Fees

Adults $120 per hour (this rate is based on 50 minutes in the office).

Children $135 per hour (this rate is based on 50 with child in the office, plus communication between session with the childs primary care provider).

I offer reduced rates or sliding scale for those with expressed need

 

Insurance

I'm not able to control confidentiality as carefully when insurance is involved (insurance companies require specific information related to your therapy). Additionally, insurance companies only pay for services which they determine are "medically necessary" which "always" requires a diagnosis. While I don't subscribe to a medical model where everything has to be pathologized, I do understand that for some using their insurance benefits is the only option. If you choose to utilize your insurance benefits AND if I determine you meet medical necessity then I am able to bill the following insurance companies for your treatment.

Insurance Currently Accepted

BLUE SHIELD

MAGELLAN (Magellan is often contracted to manage the behavioral health needs of clients with the following insurance plan: Blue Shield, Kaiser, Western Health Advantage, Medi-Care and Medi-Caid).

MANAGED HEALTH NETWORK (MHN) includes Health Net

SUTTER EAP (I am not yet contrated with Sutter Select)

CALIFORNIA HEALTH AND WELLNESS (also called CENPATICO)

ANTHEM BLUE CROSS EAP (includes Unicare, Wellpoint) "I am not contracted with Anthem Blue Cross just their EAP program.

OTHER: If you do not see your health plan above I encourage you to call the Behavioral Health number on the back of your insurance card. Insurance company contracts change frequently so it couldn't hurt to ask. If they do not show me as a provider you can ask them to contract with me on a one time basis to meet your needs (no guarentee but they sometimes are willing/able to do so).

 

WHAT A 50 MINUTE HOUR REALLY LOOKS LIKE (to the therapist)

Therapy sessions typically last 45 to 53 minutes. This is time that is prioritized just for you (or your child). It is the time that I will work face to face with a client to help them identify their goals for treatment and work towards the achievement of such. This is the time clients see their therapist working on their behalf …. But there’s much more going on before and/or after each session.

BEFORE EACH SESSION: When a client begins the process of looking for a therapist they often talk with friends, family and/or other professionals. They may look the therapist up on-line to see what others have said about them such as on insurance sites where the therapist has a profile. They often also look at sites such as Psychology Today or GoodTherapy. These sites help therapist become visible to clients searching for specific specialties, locations and/or payment options. Each therapist is responsible for completing and maintaining these sites to assure that they accurately reflect their services. Therapist often will develop a separate website. Mine is artwithpurpose.org. While Psychology Today and Good Therapy are good tools to let potential clients know our names and locations most of what is contained on those sites is limited to pre-determined fields. It is on our website that clients will get a better feel for each therapist they are considering in terms of our style of therapy. Therapist typically spend several hours or even days setting up these sites. Once they are set up they must be maintained so that the information you see is up to date. Some therapist hire this service out but doing so can be very expensive so many therapist fit this time into their schedule. I personally spend an average of 3 hours per month updating and/or monitoring my on-line presence.

     Once you have done the research you will likely begin calling potential therapist to further determine if they maybe the appropriate therapist for you, or your child. Most therapist try hard to take these calls even if they are not accepting new clients because we are sensitive to how hard it can be for some people to make that first step towards improving their mental health. Since we are often in session’s through-out much of the day, these calls are often returned in the morning, mid-afternoon break or in the evening after we are finished seeing clients for the day. I try hard to return every call I receive, even if I am not taking new clients, because again I want to honor the effort it takes to make that call. When I do not have openings I will often refer the client to a colleague. I offer a free initial consultation so that clients have the option to check out their potential work space and see me face to face. Hopefully this gives the client, and myself a sense of how we can work together. Again if the client or myself feel that I am not the right therapist for them then I do my best to refer them to someone else. I spend an average of 10 hours per month screening telephone calls or conducting consultation sessions.

     Particularly when working with children I encourage parents to communicate with me the day of or the day before each session. Children do not do therapy the way adults do and when I am informed by parents about what is going on in the child’s life I am better able to address real life issues during the therapy session. At times, this can be handled by email or the completion of a check in sheet. But parents sometimes want to talk with me about their young child’s needs. For cash pay clients I include a 10-15 minute telephone call in the session fee. Insurance panels will not pay for this service. Therefore, at the parents request we will schedule regular meetings to address the child’s progress in treatment. At times this meetings are covered but at others times since the child is the client they will not.
     Those of you who know me have learned that I frequently have done some pre-planning related to your goals and needs. Particularly with children I typically have a flexible plan to offer a specific activity or project to reinforce some aspect of the child’s treatment goals. I find that I often spend a minimum of 10 minutes preparing for each client. For more complicated issues or when children require more structure and prompts to engage in therapy I can easily spend 15 minutes preparing for the session.


AFTER EACH SESSION:
A typical session provided to a client utilizing their insurance may take the therapist an additional 20+ minutes (depending on the requirements of the insurance company) of documentation time. When you choose to use your insurance benefits to pay for your mental health service you are responsible for your co-pay and I agree to bill your insurance company for the rest of my contracted rate. Insurance companies require the therapist to document each client’s need for mental health services based on their (the insurance company) individualized definition of such being “medically necessary” for the client. This always includes an assessment, diagnosis, treatment plan, and verification (on a session by session bases) of how the therapist is supporting the client in achieving their goals, alleviating the negative impacts of their diagnosis on their daily functioning, and moving the client closer to the time when they no longer require mental health services to maintain acceptable levels of functioning. The time needed to address the issues stated in this paragraph is not billable time and insurance companies do not reimburse or pay for such.

        For therapist who don’t take insurance, or when clients choose not to use their insurance benefits, the billing process is typically much easieLegally and ethically required documentation in such cases will typically take less time and will typically include a brief note indicating issue addressed in therapy, interventions offered/used and client’s response to such interventions etc. This may take between 10 minutes give or take.

     Additionally, the therapist is responsible for submitting billing, tracking payment, and accurately recording such payments for tax purposes. This takes approximately 20 minutes per client per month.

             Lastly, therapist often maintain their office space assuring that everything in clean, organized and in good repair. Some therapist hire this out but many, such as myself work that into our weekly routine. 

            So now you know what a 50 minute hour looks like from the therapist perspective.  

WHY DOES THERAPY COST SO MUCH

     Those who choose or must pay for therapy out of pocket know there is no denying that doing so is expensive. When you walk into my office you will hopefully experience a homey atmosphere which is conducive to the work you would like to do in therapy. You may see an environment which is also child friendly, holding options desirable to children with a variety of interest. Noticing this you may appreciate the environment. However, it is likely that initially you will not see the hidden cost of operating a mental health practice.

Professional Training: To become eligible to be a Licensed Clinical Social Worker (LCSW) I had to complete 4 years of undergraduate degree education, 2 years of graduate degree education and 2 years of post-graduate supervised work. The post graduate supervised work must account for a minimum of 3,200 hours of specialized mental health service provision which is monitored by a licensed mental health professional. This qualifies one to take two separate exams offered by the Board of Behavioral Sciences which are designed to test one’s ability to ethically and legally implement their 8 years of training.

A recent report completed by Aurelio Locsin, as reported in CHRON indicated that a master level Marriage and Family Therapist will likely have a median salary of $46,238 per year. A physician’s assistant will receive a median salary of $88,650 per year. Many CEO’s with a master degree in business administration will earn a median salary of $166,920 per year. Licensed Clinical Social’s workers with an additional 2 years of supervised training during which we are required to accumulate and addition 3,200 of supervised training, receive a median salary of $69,246 in the Sacramento and surrounding areas.  http://work.chron.com/comparison-level-education-salary-6533.html

Licensing fees and Continuing Education:  Therapist are required to renew their licenses every two years. Therapist are required to complete a minimum of 20 hours of Continuing Education per licensing period. Therapist are not required but are strongly encouraged to maintain membership in the National Association of Social Worker or similar association. The cost for licensing fees and CEU’s vary but my experience has been that I typically spend $2,500 to $3000 per year in this area. This cost is in addition to the fact that we will not be working while attending trainings and therefore whatever we would have earned is in essence another expense associated with the training.

Insurance: One reason for maintaining membership in the appropriate association as indicated above is that such is required by some liability insurance companies. Therapist in private practice typically lease there building. Owners require tenants to obtain and pay for general liability insurance. Insurance rates vary but have been reported to average at $500 per year in California.

Insurance Paneling: The process of getting on an insurance panel so that I can bill your insurance for the mental health service I provide is arduous at best. It can take from 3-6 months to get through the credentialing and contracting process. Some insurance panels are easier than others to get on but none are easy. All require a lengthy application and documentation to verify that we are indeed capable of providing mental health services to their insured. This service is another that sometimes gets hired out by the therapist. The typical cost to have a company process an application through the credentialing and contracting process is $200 - $300 per company.

Billing Support: Therapist often utilize a billing support of some type to process the billing requirement of insurance companies. Each company has their own way of doing things so a therapist who accepts insurance maybe billing 6+ different companies. Depending on the company some of the processing can be done very quickly only requiring a few minutes. However, it is becoming more common for insurance companies to have complicated billing processes. When this occurs therapist have to make a choice to be available to serve their clients or spend time trying to figure out the insurance maze. Those who choose to use a billing company will often pay 6-8.5% of every dollar they receive to the billing company.

Rent, utilities, phone service, security system and monitoring, computer, printer, fax and other office supplies: Professional rent/utilities in Placer/Sacramento County vary with some small (120 sq. ft.) office spaces available for $450 per month. However, those who offer a play therapy practice such as mine typically require more space (500 sq. ft+) and therefore this rate can easily double. It is not unusual for a therapist to spend $1,000 per month in this category.

Miscellaneous supplies and fees. Therapist need to print out worksheets and forms, keep our furniture in reasonably good shape (and replace broken down chairs and sofas), maintain a working supply of pens and paper, and Kleenex. Most of us also need to pay for a web site and/or for inclusion in membership directories (Psychology Today; GoodTherapy etc) so clients know how to find us. If we work with kids, toys and art supplies need to be available and in good repair. Then of course there’s stuff like bank fees, the cut the credit card company takes, etc.

So what’s left: After all of these expenses are taken from our hourly rate the rest goes toward our salary? As a private therapist we are responsible for saving for our own taxes (about a third of our income in California), paying for our medical insurance and retirement. We also must plan for the inevitable times when we ourselves maybe ill and unable to work.

A full-time therapist (i.e., someone who works a 40-hour week) isn’t seeing clients for all of those forty hours. Some of those hours are doing paperwork, getting training, meeting with supervisors or getting peer support, marketing, talking to insurance companies, printing out worksheets for the next session, reading research, calling to coordinate care with other providers, following up with clients who missed appointments or have questions or emergencies; etc.. While most therapist choose this profession because they geniuely care about people and truely want to support in an empathic and compassionate manner. Some therapist struggle signficantly with turning a client away due to their inability to pay. Many such as myself offer a reduced fee to a limited number of clients who are able to come during the non-prime time hours. Typically this will be between 10 and 1 Monday through Friday. Unfortunately, the truth for clients and therapist is that client fees have to cover many cost outside of the 50-minute therapy session (there is an article on the 50-minute hour else on this site).

For more on this issue you can copy and paste the link below too  read a recent report from the Huffington Post

http://www.huffingtonpost.com/entry/therapy-expensive-insurance_us_5900048ee4b0af6d718992e7

 

WHAT CAN YOU AS THE CLIENT DO TO REDUCE YOUR COST

Use your insurance: Not all insurance plans offer easily accessable mental health benefits and not all insurance plans that do, make it more affordable. (Plans with high annual deductibles may take a lot of time and money before you see any savings.) You will need to find a therapist who takes your insurance and then you will need to receive a mental health diagnosis that your insurance company will cover. Once you get that diagnosis, your insurance company will need to approve the treatment plan your therapist gives. All of this sounds very complicated but therapists who take insurance generally understand how to make it work for you. Make sure you are clear about what the diagnosis and treatment plan mean and what exactly will become part of your health record. Also note that most insurance plans do not cover couples therapy. They will cover family therapy if such is considered an important aspect of your treatment. They may not cover certain diagnoses.
Use your Health Savings or Health Spending Account: If you have a HSA card, see if it will cover counseling and if your therapist is able to charge HSA cards. Most of the time these plans will only need you to submit a monthly or quarterly receipt but check first to see.

Seek out a practice or agency that offers a reduced fee: Many therapist, such as myself are able to offer a reduce fee to a limited number of clients who may not be able to afford my full fee. I offer a reduce fee to clients who are willing and able to schedule their sessions between 10 am and 1 pm Monday through Thursday. The hours of 2 pm to 7 pm are considered prime time hours for most therapist.

Explore group therapy:Groups tend to be much less expensive than individual therapy and research shows they can be just as effective.

Seek out a publicly funded agency since they often have more generous sliding scales: Depending on your income, you may qualify for therapy from an entity that utilizes government funding to subsidize or fully cover therapy cost to the consumer.

See your therapist less often: While meeting every week may be ideal (it’s easier to create and stick to change when you can devote an hour each week to working on it), you can go every other week or even less often if your therapist agrees.

See an intern at the practice: Not all agencies or practices hire interns but those that do sometimes charge less since those practitioners have less experience. Interns are supervised by other counselors with specialized supervisory training although what this means will depend on the practice. If you’re using this option, ask them what this will mean exactly so you know what you’re agreeing to.

Do the work: Counseling is not a race and how long it takes will depend a lot on individual factors but the more energy you put into therapy, the more you’ll get out of it, the more quickly you can create change and the sooner you’ll be leaving therapy. This means showing up for appointments (and avoiding the no-show fees! another way to cut costs), being honest with your therapist and reflecting on what you’ve learned between appointments.