Cost of Therapy

How much does it cost?

I price my services at the same level as plumbers and electricians and on par with other  specialists who provide a similar service.  My fees are about 10% to 20% less than those charged by similarly credentialed psychologists in the private diagnostic clinics of UNC and Duke (although I give you a 75 minute hour instead of a 45 minute hour).

Do you accept insurance?

Yes, and no.  I can submit claims electronically to any insurance company.  But I am not "in network" with anyone.  

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.  I routinely test at the beginning and end of treatment in order to provide a more strategic and focused approach to therapy, and in order to hold myself accountable to the highest standards of excellence.  When treatment goes past about 16 sessions then I might ask to administer some other kinds of tests. This would be because other, more longstanding habits of thought or habits of relating, what we think of as personality factors, may be involved and I want to be sure that I'm tracking all the right targets.  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 75 minutes and we do some hypnotherapy as part of our sessions.  I bill at $231. I am "out of network" with this particular insurance.  His insurance allows $211.43 so I write off $13.57 (I do not balance bill).  His insurance coverage is generous and pays $195.43.  That leaves him with a copay of $16.  I could "balance bill" him for the $13.57 and his copay would still be less than a burger and two beers at the local pub. 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 $52--about on par with their weekly dry cleaning bill and less than the State Health Plan's copay for a specialist, which has recently gone up to $87. 

Blue Cross does things a little differently from other insurance companies. They expect you to pay me directly and then they send the reimbursement check directly to you.  They also manage to do some "number magic" so that if you have the State Health Plan, what they apply to the out of network deductible in many cases is almost nothing.  Most of my State Health Plan patients get a check for $70.71 but some get reimbursed less and some get reimbursed much more.  No one knows why.  It's very confusing, I know.  And I wish it were different.  But I didn't make the world, and I don't make the insurance rules.  All I can do is to try to live as gracefully as possible within the existing constraints. 

If you would like my office to find out what your benefits are, and 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.  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...  The time slots available for the red envelope program are usually during the day Mondays through Thursdays.  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.