How much does it cost?
I price my services at the same level as plumbers and electricians and on par with other physician specialists who provide a similar service. My fees are about 10% to 20% less than those charged by similarly credentialed Board Certified Clinical Health Psychologists in the private diagnostic clinics of UNC and Duke. If you would like to see my full fee schedule, it is available here. A typical course of psychotherapy consisting of 6 sessions of individual, at full fee would cost $1,156. Depending on your benefits and deductible you may get half or more of that back. Some plans discount my fees and your out of pocket ends up to be roughly what it would be for an in network provider. Sliding scale discounts are available but must be negotiated individually.
Do you accept insurance?
Yes, and no. I can submit claims electronically to any insurance company. But I am not "in network" and do not have a contractual agreement of any kind with with any insurance company. This means I work for you and not for them. Sometimes an insurance compay will have mental health benfits "carved out" to some other company and that can complicate things. Remember, you are responsible for paying my fees, not your insurance company. If, despite our best efforts to find out what your benefits are, the claims are denied, then you will be responsible, and, at that point we can negotiate. I don't use a collection agency so at the end of the day, if insurance denies payment, you pay me whatever you are willing or able to and there is nothing I will do to collect, except make a good faith effort to ask nicely. I believe we're all better off on the honor system--I honor your sincere desire to pay your bills and you honor your obligations as best you can. We both accept that life comes without guarantees.
How long does it take?
That said, let's again put the cost into perspective. Psychotherapy research has made remarkable advances in the past ten years, allowing treatment to be much more focused and strategic than ever before. A little more than half of my cases are "rapid responders" meaning that the patient achieves their goals in 6 to 8 sessions. This means that about half the time a full course of psychotherapy even without insurance help, costs less than a flat screen TV. My results are consistent with the outcome literature on competent strategic CBT, and I have run the numbers in my database. But that leaves another half that take longer. But sometimes treatment may be complicated by circumstances in your life that won't go away and aren't under your control. In our society we expect that people make their own destiny. So, if their circumstances are outside of their control they feel responsible and often times, that just ain't so.
There is good news. One piece of good news is that research shows that rapid responders also have a very low relapse rate and only require occasional "booster" sessions, sometimes many years later. Another piece of good news is that even those who take two or three times longer, still pay less for full course of psychotherapy at full rates than they would for a new transmission, a new hot water heater or A/C unit--all expenses you would find some way to pay in order to continue to live comfortably. Personally, I think you get to value the emotional aspects of living comfortably at least as much as the physical ones. Research shows that when you do value emotional wellbeing, you end up paying less for other kinds of medical treatment. But only you can set your priorities.
What will insurance pay?
That depends. Let's use some examples to try and clarify. I see a patient who has a complex array of issues on top of a chronic medical condition involving pain. I see him for 60-75 minutes and we do some hypnotherapy as part of our sessions. I bill at $244 for a full hour ($214 plus $30 for the complexity of the case). He has Cigna insurance and I am "out of network." His insurance allows my full fee and his coverage is generous and pays $170.80. That leaves him with a copay of $73.20 for our individual work. Later on, when he has met his individual goals he might move into group therapy to address is habits of relating. Remember, the targets of psychotherapy are habits of thought (cognitive distortions) and habits of relating (interpersonal quirks). I bill $80 for group. His insurance allows the full fee and pays $56 leaving him with a coinsurance of just $24. His out of pocket expenses are still significantly less than a visit to a psychologist was in 1982 before insurance covered any part of mental health treatment.
Another couple has a high deductible and I am also out of network with their insurance. That insurance allows my full fees but applies everything to the deductible leaving them to pay the balance in full. They were spacing out their visits to conserve money (but prolonging treatment) until an unexpected visit to the ER forced them to meet their deductible (one way or another that deductible has to be paid). Now their insurance pays 70%. Their co-pay is $64.20--about on par with their weekly gas station fill ups, and less than the State Health Plan's copay for a specialist, which has recently gone up to $81.
Blue Cross does things quite differently from other insurance companies. They expect you to pay me and then they send any reimbursement check directly to you (if there is one). If I submit the claim for you, I will have no way of knowing if they got the claim, processed the claim, paid the claim, or denied the claim. You will have to track that information. The EOBs (which stands for "explanation of benefits" are very confusing, showing a "contract rate" and a "coinsurance." I am not contracted with BCBS. The "contract rate" is what BCBS has contracted with your employer to pay. In most cases the "contract rate" is exactly the Medicare rate. I cannot accept the Medicare rate (except on rare occasions as a need based negotiated discount) because after I back out my overhead and taxes, it amounts to mimum wage and I can't stay in business on that.
In the past, the BCBS explantions of benefits showed the UCR (which stands for usual and customary) charge. My full fee of $214 is exactly equal to the UCR for services provided by professionals with my level of expertise. Many local plans discount to $174.57 and the reimbursements range from $48.55 to $67.93 making your out of pocket liability in the vecinity of $106.64 to $126.02. Usually this equals the Medicare rate plus your coinsurance amount plus the reimbursement amount . You will need to bring me an EOB in order for us to see exactly how the discounts are applied and what they add up to be. Group psychotherapy is considerably more economical. I charge $80 for 90 minutes of group and BCBS reimburses $35.35 which makes the price to the patient just $44.65. I apologize that this is so confusing but I didn't make it up, BCBS did.
If you would like my office to find out what your benefits are, and guestimate how much your liability will be, fax your insurance information and date of birth to me at (919) 933-0611. My assistant will call your insurance carrier and find out about your benefits. Of course I should mention that some proportion of the time the information we are given is not entirely accurate, in other words, it always comes with the disclaimer that "verification of benefits does not guarantee payment." We will only know with complete certainty once we submit claims on your behalf and receive an EOB or explanation of benefits. But at that point we are allowed to negotiate. The insurance companies negotiate a discount (supposedly based on volume, but I don't do volume) and in NC it is still legal for you, as an individual, to negotiate your own discount. Personally, I am offended by "corporate discounts" and believe that discounts should be based on need.
The Red Envelope Program
In many Asian countries, doctors, teachers, and religious leaders are honored with monetary gifts which are presented in a red envelope. If you do not have insurance and are of limited means, I have a fixed number of slots in my schedule available to those in need. I ask that you honestly consider your priorities and be willing to negotiate a fee with me that we can both feel is fair and reasonable, then place your cash honorarium in a red envelope (I will happily furnish a receipt). The times available for the red envelope program are during the day Mondays through Thursdays (please do not book early morning or late afternoon time slots). So if you have a need, go ahead and schedule an appointment confident that I will treat you exactly the same as someone who is paying the full fee because what I want most is for you to get what you need and value what you're getting.