Rates, Payment, and Insurance Questions
We understand that therapy is an investment, of your time and money, into yourself or perhaps into your relationship, and the therapists in our practice do everything we can to help you to maximize your investment. Rates for the standard 50-minute appointment are $160 for Dan Fajans, Lisa Stewart, and Bill Aloe; $175 for Corey Thompson and Mary-lynn Ballew; $195 for Justin Pere. We do not charge more for the initial intake session, nor do we charge more for couples or family therapy than we do for individual therapy.
Health Savings Accounts and Flexible Spending Accounts
We are happy to run your sessions through your health savings account (HSA) or flexible spending account (FSA), which can be used to pay for medical expenses such as therapy and can often significantly decrease the cost of treatment.
Do you accept my health insurance?
The answer to this question varies, and has important implications for you as the client (whether you choose us or another therapy practice), so we ask that you please take a few minutes to read the rest of this page. We are going to be much more transparent than most therapists probably have been, or will be, with you about the realities of using health insurance for therapy, so that you can make an informed decision about this important choice.
The short answer is this: For individual clients, we provide invoices for reimbursement of whatever their out-of-network benefits will cover. Probably half of our individual clients choose to submit to insurance for out-of-network coverage, and what we most often see is 20-60% reimbursement (for example, Premera most often reimburses $94 per session). For couples clients, health insurance does not pay for relationship therapy. We know that this is often surprising and unwelcomed news but it is how insurance companies operate. A detailed explanation of this can be found below.
The longer answer, that is just as important: Insurance companies do not want to have to pay for your therapy. As a result, they have very strict rules around who can use health insurance, and for what. These rules are the exact same for therapists who work "in-network" with insurances (as in, are contracted with insurances) or who work "out-of-network" (like us), and what is outlined below applies to all insurance companies, regardless of how wonderful someone's policy may be.
The following is what we believe is important for you to know about health insurance:
The Requirement of Providing a Mental Health Diagnosis
Insurance companies will only authorize services that they determine "medically necessary". In order for therapy to be considered necessary, your therapist must determine and then provide a mental health diagnosis to your insurance company. It often comes as a surprise to clients when they learn that therapists are required to assign a mental illness to clients in order to utilize insurance benefits, and that this diagnosis becomes part of the client's permanent medical record within the medical system. Common diagnoses are Mood Disorders (Depression, clinical Anxiety, Bi-Polar), Phobias, Social anxiety, OCD, PTSD), Adjustment Disorders, and Personality Disorders.
There are some situations where this mental health diagnosis can be used against you, which is something clients should be aware of.
Accuracy of a Mental Health Diagnosis
The therapist must be able to prove that the diagnosis provided to insurance is 1) accurate for this client and 2) primarily what is being treated in session. Failure of a therapist to provide an appropriate mental health diagnosisto insurance agencies is considered substandard care, unethical, and illegal (insurance fraud).
It should be noted that therapists are extremely careful not to provide a mental health diagnosis that is any more serious or stigmatizing than necessary. However, we are required to choose an appropriate diagnosis, even though we realize a client’s medical records could be summoned at any time. We are required to maintain a client’s chart with all of their information, including this mental health diagnosis, for 7 years. During that time, insurance companies can request the client’s records.
It is important to know that the use of insurance to pay for therapy compromises your confidentiality. There are some situations where your mental health records, including your permanent mental health diagnosis, can be used against you:
- When applying for life insurance or long-term care insurance, all medical records, including mental health records, are likely to be evaluated. Certain diagnoses, such as Depression or other mood disorders, can result in an increased rate and/or the rejection of your life insurance application.
- If you are summoned in a court proceeding such as a divorce, a custody hearing, or as a witness, your medical records can also be subpoenaed and used against you.
We sure don't like to give this news but here it is: health insurance does not cover couples/marriage counseling. It certainly should but it does not. Per the "medical necessity" requirement outlined above, couples are rarely entering into therapy to primarily focus on one person's mental illness. Instead, couples seek counseling for reasons such as communication, connection, conflict, parenting, premarital, sex, betrayal, life changes, etc. And in our opinion all of these should absolutely be covered by health insurance, but they simply are not.
We are sometimes asked if we will bill the couples sessions as individual sessions in order to have them covered, and we hear that some therapists have allowed couples to bill insurance in the past. Billing insurance as an individual session when it is couples therapy isinsurance fraud and puts our license at risk, among other penalties. We are very willing to walk up to the line but we cannot cross it.
Every once in a while a couple is indeed seeking couples therapy for the purpose of focusing on one person's diagnosable (or previously diagnosed) mental illness, in which case we can provide you with an invoice for reimbursement. However the therapist must be able to prove that the problem(s) in the relationship is adirect result of the "identified patient's" mental illness, and that the time spent in couples therapy is only to address that issue. Again, medical necessity is in play here.
So where does this all leave you?
This was a lot of information, we know. Though perhaps overwhelming, it's intended to help you to make an informed decision about your health care and to protect your health information. If you have any other questions please don't hesitate to reach out by phone or email. And if you know what you need to know about cost and insurance, feel free to request an intake call with Makenzie, our intake coordinator.