I believe in two basic principles: I believe that psychotherapy records should be private and I believe that care that is coordinated is good care. To achieve both you must understand what you’re being treated for and what kinds of experiences would signal that the treatment is working. I think those two things are important whether you we’re talking about our work together or whether you are working with someone else - a primary care physician, a neurologist, a psychiatrist, a surgeon, a nurse practitioner, or an occupational, physical, or speech therapist.
When you know what you’re doing in our interactions, you can easily describe those things to others, including other clinicians. If you want help preparing for a doctor appointment, I’m happy to help you with that. But you will choose what you share.
What you will pay for my services
I believe that you should know what an encounter with a clinician will cost. So I have tried to make transactions between us as simple as going to a bakery, a restaurant, or a salon. I charge $300 for a 90 minute initial meeting with a prospective client. For any encounter after that, I charge $224/hr for individuals and $244/hr for couples. By the way, an hour, since I was a kid, has always been 60 minutes and not a 45-50 minute “therapy hour”. No matter what kind of service I provide - psychotherapy, assessment, neurocognitive rehab, or neuropalliative care - and hour is an hour.
This policy makes things simple. It is also consistent with my pledge that you will always know what a clinical service will cost before you are billed.
About insurance and privacy
In keeping with the idea that our conversations are private, I do not have a relationship with your insurance company. I do not enter into a what is called a “special case agreement” with an insurer. Taken together, these two things mean I am always considered an “out-of-network provider.”
“Army” by Tommy Ingberg
I do not prepare receipts for clients to send to insurance companies. I’ve made this choice for a few reasons:
Processing Complexity
The first is practical. Reimbursement processes involving insurance companies have grown more cumbersome (and sometimes more contentious) even as the use of health savings accounts (HSA) or flexible savings accounts (FSA) have gotten easier. So the receipt you’ll get immediately following one of our interactions is handy because it is quick and because it becomes part of an archive you control.
Privacy
Insurance companies and health systems are, by definition, companies that collect, analyze, and share data. The walls between the entities that possess and use data can be too porous for my comfort. For example, clients have told me that they don’t mind if the nurse who checks them into a doctor’s office knows they had the flu 2 years ago, or saw a physical therapist last month about their knee, but they want to decide for themselves how to talk about any symptoms of depression or anxiety they’ve been feeling. Professionals of all kinds are also understandably concerned about asking questions about or bringing observations of possible changes to thinking, memory, or consciousness.
At a time when financial records are increasingly at risk of being mixed up in health records – and information from health records can show up in financial documents, actuarial tables, and “data dumps” – I like the idea that our private conversations can remain private. Recent changes in the HIPAA law provide that persons who make the decision to 1) pay out of pocket for their healthcare services, and, 2) do not submit the fees to a third-party payer for reimbursement - may stipulate to that clinician that no information about those services be shared with their insurance company or third-party payer. So you can make this choice yourself with any other clinician in private practice so long as these two conditions are met.
The government
Beginning in 2025, I have started to have more concern about the privacy of data held by governments. The records generated by my practice are not collected or indexed or aggregated by anyone.
At the intersection of clinical & ethical responsibilities
Finally, this is an ethical and clinical decision for me. I made a choice when I went into private practice that all the time I spend with you would be spent thinking about your experiences, strategizing with you about next steps, and planning with you to leave therapy feeling that our time together was well spent.
A note: for people using Medicare. Another form – one called the “Medicare Opt Out” form – must be signed by all people covered by Medicare. If this is relevant to you, please let me know.
Taxes
It is possible that session fees, like all healthcare expenses, are tax-deductible under some circumstances. That may be particularly true for people with health complications. If you have questions about the conditions that could result in a tax deduction for you, those should be directed to your accountant or tax professional.
Pay as you go
Each client pays for each session on the day of the appointment. The price of the experience is set. Paying at the time you use a service means you own the experience that comes next. It focuses your mind and mine on the issues that animated your interest in coming here in the first place. Moreover, we never lose sight of the idea that you are here temporarily - that you've come so you can leave again - feeling better and/or more prepared for what’s next.
Paying as you go also means you are guaranteed to always understand what you are paying. You will never pay more or get a bill. Some peace of mind from a psychologist. Seems right.