FEES

The Fee Standard of this office is direct fee for service (“Private Pay”)

The Base cost for a 50-minute session is $100.00. That fee may be reduced according to circumstance.

History leading to my private pay decision:

I began my practice in 1977, at which time my fees were completely ‘private pay.’ Then as time progressed, I was invited by various insurance carriers to become “paneled”, which gave me the freedom to bill them for client (patient) services. That, of course, added an additional amount of office and paperwork time, in addition to hiring a billing expert. At the time I felt it was worth it, as it increased my income and was a perceived benefit to many clients.

However, in recent years I have become increasingly uncomfortable with insurance billing and coding, to the point where it becomes a specific impediment to my ability to provide the effectiveness, integrity and efficiency of the therapeutic expertise I’ve developed over the past four decades. I realize how much more effective, focused and creative I can be working under a strict private fee for service contract.

In the Spring of 2015, I began to see more clearly that in our digital culture, there is virtually no longer any psychological confidentiality – which is a keystone of the psychoanalytic relationship. At the same time much more diagnostic and personal information is being demanded by insurance companies. I spell this out in greater detail in a subsequent document on the perils and pitfalls of insurance reimbursement.

Under a private pay arrangement, no client information leaves my office, unless authorized by the client (or a parent or guardian in appropriate circumstances) or for statutory legal and safety issues. Client files are shredded after 10 years of inactivity. Any client billing statements carry no psychological information.

Due to my increasing age, it is perhaps of note, that upon my demise (yes, it will happen someday), unless I have contracted otherwise with a legal partner, or unless there is other legal impediment, all client files both paper and digital will be destroyed once financial and any other obligations are satisfied by my estate.

“Money”

Perhaps in a perfect world I could offer my services at no cost. But much of the “psychology” of our culture, is that we value things generally in terms of what we pay for them. And when something is “discounted” it also tends to become of lesser value. On the other hand, for some it is a common art to bargain or negotiate an appropriate price for something – which can become an integral part of establishing a therapeutic relationship.

It is true for me as well, that the base price I put on my work reflects my own value of my services, also balancing the economic needs of own current life. I give you something of value (my expertise as a professional and experienced therapist) and you give me something of value (your money, and the joy of doing my work). That balance is much of the genius of good therapeutic work, as well as the healthy balance of post-therapeutic life.

That said – I have set the base price for my work at $100 per hour. I am comfortable that this is an appropriate value base for my work at this time in my life. (I know I could move or commute an hour from Fenton and easily charge twice that amount.)

When a client’s means cannot realistically manage that, I have a “sliding scale” – an informal way of ascertaining what would be an acceptable fee for the client, and yet not reduce my own full professional involvement, and income needs.

Notwithstanding, one benefit of having someone else to pay (such as insurance coverage) is that it would allow some people to work with me that could not access me otherwise – in spite of the pitfalls of insurance (see the following article). This deficit in my own practice does weigh heavily at times on the heart of this old social worker.

Afternotes:

1: To the best of my knowledge, many HSA (Health Savings Account) benefits may be used in payment for my services. Pleases check with your provider. I can provide an end-of-year statement for “Counseling and Psychotherapy.”

2: In some cases, as with self-employment, my work can appropriately focus as “business consultation” which may provide additional tax benefits.

Forms

Various documents and forms that I use in my practice:
New Client Information Sheet
If you are a new client, you may print out this form to fill out before your first session.

Personal Agreement form
This is a personal history information form I ask each new client to prepare. You may also download this PDF file for your first session.

Treatment Agreement
This is a somewhat motley collection of ‘necessary stuff” about how you behave and how I behave in ‘therapy’. When I wrote it, it seemed wise and important. Now that I look at it afterward, it’s kinda scattery. But for professional, ethical and even legal reasons, it’s necessary anyway.

Couple Therapy understanding

This document is for couples coming in for therapy. It gives some important background and structure. You may download this, read it through, and bring it to your first session with your signatures. Or, if you wish, you can sign it at your first session.

Minor New Client Info
If you are bringing a child or adolescent for counseling, you may print out this form to fill out before your first session.

Consent for TX of a minor
This form gives legal permission for a minor child to receive counseling services.

Therapy or counseling is actually a contract – an agreement between two parties in which each has appropriate responsibilities and expectations. Let me spell this out in greater detail.

I. My Responsibilities

As your therapist, I agree to provide the following three elements:

1) I will provide safety. My location and work with you is designed to give a safe environment for you to open yourself to the inner work of psychological and personal change. My office will be free of physical, sexual, and other abuse, threats and acts of violence, weapons, or illicit drugs.

Another form of safety is the legal confidentiality that is afforded your work with me as set out by the laws of the State of Michigan. Further information about this can be found in my specific web page on Confidentiality.

An area of increasing concern for me is the securitiy of psychological and other private information released to third-party payors, especially in an era of frequent large-scale data breaches in the news. I also address this in other places on this website.

2) It is my pledge to do my best to be more powerful than your problem or problems. If i need help in fulfilling that, it is my responsibility to get myself that help – which can involve reading and research, consultation with other clinicians (not revealing the identity of our client), or obtaining further professional training.

3) It is also my responsibility to be clear with you about how I evaluate your presenting problems and your ongoing work with me, as well as to explain what my treatment plans and goals are. Treatment plans are by nature often ongoing works-in-progress. This means that I am constantly re-evaluating mywork and thinking about how best to serve and care for you.

You have the right to an explanation in language you can understand, of potential risks, consequences, and benefits of treatment and methods prior to their use, and are entitled to request and obtain information regarding treatment alternatives.

II. Your Responsibilities

As the Client, you also have responsibilities in your work with me.

1) First, it is your responsibility to show up for client sessions. When possible, client sessions are set up on a regular schedule, which is not just for the convenience of my scheduling. The regularity of your sessions is an important part of your “inside” work. There are circumstances when clients don’t have the ability or luxury of such a regularity. And in those circumstances I will work with your schedule as best as I can.

2) Your second responsibility is to take seriously the work we are doing – to cooperate with requests to do any “homework” given to you, and to spend time between sessions thinking, exploring and experimenting in the areas we are working on together. In short, it is your responsibility to pay attention to what is going on within and around you.

3) Another part of taking the relationship seriously is upholding the financial agreement established with me. When or if circumstances make this impossible or a serious problem, I ask that you be straightforward with me about it, so we can explore additional options available.

4) You are responsible for being as open and honest with me as is possible. At times this may be your greatest challenge in therapy. And it is my pledge to encourage and honor the specific trust involved in that openness.

5) You are expected to be free of the influence of alcohol and drugs, except with my specific knowledge and approval.

6) When it is time for treatment to discontinue, I ask that you participate in a final session designed for the specific purpose of terminating the treatment contract, evaluating its course, and projecting its benefits into your own future.

If I experience that you are not taking your work with me seriously, that you are not taking seriously the responsibilities listed above, in extreme cases I do claim the right to terminate treatment for lack of compliance. However, this would be considered as a measure of last resort for me, since I realize that once I have agreed to work with you, the stability of our my work is an important part of the therapeutic relationship.

Confidentiality in Therapy

One hallmark of psychotherapy in our culture is the presumption of client confidentiality. It is an important part of the therapeutic relationship that the therapist will maintain to the utmost the privacy of any therapeutic communication.
In addition to professional ethics, the laws of the State of Michigan protect this.
I keep a written record of treatment and conditions, this record itself is considered confidential in accord with Michigan law regulating privileged communication, except when:
– legal constraints apply
– when a compelling need arises based on substantial probability of personal harm to the client(s) or others, or in cases of a life-threatening emergency,
– when an insurance carrier asks to review the records to verify the services billed to it have been rendered, and/or
– when the client has signed an appropriate form for the release of information.

I am very careful about the storage and protection of client files. And it is also my policy that files in which there has been no client activity for a period of ten years, may be removed and safely destroyed.

A note about Insurance and confidentiality
When you wish us to submit a claim for payment to an insurance company, or any other third party payee, you will be asked to sign a release of information form that allows me to share with them certain information about you. This information generally consists of a diagnosis and a record of service dates and settings, as well as progress notes and evaluatory information. At a practical level, this shared information cannot be considered as absolutely confidential. Also, whereas this information used to be primarily paper information, now it is being requested in electronic format, and involving a more extensive amount of clinical information.

I used to consider this risk to be minor, but in our current age of rapidly increasing healthcare security breaches, my level of concern has been increasing for effective confidentiality whenever insurance coverage is used. Realize this involves your own psychological diagnosis and treatment records. Once such information enters electronic format (which is mandatory these days), it lasts forever, independent of actual accuracy.

[On a personal level, I can have some comfort that if I were to end up in an ER while visiting family in San Francisco, my (now electronic) medical records from Michigan could be available in 2½ minutes. But to have my lifetime psychological information so readily available gives me pause.]

For this reason, I have long had clients who opt not to be involved in the use of their insurance benefits, so that the confidentiality of the client/therapist relationship is more absolute. For professional, ethical and philosophical reasons I increasingly take this matter seriously.

A note about confidentiality with Minor clients
When a client is of minor age, that is (in Michigan) under the age of 18 years, therapy can only be undertaken with the written consent of a legal parent or guardian. The parent or guardian also has a right to confidential information about the minor client.
As a matter of policy and practice, I inform a minor client that “I will not keep secrets” between him or her and their legal parent or guardian. However, I will tell the minor client that before I would reveal significant confidential-type information, I’ll inform the minor client ahead of time (if possible). With many minor clients, it’s very important that much of what they share is considered “private” – which is much of the value of “being in therapy.” However this “privacy” is not an absolute right, and I will use my discretion as to what is appropriate and useful to share with the legal parent or guardian.

129 N. River St
Fenton, MI 48430
(810) 629-0760
I’m in the River Park Building, at the SW corner of River Street and Silver Lake Road in the center of town. [Headlines barber shop is at the north end.]

Mine is the middle entrance at the rear of the building, right next to the Shiawassee River. There’s a sign with my name. Park right in front of the door. Once in the entrance vestibule, turn left.

Here’s the phone number to call if you get lost: (810) 730-9454. I’ll guide you in.

Due to the constant changes of insurance, it is no longer an easy job to interpret each individual policy. We will try to help you know your individual coverage and insurance limitations. Most policies have deductibles and co-pays. In the long run, it is your responsibility to know your individual coverage and insurance limitations, but we will help you as much as we can.
If there are any changes in your insurance policy or coverage, please let us know right away. It may be useful to remember that your insurance policy is between you, your employer, and your insurance company and not between the insurance company and our office.
Please plan to make any payments or copayments at your appointment times, or as otherwise agreed. You will be given a payment receipt. You can also have your credit card billed regularly through our biller.

For specific information and assistance, please contact our biller, Bethany Locke, of F&P Medical Billing – (810) 835-1555. She knows this stuff.