Insurance and Fees

I am 'in-network' for several companies, and do routinely bill the following for those who choose to use their insurance. My services are often covered at least in part by:

Blue Cross Blue Shield; Community Blue; Blue Choice; PPO; MESSA; Super Care I; Super Q; Choices; ChoicesII; Tri-Med; McLaren; Aetna; Cofinity.

My billable rates:  $180.00 for your Initial Visit; $120.00 for each subsequent fifty minute visit. Find more information about this in the last section: My Office and Fees.

That Said…

I have given a lot of thought to this over the years.  There is not a therapist that I know, or that I can imagine who has not.  And nowhere in this writing will you hear, or could you infer that there is any benefit to me, as I offer these thoughts to you. Ethically, I simply think that it's important for me offer my viewing point about this. 

While I do, and will continue to bill insurance companies, like a great many Psychologists and Social Workers at my level of experience, I prefer not to accept insurance directly.  There are several reasons that this is becoming an increasingly popular preference, which you'll read below.  Several companies, other than those listed above, will consider me an 'out-of-network' provider for their PPO plans, and most flexible spending plans or HSA-Health Savings Accounts typically consider a diagnosed service rendered by a Psychologist or Social Worker to be qualifying expenses. Some flexible spending plans may also provide you with a debit card for ease of access for medical/therapy services.  While I am not set up to accept debit or credit cards yet, I do consider this a future possibility.

While I can bill, typically, I do not call, write or fax insurance companies. Instead, I will provide information directly to you that can be shared with your insurance company if you so choose.  This might include an itemized invoice with all the necessary codes and numbers for reimbursement, or more detailed documentation that your insurance company may request.  This gives you a chance to think about the implications prior to communicating any information to your insurance company.

Why so many of us have begun to prefer this...

Threat to confidentiality

30 years experience working with insurance companies (including 5 years in one as a clinical case manager) has led me to understand that filing insurance claims on your behalf severely jeopardizes your confidentiality, which is guaranteed by federal law. If I submit a bill to the insurance, your confidential information is processed by that company and then stored in a database.  Anyone who is involved in the processing or handling of your claim may have access to your records and anyone who has a legitimate reason to access the medical database, such as future insurers and future employers, can view your confidential records.

The potential threat to future insurance and more...

The second reason I don't like to process insurance is because of the possible negative consequences to having a record of mental health services.  Health insurance benefits can only be used to treat a disorder, an illness.  So, therapists are required to give a diagnosis that can forever be associated with a client.  There are many examples of a mental health diagnosis affecting other aspects of a person's life. Some of these stories include being characterized as a high risk, resulting in increased premiums and even being denied life insurance or turned down for jobs that require a security clearance.  If you do not use insurance, your privacy remains intact and secure.  Many people that I work with simply need a new or different skill set or some different strategies to try at home or school.  These occasions do not necessarily require a diagnosis!

The potential threat to our relationship...

These days, insurance companies have begun to severely decrease claim reimbursements which necessitates that clients be responsible for the additional fee.  It is totally natural to be irritated by this!  We all are.  Furthermore, when companies have paid more than expected (which is very rare these days), clients or their families have wondered whether I might not have been completely honest about the fee. In these instances, both my clients and I have been at the effect of these company practices.  Precious session time has been needed to process the feelings about this, which has run contrary to our therapeutic mission.  More, insurance companies often limit the number of sessions allowed, per year. So this process has waisted both time and money that clients simply can’t afford, financially or psychologically! My view therefore, is that these situations can interfere with the therapeutic partnership at the expense of clients’ more expedient movement to the well-being they’ve expected.

Changes in Health Insurance Industry

Finally, as I’ve intimated above, the health insurance industry has recently undergone drastic changes. Many people now have high deductible policies. I will submit a diagnosis, clients pay their weekly deductible out-of-pocket, while no benefits are reimbursed during an entire treatment episode!  Therapy is complete, having received no reimbursement yourself.  Additionally, many of my clients for their own personal reasons that include many of the above, have already chosen not to use insurance.

The Value of my Orientation

You may surmise from the above that my referrals DO NOT come from insurance companies.  That’s true.  In these difficult financial times, it is important to stress that I have always been committed to providing my best, in the most efficient, cost-effective, individualized way possible.  No 'cookie-cutter' solutions.  Consistent with the research, I have found that for many of my clients, Cognitive Behavioral Therapy and Brief, Solution Focused orientations have been most efficient clinically, and cost effective.  So much of the Therapy happens outside the office. So I also provide practical, concrete, doable tools and strategies to begin immediately practicing in your world, to create the change you want.  Even with those for whom a longer term, more analytic orientation is appropriate, practical, realistic applications are also offered each session to facilitate your desired change.  So, in many cases, the total number of office visits may be far less than required with traditional psychotherapy.

My Office and Fees

I believe there is a real benefit to seeing a therapist that you chose based on factors often beyond insurance plan dictates.  My office is located in my home, easily found in Okemos Michigan.  It is a comfortable, safe environment that is clearly more a “living room” than a clinical office. This not only affords more privacy and anonymity, it feels much more casual and open, and so much more conducive to just being yourself!

My fees are easily comparable to other senior level, out-of-network specialists.  Working out of my home also affords a bit more latitude when there is a real need to reconsider fees.

I do hope this has been helpful to you.

If you live in the Lansing, Michigan area, please feel free to call to with any question, comments, or to set up an appointment with me"  

Peter Roseman Psy.S.
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