Q: What insurances do you accept?
A: At the present time, we are a participating provider with Fidelis and CDPHP. As time goes on, we intend to add other insurance companies.
***SPECIAL NOTE FOR THOSE WITH INSURANCE:
If you have insurance through Fidelis or CDPHP, and have a copay, or a coinsurance amount, we will accept this copay or coinsurance amount as payment in full. The balance of the fee is billed directly to Fidelis or CDPHP.
If you have coverage through another insurance company that will pay an out of network provider directly; or reimburse your out-of-pocket costs for a non-participating provider; or you obtain reimbursement through a flexible spending program-- we will work with you to provide the appropriate documentation (e.g. a diagnosis, services rendered, dates of service, and receipt of payment) required to facilitate coverage and reimbursement whenever possible.
Q: If I don't have insurance, or have another insurance product that does not cover out of network providers, have a deductible to meet, must pay out of pocket to get reimbursed, or simply choose to pay out of pocket (due to lengthy and confusing paperwork, poor coverage or reimbursement, or privacy concerns)--what is your standard fee?
A: Our fee is $90 per hour; and $120 for an evaluation. However, for private pay or self-pay patients, the fee is $65 per hour or $90 for an evaluation, which is the lowest insurance reimbursement we currently accept as payment in full.
Q: What if I cannot afford the standard fee?
A: Until December 31, 2015, we used a sliding fee scale based on income. We wanted to follow this ethic so as not to deny our services because of an inability to pay. As of January 1, 2016, we no longer offer a sliding fee scale. In part, this has to do with perceptions of unfairness. If we lower our fee based on a lower income, individuals with a higher income feel they are discriminated against; or feel that we are somehow squeezing more out of them because we can. While this was not our intention (our intentions were quite the opposite), some clients felt this was the case.
Also, insurance companies that pay for out of network providers use the UCR (Usual, Customary, and Reasonable) fee schedule to determine how much they should pay. This fee schedule is based on an average of all the charges submitted on claims they get in a certain time frame from a certain area. However, when providers are using a sliding fee scale, these lower fees lower the average for all providers in the area--including providers who cannot afford to use a sliding fee scale, and those providers get hurt the most. While we weren't hurt by this, we don't want to contribute to the problem for other providers.
Also, an insurance company can base their out of network payments to us on our average fee; which becomes our USUAL and CUSTOMARY fee...even if it is less than the standard UCR. Lower average fees mean lower reimbursement rates from insurance companies; but subsequently higher portions of the fee that have to come out of the client's pocket for clients who have insurance and don't qualify for a discounted fee.
An example is this: let's say the UCR for counseling in our area is $70.00/hr. But because we've been cutting fees for our less affluent clients, or clients without insurance, our practice's average fee (our practice's Usual and Customary fee) is $50.00. The insurance company pays us 80% of this, which is $40. But because this is a client with insurance, we don't discount the fee for this particular case. And because we're an out of network provider, the client has to pay the co-insurance amount ($10), plus any portion of the fee in excess of our UCR, which is an additional $15; which means that the client's out of pocket cost is $25. Compare this to keeping the fee at $65, and never giving a discount. Our practice UCR is $65, so the insurance company pays 80% ($52). The client pays the coinsurance amount ($13) but there is nothing else owed because the fee is paid in full. Total out of pocket cost is $13, a savings of $12, when compared to the previous example.
So as a result, we have decided not offer a sliding fee scale for patients admitted to the practice after January 1, 2016. Those who are already on a sliding fee scale will remain so for the time being; we will provide reasonable notice if and when this practice ceases altogether.
We will offer alternative ways to manage fees for patients who have difficulty paying them. Starting January 1st, we will begin to offer 30 or 45 minute sessions in addition to one hour sessions. This does not lower the fee per hour, but it may be a more manageable cost for self-pay or private pay clients.
We also offer telephone sessions which are billed at a lower rate, and may be a more affordable alternative for some patients. Telephone sessions will not lower our average fee because it is not a face to face contact and thus is not counted in calculating our average.
In addition, we will look at offering a limited number of time slots (between 1 and 4 per week) for pro-bono (free) services for clients who are facing economic hardships. We may also alternate between paid and free sessions to keep the average weekly or biweekly costs down. And while occasional pro-bono services may lower our average fee slightly, it should not have a significant effect on our average fee if we have a sufficient number of services that are paid for in full.
We hope that these measures will sufficiently address patients who are experiencing hardship or periods of being uninsured, and still want and need to access our services. And with more uninsured patients becoming insured, there should be less need to cut fees at all.
Q: How does counseling differ from the practice of psychology?
A: It's not easy to describe the "differences" between the disciplines, since counseling involves the study of psychology (and psychologists also study counseling!) but the primary difference seems to be that counseling tends to have a shorter term focus than the practice of traditional psychology.
Q: What are your credentials?
A: Jonathan has a Masters Degree in Community Psychology, Counseling Track from Sage Graduate School. He is also a Licensed Mental Health Counselor.
Q: How does this differ from a Master's in Social Work/LMSW/LCSW?
A: Both Licensed Mental Health Counselors (LMHCs) and Social Workers are Masters Level practitioners. In New York State, both disciplines have Masters Degrees that are 60 credit programs; and licensure for both disciplines require 2-3 years of properly supervised post-master's experience.
In my experience the primary difference between the disciplines has always been a philosophical and historical difference rather than an actual one.
Originally, social workers had a more "clinical" approach; where problems of the individual are caused by factors within that individual. Problems were the result of either developmental issues, learned behaviors, or genetic predispositions; or any combination of all three factors within an individual. If and when family relationships played a role in a person's functioning, it was how those relationships affected the individual that was the cause of the problem.
LMHCs and Masters in Psychology are more exposed to and trained in more different schools of psychology and models of treatment than a social worker. They are less wedded to the "clinical" perspective and more likely to recognize that an individual's behavior is not simply the result of problems in the individual; but are also affected by factors in the family and the community at large.
Nonetheless, many of the traditional and historical "differences" between social workers and LMHCs/Masters in Psychology have largely disappeared. Social workers accept that the family and community environments play a role in behavior, and LMHCs/Masters in Psychology accept that factors within the individual (developmental issues, learned behaviors, and genetics) play a role in behavior and cognitive processes.
Q: How do you look at diagnoses? What is a diagnosis?
A: A diagnosis is a convenient box to put a set of observable or self-reported behaviors, thoughts and feelings into. Our practice uses diagnoses as a "jumping off" or starting point in counseling, and for insurance reimbursement. It is not to be used as a label, to make a set of assumptions on how someone will do in counseling (or in life), or as a limit or barrier. It is never the sum total of who a person is. People are more than a just a diagnosis.
Q: What are the limits of your practice?
A: Please see below:
1. Our practice does not do IQ testing. For those services, a client would be referred to a licensed psychologist or certified school psychologist.
2. State law requires that individuals with a major mental illness (e.g. schizophrenia, schizoaffective disorder, bipolar disorder, major depression, autism, etc.) must be referred to a psychiatrist within "a reasonable time". Our practice defines this as within 60 days. However, if the individual is already receiving psychiatric services, or if a psychiatrist determines there is no need for psychiatric treatment, then he or she may continue to be seen by this practice.
Q: What issues do you specialize in?
A: Ours is a general counseling practice. We have experience in treating individuals with mental health, addiction, anger, family, relationship, and interpersonal issues. We also have experience working with individuals with dual diagnoses and multiple or co-morbid issues.
---Thanks for taking the time to read these FAQs. We hope they have answered your questions...but if you have other ones, please call us at (518) 210-5288.
Jonathan Riven and the staff of New Scotland Counseling Associates