covered. This is most likely the case with a PPO or similar policy but even some HMOs and similar "closed network" plans will pay a portion of my fee. The question is, "does my insurance policy have provisions for out of network providers of mental health services." A phone call to your insurance company is the only reliable way to find out. I have a billing service that will file your claims asking the insurance company to send the payment to you.

They are also issues like deductibles (how much remains to be paid) and limits on coverage (number of sessions and total amount paid per year). Also, some insurance plans require pre-approval of mental health services before the service begins, others don’t. You will find these on this list of questions for the insurance company.

Session Length, Fees & Payment Options

While the "old school" psychotherapy session is 50 minutes, I have found 90 minute sessions to be much more productive with the Mindfulness Based Psychotherapy and other health- and growth-oriented models of therapy I provide. The longer sessions allow therapy to move along more quickly, generally with fewer and/or less frequent sessions with the support of "homework" readings and practice CDs.

My fees are within the "usual and customary" range for this area of the country (i.e. $150 per therapy hour or $225 for my 90 minute sessions). My "typical client" comes in for two or three weekly sessions and then moves to a bi-weekly or once-a-month schedule. The total cost of my services can be less than the typical 50-minute-hour, once-a-week model (e.g. $150 X 4 sessions/month vs. $225 X 2 sessions/month).

Additionally, I have an informal "sliding scale" which drops my fee to $200 (and in certain cases even lower). This reduction combined with less-frequent sessions and an extended period payment plan (e.g. 12 months or more following termination of treatment) can bring my services well within just about any "monthly therapy budget."

We can discuss a fee adjustment or payment plan in a telephone conversation before we begin therapy if paying for the psychotherapy is a significant concern for you. I can be reached at 813-980-2700.

It is customary to pay for psychological services at the time they are delivered unless other arrangements have been made in advance. Payment may be made in the form of: (1 ) cash, (2) personal check, or (3) a major credit card including: