THE NITTY-GRITTY OF COST EXPLAINED:

Many clients don't realize the time & resources that go into providing a traditional 60 minute session.  We've all heard it:  "Therapy is expensive!"  And I'm here to say absolutely, yes it can be.  I'm here to help you understand the why, communicate the value of therapy as a worthwhile investment, and discuss your options going forward so you can make an informed decision for you.

​​

​

I BELIEVE YOU DESERVE THE BEST POSSIBLE CARE.

 

YOU DESERVE TO "CLICK" WITH YOUR THERAPIST.

​

YOU DESERVE TO FEEL COMFORTABLE AND LOOK FORWARD TO GOING TO THERAPY, EVEN IF WHAT WE TALK ABOUT IS HARD.

​

YOU DESERVE CONSISTENCY AND EASE OF ACCESS.

 

​YOU DESERVE A PRACTITIONER WHO IS INVESTED, ENERGIZED, PRESENT,

EXCITED & FOCUSED ON

​

YOU.

 

NOT A THERAPIST WHO'S EXHAUSTED & APPROACHING BURNOUT BECAUSE THEY SEE SO MANY CLIENTS A WEEK THEY CAN'T KEEP THE DETAILS STRAIGHT.

​

​​

 

Read on to understand some of my costs associated with doing business that remain hidden in the background!

​

A broken system:  The reality is, the healthcare system is broken as we know it.  Instead of being a part of that broken system, I have chosen to work independently in a way where I can assess what clients are the best fit for me and show up as a practitioner with a good work-life balance to provide the best-quality care possible! (FYI did you know in private practice, a "full" caseload is considered 20-25 clients a week?   As a practitioner a session is like being in charge of leading an hour long company meeting.  Now imagine running EIGHT back to back meetings five days a week...  Phew!)  A caseload of 20-25 is the upper limit of most clinicians' ability to be able to provide focused and quality care, and still have adequate time for all of the required paperwork, admin time, etc.  Many clinicians carry a smaller caseload, as high-quality and focused work can be physically, mentally, and emotionally draining.  During a day, the topics I hold space for range anywhere from family dynamics, to infant loss, unspeakable personal trauma, grief and loss, anxiety and depression, to parenting stressors and relationship woes.  You deserve a practitioner that is present to sit with your pain.

​

Insurance Woes:  The yucky truth:  insurance companies save money when they don't pay.  Sadly, for profit healthcare is just that-for profit.  They make money off of denying care or charging exorbitantly for it, rather than preventing the problems in the first place.  Many individuals *have* to have insurance in order to pay for healthcare, but the very healthcare they pay for is invested in paying as little as possible.  Insurances are allowed to change what they pay for and authorize on a whim, and unfortunately providers bear the brunt of this financial devastation when this happens.  Insurance companies do not provide pay parity for providers, and sadly mental health services are sorely under-reimbursed compared to other medical services.  Insurance companies have a monopoly on the healthcare system, and even sometimes retroactively change their mind and demand repayment for services they authorized and paid for prior.  As someone who has been on the receiving end of clawbacks (delivered prior approved services, was paid, then months later insurance changed policy regarding covered services and required me to pay back funds!!!) I have decided to opt out of the system all together.  Dealing with claims and denials can take hours, and that's if you're lucky enough to actually reach a representative.  The bottom line:  I can't help people if my livelihood and ability to pay my own bills is on the line.  In order to serve clients who do have insurance, please note that many plans have out-of-network benefits you can utilize, and yours may be one of them!

​

 No shows and late cancellation:   Unexpected things happen.  Sickness, scheduling fiascos, a flat tire-life has a way of happening to us sometimes.  However, every time you no-show or cancel late I lose valuable time working with you and am unable to recoup that lost income.  Since I am the sole provider seeing pre-scheduled clients one at a time, it's nearly impossible for me to find someone else to fill in your slot if you no show or late cancel.  Some insurance plans do not allow providers to charge for late cancellations or no shows.  As an OON provider, I can and do charge no-show and late cancellation fees which protects both my investment AND yours.

​

Notes and paperwork:  Paperwork and documentation is unpaid, yet necessary, labor.  I document each session as part of your medical record.  Any time I spend  researching information and resources, sending and communicating  information to clients, scheduling, returning phone calls, emailing, etc is unpaid.  Coordinating with other healthcare professionals, advocating for your care if there is a signed ROI, etc is all unpaid!  The only time I get paid for is the time you are physically (aka virtually) live in front of me.  All of this adds up to a large amount of unbillable time and work I do behind the scenes in order to provide the best possible care. 

​

Education costs:  As a Master's level therapist I have 4 years of undergraduate work plus a graduate degree.  During graduate studies therapists gain experience through providing thousands of hours of free labor in their practicum and internships.  After graduating, state laws require counselors to work for a period of at least two years in a "candidate" position under a supervisor before we are fully licensed providing anywhere from 2000-3000+ hours of poorly paid work.  Some supervisors require you to pay out of pocket for supervision during this period.  This equates to 6 years of education, plus at least 2extra years of less-than-optimal pay *before* professional independent licensure!  Thousands of dollars in student loans.  Even once licensed, pay structure does not value mental health services even though there is a tangible need and shortage of clinical service providers in many areas.  My first job in community mental health out of grad school I made a measly $25 dollars an hour and about 56k a year.  I was overworked (80+ clients on my caseload!) and chronically underpaid...  I was given high acuity clients that needed more specialized care.  I didn't have a say in what clients were a good fit vs. which ones weren't.  I experienced the death of a loved one and a traumatic event back to back and could only take two days off because it was all I was allowed.  There was a point where I considered quitting-and I was not even a year into my job.  This is the norm in many mental health agencies.  Providers are made to feel selfish for wanting to be paid fairly.  I was struggling to pay my bills for my family and didn't even have to pay on my student loans because my pay wasn't high enough.

 

The Private Practice Pro writes, "Individual generosity isn't the solution to a broken system.  We can't keep asking therapist to carry the weight of underfunded mental health care.  We need systemic change."  In my career I've done it all-worked for a non-profit, taken every insurance, offered sliding scale spots, and given away thousands of dollars and thousands of hours of free therapy.  "Mental health is healthcare.  And therapists deserve sustainable, ethical, well-supported careers."  -Private Practice Pro

​

Continuing education & licensure costs:  Did you know that by law, therapists are required to accrue continuing education hours yearly in order to remain up-to-date on best practices and comply with laws and ethical standards?  These certifications allow us to stay up to date with new information, apply new-findings, and continue to grow in knowledge relevant to our field.  Continuing education courses can be expensive (some specialty trainings are thousands of dollars) time consuming, and take clinicians away from face-to-face clinical earning.  We also must renew our license every two years, and are required to pay applicable fees to stay in good standing, along with carrying business licenses and other applicable certification fees!

​

Specialization:  Many therapists choose to specialize in specific areas to better serve the populations they work with, and so they can utilize effective interventions and modalities that require additional training.  These specializations are not part of graduate school curriculum and can be pricey:  on the low end hundreds,  on the high end several thousand of dollars -plus- adequate supervision and time in training depending on the specialty as well as recertification fees as needed.  Not to mention the cost of taking registered exams, and separate continuing education requirements we are required to maintain yearly!

​

HIPAA compliance:  EHR platform, as well as encrypted email, HIPPA compliant video platform, texting, etc.  These are out of pocket costs and are monthly fees I pay up front in order to keep your information safe and secure!

​

Technology fees:  High speed internet, anyone?  Costs of maintaining a website, domain name, secure emails and forms, etc.  All out of pocket costs!

​

Malpractice Insurance:  I carry a high level of malpractice insurance to protect myself, my business, my family, and our assets.  Being a therapist is a profession that carries a large amount of liability and responsibility.

​

Setting:  Private practice vs. Outpatient clinic.  Many costs are absorbed in outpatient settings, such as technology fees and HIPAA compliance, and EHR platforms.  Administrative personnel answer phones and inquiries and book schedules, IT techs trouble shoot issues and update websites, and clinicians see clients in individual or group settings.  Outpatient practices typically are salaried positions, and provide health and employment benefits such as paid time off and health insurance.  However, there can be multiple downsides to outpatient clinic care.  Many outpatient clinic counselors have extremely large caseloads; they oftentimes have long wait lists and limited availability.  You may be directly assigned a counselor who is not a good fit for you, and you may not be able to choose who you see-much less screen a counselor to see if you're comfortable moving forward.  There may be regulations and policies you don't agree with or understand.  Pay for a master's degree position is typically low.  Counselors can be rushed going from client to client and oftentimes have appointments back to back with no break in-between.  There may be less than ideal appointment times available forcing you to have to take time off of work or have difficulty scheduling appointments.

 

Many private practice practitioners end up going into private practice for the freedom and flexibility it provides.  I switched to private practice so I could provide the best possible care and ensure that I am a good fit for every client that I see.  I did not have that option in an outpatient setting; at its height I had 85 clients on my caseload, no time in-between clients to take care of myself or decompress, much-less to do required paperwork, and was quickly approaching burnout rushing from patient to patient.  I was tired, overworked, underpaid, and frustrated that a system that was supposed to help people had so many cracks, and the same system I worked for was hurting me in the process, too.

 

A large outpatient clinic headed by an upper-level office CEO whose company has won the designated insurance contract and has a steady-stream high volume of state insurance clients looks vastly different than an independently owned and operated one-woman private practice.  Instead of a salaried position with a steady paycheck or being able to utilize PTO when needed, I rely heavily on the value I provide to my clients and therefore I am incredibly invested in ensuring my clients receive high quality, ethical, personalized, energized, focused, present, and effective care.  If you made it this far, now you have a better idea of what happens behind the scenes, and rest be assured I am here to be part of the solution and be a present and active participant in your care-because it's absolutely what you deserve.​

​

​

​