Thoughts on how to manage the cost of therapy and problems with insurance

You may have questions about how you are going to pay for therapy and whether you must use your insurance. There are probably more choices about how you can afford therapy than you may realize.

I feel third-party payers can sometimes hinder therapy. They can be helpful, even necessary, when there is an emergency or grave illness that requires heightened levels of care, such as hospitalization, but that is the exception. I am a provider for Blue Shield insurance and I work and have worked with other insurance companies as an "out-of-network provider" and will help get you reimbursement when possible, if that is what you request. 

About my fee: I have a fee (my "standard, full fee"), which I do not advertise, that is comparable to typical local PhD therapists' fees. Often I adjust my fee to accommodate financial difficulty of a patient, although my policy is not technically a sliding scale. A sliding scale would mean that fees are always a set percentage of whatever your income is. You and I will discuss during the first session what would be fair and acceptable to both of us, and this usually results in a satisfactory arrangement However, if we cannot find a mutually agreeable fee, I will help you develop an alternative plan for finding therapy.

THIRD-PARTY PAYERS: INSURANCE AND HEALTH CARE PLANS

Seeking insurance reimbursement: You pay the fee and then afterwards submit to the insurance company a completed "super-bill" that I provide for you. A super-bill includes a diagnosis, dates of treatment, type of treatment, and anything else required by the insurance company. The insurance company then decides whether to reimburse you.

By law, health care plans must cover mental health treatment. Two laws in particular, The California Mental Health Parity Law of 1999 and The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2010 require "parity," or equal coverage for treatment of physical disorders and mental disorders. This was intended to ensure that people who need help got help but there are consequences of this. These laws defined mental illness as a medical disorder, guaranteeing it is covered by insurance. But that means to be covered, you have to be diagnosed with a disorder, which then allows insurance companies to dictate how you are treated. It also leads people to believe that you can only get help if your insurance company agrees that you have a mental illness. However, wanting therapy should not mean you must be diagnosed with a mental disorder.

HOW IT WORKS GETTING THERAPY WITH ME THROUGH INSURANCE:
I require that my insurance patients pay me my normal rate at each session and then get reimbursed by the insurance company. I help with all the paperwork required for my patients to get reimbursed. The insurance company covers about half of my fee, so they will reimburse that amount minus any copay and deductible they require from the patient.

If you decide to get therapy through your health care plan, it requires their pre-approval and that you accept their conditions. Some of the drawbacks of using managed health care to pay for therapy are:

1.) Therapy must be justified as a "medical necessity" to get coverage, which means you will be given a diagnosis of a mental disorder. This diagnosis, which is out of your control, will become a permanent part of your medical record.

2.) Restriction of treatment: Insurance companies and health care plans carefully dispense approval for treatment and their main concern is their financial bottom line. They approve a block of sessions at a time (usually 6 or 10 session) that must be renewed repeatedly. When they decide you no longer require treatment, you are not allowed to get it. Some insurance companies forbid their customers from continuing their treatment, even by paying out of pocket, after they have denied coverage.

3.) Treat the disorder or treat the person? The goal of managed health-care is to prevent and cure diseases and disorders at the lowest possible cost. The prescribed treatments for mental disorders focus on managing symptoms. Psychotherapy, I believe, should be more concerned with who you are and who you are becoming rather than simply managing symptoms. As patients grow and become stronger in therapy, the original diagnosis (and corresponding symptoms) typically becomes less important. Who you are as a whole person should not be ignored due to the fiscal decisions of a managed-care organization.

4.) Insurance companies and health care plans offer you a limited choice of providers. Most insurance companies have panels of approved providers. You might find a good fit with someone on their list, but you might want to work with someone not on the list. The relationship with your therapist is the single most important part of your experience, so choosing someone with whom you actually want to work is essential. 

DIRECT PAYMENT FOR THERAPY

1.) Financial well-being and mental health: This is not a guarantee or promise, but I have never had a patient in worse financial shape after being in treatment than when they started. This is neither a magic trick nor a stated goal of treatment; it simply reflects the growth that people experience.

2.) Flexible fees: Even though therapy does require an investment of time and money, many therapists, myself included, are willing to work with people at somewhat discounted fees (see above). Therapists who value the work enjoy working with people who desire be in therapy.

3.) If you cannot afford a typical private-practice fee, there are other options (see the Links tab at the top of this page). Training centers and lower-fee clinics offer quality therapy. There are potential drawbacks to going to a clinic that is a training center: limited experience, the likelihood that they will be at that clinic for a limited time before moving on, etc. But highly gifted and skilled therapists can be found at these clinics.

4.) There is a mutual give-and-take when you pay directly. You have more control, power and dignity.

You have choices in the process of finding an affordable and qualified therapist. I have known many people who prefer to use their insurance and they are satisfied with doing it that way. But there are many people who pay themselves and find it affordable and meaningful to handle the responsibility.

Thank you for reading and congratulations on considering something so important and valuable! If I can help you in your search, please contact me and tell me what you are looking for.

Dr. Yates