Money and Insurance
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.
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.
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.
© William K McDonald
June 15, 2015
rev July 31, 2015
(Note: This article was last revised in 2008 and therefore somewhat dated. However, until I upgrade it, it still contains good information and an accurate representation of my thinking on the subject.)