FEES
The Base Private Pay cost for a 50-minute session is $110.00 – slightly less than most insurances will pay. This fee may be reduced according to circumstance.
The history behind my private pay option:
I began my practice in 1977 when my fees were ‘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 an insurance billing expert. At the time, I felt it was worth it, as it increased my income and was a perceived benefit to many clients who could not otherwise afford me.
However, I was never truly comfortable with the philosophies behind insurance billing and coding, to the point where they sometimes became an impediment to my ability to provide the effectiveness, integrity, and efficiency of the therapeutic expertise I’ve developed over many decades. I sometimes fantasized about how much more effective, focused, and creative I could be under a strict private fee-for-service contract.
About ten years ago, I began to see more clearly that psychological confidentiality—a keystone of the psychoanalytic relationship—is virtually no longer possible in our digital culture. At the same time, insurance companies are demanding much more diagnostic and personal information. I spell this out in greater detail in a subsequent document on the perils and pitfalls of insurance reimbursement. (noted below)
But I will still bill insurance, when available, for clients. As other therapists have, I have learned the art of speaking to Insurance companies in their language while working with clients in my own language, representing the art of becoming a psychologically richer human.
Yet, 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.
– William K McDonald
Fenton, Michigan
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For a PDF copy of a longer article I’ve written on the subject:
The Benefits and Pitfalls of Third-Party Mental Health Insurance