Individual Sessions:


Couple or Family Sessions:


Group Sessions:

Remember:

Payment Options:

Medicare Clients:

$125.00 for a 55-minute session
$190.00 for a 120 minutes session

$140.00 for a 55 minute session
$210.00 for a 120 minute session

$45.00 per person for a 90 minutes session

The key to minimizing the cost of your therapy is “therapeutic effectiveness” and NOT the hourly rate. What’s the point of saving 20-30% on the hourly fee – if it takes twice as long to get results!

Penny accepts cash, personal checks and the following credit cards: Visa, MasterCard and Discover.

For additional services, such as report writing, consultation with other professionals, hospital visits and/or phone calls over ten minutes with you or others, you will be charged $32.00 for every 15 minutes or $125.00 per hour.

Payment in full is expected at time of the service unless other arrangements are made in advance. Fees are subject to change every six months.

Penny is a Medicare provider. If you are a Medicare client then you pay only your co-pay at each session. Penny will bill your Medicare directly. You are responsible for the entire fees whether the insurance pays or not. You are responsible for any charges applied to your deductible and for whatever co-pays your insurance stipulate. You can pay by cash, check or credit card.

The contracted medicare fee is $70.00 per session, with 50% co-payment that most MediGap insurance policies pick up. Penny's Medicare Provider number is SW21570. Medicare Advantage Plans (ie. HMO's, PPO's) are not accepted.

Insurance Coverage
Many clients ask Penny whether her fees are covered by their insurance. The answer is both yes and no. These days it takes a Ph.D. to understand the wide variety of mental health care insurance reimbursement plans that are offered. It is complex to say the least. Hopefully, the below information will help answer your specific insurance questions.

Generally there are three types of insurance: Fee for service, closed system managed care and open system managed care. Fee for service companies allow you to select any provider and they will reimburse what they have determined is "usual and customary" (more about this later). Closed system managed care providers will not pay for services unless the provider is on their specific provider list. Penny no longer belongs to any managed care panels (for reasons why, see below). And finally open system managed care companies will reimburse a portion of Penny’s fee.

So how do you determine if Penny's fee is covered and how much will be reimbursed? Follow the below flow chart and hopefully you will have a clear answer to the latter question.

What insurance do you have?

Closed System Managed Care: Penny is no longer on any managed care panels therefore her fees will not be covered. See below article why Penny decided NOT to be on any panels.

"Fee for Service" or "Open System Managed Care": A portion of Penny’s fees will be covered under these types of insurance plans. The crucial questions is how much of the fee will be reimbursed to you. Below are the questions to ask your provider.

1. What are my benefits for a Licensed Clinical Social Worker?

At this point the insurance representative may state “(a certain percent) of usual and customary”

2. What is "usual and customary" for Northern San Diego County?

You may have to press them for this amount because for reasons unknown they like to keep it a secret until after you have submitted your claim. The key here is to tell them you need to know exactly what will be covered before starting therapy. You have a legal right to know what your coverage is. They will ask for CBT codes - give them 90801, 90806, 90847 and 90853. They will also need to know that Penny is a LCSW (Licensed Clinical Social Worker).

Remember, after speaking with your insurance company you should have a specific figure on what they will reimburse.

Why Penny does not accept managed care reimbursement for Mental Health therapy

If you are a member of an HMO or PPO that provides reimbursement for mental health counseling, please read this section before making your choice regarding accessing those benefits.

Reason #1: Lack of confidentiality

All managed care plans (MCP’s) involve direct clinical management by the plan’s case managers. If you access therapy through your MCP, it makes it necessary for your therapist to disclose anything and everything related to your case to your insurance company.

This information is used by the MCP for determining benefits, which they allocate at their own discretion. This impacts your right to confidentiality, and it is possible that your information will be stored in a computer system which could be accessed by anyone.

The FBI and law enforcement officials can access your insurance information at any time. This information could be used to your disadvantage should a legal problem arise.

Furthermore, this lack of confidentiality could impact your minor children even more negatively. Should they ever desire to apply for certain jobs or educational programs, such as law enforcement or the military, the information in their insurance files could be used against them.

Reason #2: Difficulty getting treatment authorized

Due to the direct care management by MCP’s and their desire to keep costs to a minimum, getting therapy sessions authorized often becomes cumbersome and time consuming. Every plan has different requirements and standards for authorizations. Usually they require many hours of paperwork and phone calls by the therapist in order to receive authorization for service. Some will deny therapy in lieu of taking prescription medications.

MCP’s allow a certain number of treatment sessions per year for each plan. Let’s assume your MCP allows up to 20 sessions per year of outpatient psychotherapy. This does not mean you can automatically access your benefits. Generally, you first have to be referred for therapy by the MCP's primary care physician. Then you may have to go through a phone interview with a MCP case manager. Then you may have to contact several plan providers to find one who is accepting new clients, who has a convenient location, or who has expertise in your issues. Once you have found a provider, there may be a long wait for an appointment due to pre-authorization requirements. Then you are often given only one to three sessions to start (50 minutes per week — though you may feel you need more), as an assessment. Then you may need to wait for more visits to be authorized — often weeks of phone calls and paperwork flow back and forth between your provider and the MCP. Then the MCP may only authorize three sessions at a time with this continual waiting period in between. This causes your treatment to be inconsistent, broken up, and can cause you more anxiety not knowing if you will in fact get your benefits authorized at all. Some clients give up on their treatment due to these frustrations.

Furthermore, some MCP’s want to control the treatment plan. Some will even dictate the specific treatment plan, which is often very subjective and may even be anti-therapeutic. Some plans will determine when it is time to terminate treatment, even when the client continues to be in distress, or their problem has not been sufficiently resolved.

Reason #3: Mis-diagnosing and/or over diagnosing in order to get treatment authorized

Some MCP’s will not cover treatment unless it is a “medical necessity.” This may mean the client has to “pretend” they are “sick,” or worse off than they really are, in order to receive their benefits.

Most MCP’s do not cover marriage counseling, family counseling, or grief counseling, unless they are part of the treatment plan for a serious mental disorder or drug/alcohol problem.

This situation puts both the therapist and client in a quandry. Often the “assessment” sessions that are initially authorized are not sufficient to give an accurate diagnosis, yet the MCP will not authorize more visits without one. The therapist may be inclined to “make up” or “guess at” a diagnosis, which is not in the best interest of the client.

Most importantly, you, the client should not be given a mental illness diagnosis that is not correct, or is more serious than what is true, simply to get treatment paid by the MCP.