A major part of the cost of psychological treatment is related to the personal attention and individual treatment you receive from a psychologist. For example, when you visit your family physician for a problem, you might receive between five and fifteen minutes of one-on-one attention from your physician during an office visit. However, psychotherapy appointments are 45 minutes long, and sometimes longer. For testing and evaluation services, a psychologist may spend several hours with you. The fees charged for psychological services reflect this time and personal attention. Actually, the cost of psychological services is far lower than other medical services.

Some people delay starting psychotherapy because they are not sure if the cost of psychological treatment is covered by their health insurance, and/or because they believe they cannot afford treatment. Health plan brochures are often misleading or vague, leading to doubts about coverage. Managed care can add to the confusion because the same plan may provide different coverage, and have different co-pays and deductibles, depending on the contract negotiated with your employer.

When insurance plans use the word "choice" in their descriptions, they are usually referring to their choice, not yours. Many managed care companies subcontract the mental health portion of your coverage with another specialized mental health managed care plan. This means that the company name on your insurance card may not be the name of the managed care plan that handles your mental health or psychological coverage. Some plans allow you to use either the managed care company, or to choose an out of network psychologist, simply by paying a deductible and a percentage of the fee charged by the out of network psychologist. This option gives you much more choice in deciding who will provide your treatment. It allows you to select a psychologist who has experience treating your problem, and who has an office, and office hours, that are convenient for you.

The cost of psychological treatment is based on several factors:

• Is your plan a managed care plan or a point of service plan?
• What percentage of the fee is covered by insurance?
• What is your deductible?
• Do you have an out of network option on your managed care plan?
• How many treatment sessions will be needed (approximately)?
• Will the managed care plan cover the needed treatment?
• How often will treatment sessions be scheduled?
• What is the cost of not receiving treatment? What effect is the problem having on your personal health, your work, and your family?
• What is the value of going out of network?
• What managed care plans does Dr. Franklin accept?
• What kind of payment options are available for psychotherapy?

Is your plan a managed care plan or a point of service plan?
A managed care plan, or PPO, will require you to select a psychologist from a limited network. Often, they will steer you to a counselor with less training or experience, because the reimbursement rate is lower for the insurance company. The provider will be required to give the insurance company a considerable amount of information about your confidential treatment, and then the insurance company will decide how much treatment, and what kind of treatment, you will get.  Sometimes treatment sessions are approved a few at a time, so it is impossible for the psychologist to plan treatment, as every session might be the last one approved. 

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What percentage of the fee is covered by insurance?
You may or may not have a deductible, or a CO-payment. Sometimes this is fixed, and sometimes it is a percentage of the fee. Often, the CO-pay for mental health benefits is higher than the CO-pay for regular medical treatment.

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What is your deductible?
Deductible can range from Zero to $750. or even higher. If you have a high deductible, you are really paying for the service yourself, so you may want to avoid managed care altogether, to maintain the confidentiality of your mental health records.

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Do you have an out of network option on your managed care plan?
An out of network option allows you to select a treatment provider who is not in the network.  This can be any licensed mental health treatment provider. The plan may require a higher deductible for out of network benefits, and the reimbursement rate may be a lower percentage, but you maintain confidentiality and freedom of choice.

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How many treatment sessions will be needed (approximately)?
Generally, adjustment problems can be addressed in six to twelve sessions, moderate problems in ten to twenty-five sessions, and more serious problems require twenty or more sessions. The number of sessions required for your problem will depend on the specifics of the issue.

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Will the managed care plan cover the needed treatment?
Sometimes managed care plans only approve a set number of sessions.  If treatment is required beyond this, you will need to pay out of pocket. Some plans prohibit a plan provider from providing additional treatment unless the treatment is approved by the plan. This is another reason to consider an out of network provider.

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How often will treatment sessions be scheduled?
Typically, treatment sessions are scheduled once per week, at least until there is progress in treatment. If a person is experiencing a crisis, sessions may be scheduled more than once per week.  Once treatment is progressing, you may opt to have sessions less than once per week. The appropriateness of scheduling sessions less than once per week is a clinical decision, depending on issues in the case.

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What is the cost of not receiving treatment? What effect is the problem having on your personal health, your work, and your family?
When you are struggling with emotional problems, it can affect many areas of your life. At work, your productivity can suffer, especially in areas that require concentration and decision making.  Stress appears to depress the functioning of your immune system, so you are at greater risk for physical illness. In fact, one study found that people who had easier access to mental health services, before the problems become crises, tended to spend about half as many days hospitalized for physical health problems, as compared to those who don't use mental health services when needed. And of course, emotional problems place a great stress on your family, and increase family relationship conflicts. If you consider all these factors, seeking psychological treatment when needed appears to be the best preventative health care you can get.

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What is the value of going out of network?
Managed care plans typically provide easy access to basic health services and primary care physicians, but seem to try to save money by restricting access to specialty services, such as psychological treatment. As a result, the plans often micro manage mental health services by approving only a few sessions at a time, requiring a lot of information about treatment before approving any additional services, and having small panels, or panels with a lot of lesser trained professionals, and only a few psychologists and psychiatrists. The result is difficulty scheduling appointments when you are available, having to travel a greater distance for service, and receiving service from whoever is available, rather than the treatment provider who can best assist you with your problem.

Out of Network benefits can help you avoid all these problems, often for only a few dollars more than your normal copayment. You can choose to receive treatment from any licensed psychologist, and confidential information about your treatment remains confidential. Greater choice always means greater quality of service, because you can select a psychologist who has experience and training treating your specific problem, who has an office that is accessible, and who can accommodate your time schedule.  Most plans now offer Out of Network options.

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What managed care plans does Dr. Franklin accept?
In the past Dr. Franklin participated on several of the better run managed care panels. However, these panels eventually began to micromanage treatment, and often restricted treatment that Dr. Franklin believed to be a clinical necessity for a client. This created an ethical problem. As a psychologist, I must provide the treatment that is most likely to be effective in treating a client, but often a managed care reviewer (usually an individual without any clinical licensing) would restrict the number of sessions that could be provided, or simply not approve treatment. Eventually, I resigned from all managed care plans because their policies interfered with high quality services.

However, most plans now offer an Out of Network option that allows me to provide treatment to you, without the insurance compnay interfering with treatment. If you have Out of Network benefits with your insurance plan, you will be responsible for payment for services, but you can submit all statements to your insurance for reimbursement. Generally, there is a deductible with Out of Network benefits, and the amount of the deductible varies from one plan to another. After you meet your deductible, your insurance will reimburse you for a percentage of the costs of treatment, according to your plan coverage.

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What kind of payment options are available for psychotherapy?
Most people complete psychological treatment in ten to twenty sessions, with a few needing additional treatment. With this in mind, Dr. Franklin can work out a payment plan to help you receive the treatment you need, without the cost creating additional stress for you. You can also transfer some or all of your balance to a major credit card, to allow you to make extended payments if needed. Most importantly, Dr. Franklin invites you to discuss payment issues, without fear of embarrassment, at any time during your treatment. He will make every effort to work out a plan that will allow you to receive needed treatment.

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Donald J. Franklin, Ph.D. is a NJ licensed psychologist (#2244)
with offices in Bridgewater, NJ and Flemington, NJ.
Please call for information or to make an appointment:
Bridgewater - (908) 526-8111 or Flemington- (908) 806-7344

Please Note: I do not provide online counseling or consultations
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