what you will pay for my services

I charge $300 for a 90 minute initial meeting with a prospective client. At the end of that time, I’ll offer a preliminary set of clinical impressions and a sketch of what work together might be like.

If we decide together to move forward together, 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 and you will never pay more for any encounter with me because you will never get a bill from anyone else related to a deductible or co-insurance.  Some peace of mind from a psychologist. Seems right.

By the way, if you do the math, these decisions mean that every client gets the equivalent of 5+ sessions for every 4 we bill.

Pay as you go

Every client pays for the session on the day of the appointment.

You will put a card on file (HSA, FSA, debit, or credit) with a HIPAA compliant billing service called Ivy Pay. After our meeting, I will let Ivy Pay know that we saw one another. I’ll note the duration of the session. I give Ivy Pay no other information about you. Within seconds, you will have been billed and gotten a receipt from them directly. I do not see your card information ever.

About insurance and my policies

I do not have a relationship with any insurance company. I do not enter into a what is called a “special case agreement” with an insurer. I do not prepare what are sometimes called “super-bills” for people to take to their insurance company for reimbursement.

Taken together, these things mean I am always considered an “out-of-network provider.”

why I don’t work with insurance:

Processing Complexity

The first is practical. I am a small business owner as well s a clinician. 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.

Now, there are also billing services that meet or exceed my expectations for privacy. So, I am happy not to be preparing monthly statements and a client gets a receipt immediately. It stays in an archive you control. I cannot improve on that process for either of us.

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 two 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.

Mental health records used to be “quarantined” away from all other health information. But the technological investment involved was enormous. In the last year or two, it is not unusual to hear a client say they saw mental health diagnoses or even notes from therapists or psychiatrists in their records - even when the clinicians are not part of the same health system.

Professionals of all kinds are also understandably concerned about bringing observations of possible changes to thinking, memory, or consciousness to a clinician connected to a “share everywhere” electronic health record.

Health records are now bigger targets for hackers than financial records.

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.

The government

Beginning in 2025, I 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 in any way I initiate.

Your choice

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 clinician in private practice so long as these two conditions are met.

At the intersection of clinical & ethical responsibilities

What to do about fees and billing is an business, an ethical and a 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. Any time spent doing administrative work for an insurance company is time I could be doing something else to add value to your experience.

the record, privacy, and healthcare coordination

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 - like 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. So, you don’t need clinicians to talk to one another about you, without you.

That said, for the people who’ve come to talk about changes related to progressive conditions, it has proven helpful for those clients to think through what kinds of observations seem most important to share with another doctor. Appointment with doctors are always shorter than encounters with me. For these clients I am also always the clinician they see most often and for the longest time/meeting. So, it is easy for us to sift through your impressions and mine to come to a set of priorities.

After a couple of decades of working either in healthcare systems or closely with doctors and rehab therapists (OT, PT, Speech), I understand how many clinicians think. If that can help you relax and make the most of your other appointments, that’s a good thing.

Here’s how it works: in the days before a doctor’s appointment, and only after we’ve talked, I write a letter to you with a summary. I send it directly and only to you. You can decide what to do with it after that. Some people take their letters into their appointments. They might use them just for themselves to make sure they’ve covered everything. Some give the letter to the doctor - to read or to keep. It is entirely up to you.

If you want help preparing for a doctor appointment, I’m happy to help you with that. But you will choose what you share.