Do you take Insurance?
I have chosen to remain an “out-of-network” provider for all insurance companies. In my experience, this allows me to provide a higher quality of care, independent from insurance-based rules or decisions. Accordingly, full payment is due from you at the beginning of each therapy session. I accept payment by cash, check or credit card.
It is your choice whether you would like to apply for insurance reimbursement or not. Although I do not accept direct payment from insurance companies, I provide a “super-bill” to you which includes the standard information (such as diagnosis and treatment codes) that most insurance companies require. You then submit the super-bill to your insurance company for reimbursement. Please note that I do NOT fill out any forms that are created by your insurance company and do NOT correspond directly with them in any way.
Superbills are automatically generated in the client portal after the first day of the month following the appointment. You can log in and download the super-bill at your convenience.
DIAGNOSIS IN COUPLES THERAPY:
For couples therapy, most insurance companies will reimburse for therapy involving two people if one person has been given a diagnosis. We should have a discussion to make sure the appropriate partner is provided with a diagnosis.
QUESTIONS TO ASK YOUR INSURANCE PROVIDER:
To find out more about your coverage, call your provider, get the name of the person you’re speaking to, and ask the following questions:
Does my policy cover out-of-network outpatient psychotherapy?
CPT CODES: If yes, what is the reimbursement for out-of-network psychotherapy services for the following CPT codes: 90834, 90837, 90847. What is the reimbursement rate for telehealth CPT codes, 90834-95, 90837-95, and 90847-95? Your insurance company should understand what a “CPT code” is, and whether they reimburse for these specific codes.
Is there a maximum number of psychotherapy sessions for which they will provide reimbursement?
DIAGNOSIS CODES: Will the insurance company reimburse for the following diagnoses (which are common for my clients to have): adjustment disorder, PTSD, generalized anxiety disorder, major depressive disorder, dysthymic disorder, autism, and agoraphobia with panic disorder?
For couples therapy, the most common diagnosis by far is "adjustment disorder", which means you are experiencing stress (relationship difficulty) which is causing significant problems in your life.
While some clients may have additional diagnoses, the ones listed above are the most common ones used in my practice, and it is helpful to know ahead of time if the insurance company will be willing to reimburse for the ICD-10 codes attached to these diagnoses.
% REIMBURSED: If your insurance company reimburses a percentage of the cost, what is that percentage, and what is the maximum cost per session they are allowing?
For instance, they may reimburse 70% of a psychotherapy session (CPT code 90837), but assume that the maximum rate of the psychotherapy session is only $120 (instead of my actual rate). This would mean the client would be reimbursed $84 per session. Another insurance company, however, may only reimburse 50%, but allow a $250 hourly rate, meaning that the client would be reimbursed $125 per session. Thus, it is important to understand both the reimbursement percentage and the maximum per-session rate allowed.
Is a doctor’s referral required and/or is pre-authorization required? What is the name and number of the person to be contacted for pre-authorization?
DEDUCTIBLE: Is there a deductible and how much is it? Is it a yearly deductible? How much of the deductible do I have left over to meet?
ADMINISTRATIVE: What is the address of the office where I should send my claims? To whose attention is the claim to be sent?
HSA AND FSA ACCOUNTS:
Many clients have been successful in utilizing a Health Savings Account (HSA) and/or Flexible Spending Account (FSA) for reimbursement of accrued therapy expenses. Please note that the superbill as discussed above can serve as documentation for your FSA or HSA.
I understand that financial concerns may lead you to use an in-network provider. Please be aware that there are local non-profit agencies that provide low-cost counseling services.
After we meet individually, I do NOT share secrets that you tell me in an individual session in a later couple session. It is healthy for you to communicate directly with your partner (not through me).
In very special circumstances, secrets have to get dealt with by the couple and may cause me to stop couple therapy. I will still NOT tell the partner. Again that is your responsibility. The three criteria that I use to evaluate whether a secret shared individually will cause me to suspend couples therapy are:
Is the secret information currently adversely affecting the relationship in a meaningful way? Examples of this would include an ongoing affair, current domestic violence or current substance dependence.
Would the partner disclosing the information have a therapeutic benefit? For example, disclosing an affair that occurred 10 years ago without recurrence may only hurt the betrayed partner but not furthering the current relationship goals.
Does disclosing the information put one of the partners at risk for physical harm?
If the answers to these questions indicate that disclosure would have a net therapeutic benefit, I urge the partner (again, not me) to disclose the information and support him or her in doing so. If the partner refuses, I may suspend treatment until the couple is ready to deal with the critical issue that is being held secret.
Meeting Clients Individually
My practice is to meet with both members of the couple together for the FIRST session. This has the benefit of establishing that the marriage or partnership is the client, and that the welfare of the relationship will be the top priority. With that said, after the first session, I will meet with one partner alone, but for short periods or for a discreet purpose. Also, the partner not attending the session must consent to the individual session in advance. This is important because we need to MAINTAIN TRUST for me to be an effective couples counselor for you.
The typical reasons to meet individually are:
Practical considerations such as childcare or sickness make it difficult or impossible for one partner to attend. In such cases, it may be helpful for the other partner to use the time to work on his or her issues with me. Sometimes progress is made when a partner feels free to talk openly.
Valuable information can be gathered regarding each individual’s history and commitment to the relationship and treatment.
The individual may be able work on his or her own issues in a less triggering environment so he or she can be more open and less reactive when together. I will only do this for a limited amount of time, usually 2 to 5 sessions.
There are things that may feel scary to say in front of a partner so it may be wise to get my help on how to express it more skillfully.
Both partners feel stuck in the couples work and decide they need to grow individually so that they can come back together in a healthier way. My first recommendation is for each partner to find their own individual counselors; however, be careful as some individual counselors, in an attempt to bond with you, may unintentionally demonize the other partner. Alternatively, some couples wish to alternate seeing me individually at their regular time of their couples sessions. This should be viewed as an interim step to returning to couples work.
A partner may be thinking about whether to end the relationship and need to discuss it without the partner present. I will help you process your thoughts and carefully weigh your options. I will not tell you what to do. Also, please know that I am a pro-marriage therapist but totally respect your right to choose your own path in life.
You should be aware that the partner who is not in the individual session may feel left out, anxious, or mad. If that happens, it is a good idea to share those feelings in your next couples session. If, at any time, you feel an imbalance in my time and/or support, please tell me. Such feelings could derail therapy, especially if they don’t get tended to. It may also be appropriate for me to meet with the other partner so the therapy remains balanced.
To be clear, I can not be one partner’s individual therapist and your couple counselor at the same time.
If you have significant areas of growth that you want to work on in yourself, I would be glad to recommend several excellent individual therapists for you to consider. In this case, if the couple agrees to it, I would talk to that therapist to coordinate individual and couple treatment so they complement each other.
Contact Between Sessions
It is tremendously helpful for you to work through your feelings and thoughts between sessions. That is an important part of healing. Often, as clients are processing these thoughts, they send emails or texts to me with questions that they want to ask or thoughts that they just want to share. Because of this, I have set the following guidelines for emails, Phone calls, and texts between sessions.
GUIDELINES and FAQs:
PHONE CALLS: If you have an administrative issue please feel free to call and leave a voicemail. If you need to process challenges or relationship struggles then you will need to schedule a phone consultation through the client portal. Please know that I offer only 5 minute consultations in between sessions. If you need more time to process a challenge over the phone then an apt is required and you will be billed separately. Please know that I want to support you but am not always available. That is why it is best to schedule the apt through the client portal.
ADMINISTRATIVE EMAILS: It is fine use email and texts for administrative items such as changing appointments. You can also use the secure messaging in the client portal.
COPY PARTNER: If you do send an email or text and are in couples counseling, please always copy your partner. This helps us maintain trust.
EMERGENCIES: Please do NOT send an email or text for emergency situations. In those cases, you need help that can respond immediately. I am not always available and can't be counted on to support you 24 hours a day. The best approach is to call 911.
CLINICAL MATTERS: Even though I deeply care about you and your situation, I kindly request that you do not send emails with thoughts about what happened in therapy, background on your personal lives, or other matters related to our clinical work together.
This information is better processed by discussing it in session because I can:
fully experience your tone of voice and body language,
ask questions to help clarify what may be unclear,
explore your concern with your partner in real time,
avoid giving you poor counsel based on limited text information, and
avoid getting caught in the middle.
BRING THOUGHTS INTO SESSION: I generally recommend that you journal or write an email to yourself and then, when in session, read it out loud in session. This is a great way to prepare your thoughts and then have a robust discussion. If you need to discuss or resolve an issue before our next scheduled session because it is time sensitive, it is best to schedule an extra appointment.
ONE-PARTNER SESSIONS: If you need to communicate something that you do NOT want your partner to hear, please let me know this and we can schedule a special session. See the FAQ about one-partner sessions.
SPECIAL EMAIL COUNSELING: For some couples, the situation is such that the couple needs or benefits from significantly more between-session support. In such cases, I will read and respond to emails between sessions; however, both partners must consent to this and I must approve this "special email counseling" in advance.
With some couples, one partner (who writes a lot) can flood the other partner (who does not feel comfortable with processing through text). In such cases, email counseling is not advised.
When we agree to special email/phone counseling, I bill the time spent separately.
PRIVACY: Lastly, please know that electronic communications, even ones just sent for administrative purposes, can never be guaranteed to be 100% secure. If you send an email, please do so knowing that you are willing to accept the risk of a breach of confidentiality.
FINAL WORDS: It is difficult for me to turn away from your heartfelt communications because I really do care. Please know that my policy is aimed at healthy boundaries and setting up a safe place where you can both feel fully heard. After serving many couples, my experience has taught me that this approach ultimately leads to better healing for you. Please accept my apologies if my policy hurts your feelings in any way!