Lawyers Concerned For Lawyers

Issue October 2015 By Dr. Jeff Fortgang

Looking for Dr. Good: seeking a therapist in the HMO era

Q: I work at a Boston law firm and, sensing it was a good time to return to my former therapist in town, found that she has retired. I got another name from a colleague, conveniently located, but she does not take my HMO (or any insurance), and is surprisingly expensive -- over $200 per session. The colleague expressed the view that, in terms of confidentiality, self-pay is a better arrangement anyhow, but I hate to part with that kind of money on top of those mounting health insurance premiums that are supposed to cover my health needs. A number of people listed on my HMO list turned out to be working only at hospital clinics which, for one reason or another, are not accessible to me (e.g. because my primary care physician is not at that hospital). There are other names near my home in the suburbs, but those I've called have no availability before or after my work hours. Any ideas?

A: You have encountered a reality that we at LCL face recurrently (since a majority of lawyers who come to us for consultation and referral work in Boston). Probably because office rent is more expensive in Boston, and small therapist-friendly offices are few, the supply of therapists practicing in Boston proper is lower than the demand. Although most therapists accept at least one insurance plan (for access to a wider pool of patients and/or because they prefer not to treat only the relatively well-to-do), they would generally prefer self-pay if they can get it. This is because jumping through the managed care hoops can be demanding (each company doing business its own way, and time spent on this is unpaid), and also because signing a contract with a managed care entity means accepting about a 50 percent fee discount.

At LCL, we refer mainly to therapists who do take our clients' insurance; Sometimes that means trying a therapist we don't know or whose practices are less conveniently located. We are also sometimes in a position to help with payment for our clients whose incomes/resources are very limited.

The confidentiality/privacy issue that your colleague raised is real, though perhaps not a big enough problem to deter most people from using insurance. On each claim submitted to insurance, the therapist must indicate a diagnosis. In addition, for HMOs and even some non-HMO plans, the therapist will need to recurrently submit more detailed information in order to get additional sessions (anywhere from perhaps 4 to 12 at a time) authorized. That information typically includes ratings of level of functioning, specific therapy problems and goals, a list of risk factors (such as abusing alcohol/drugs, having suicidal thoughts, having endured past trauma), current medications, etc. The contracts between therapist and insurer and subscriber also permit the insurer to review clinical records (though we have rarely seen this happen with individual practitioners). The upshot: If you can easily afford the fee, the somewhat wider range of therapists and decreased concern for confidentiality may be worth it. If not, though, the privacy risks are relatively low.

LCL's services are free to you as a lawyer (or law student or judge or family member of one). Although our services are limited to consultation/referral, not ongoing therapy, we can help you navigate managed care and make a more informed choice of therapist. We try to keep our referral database up to date and we urge you, as well, to let us know if you have had either quite positive or quite negative experiences with any Massachusetts mental health/addictions provider - that information will, in turn, help our future clients.

Dr. Jeff Fortgang is a licensed psychologist and licensed alcohol and drug counselor on staff at Lawyers Concerned for Lawyers of Massachusetts, where he and his colleagues provide confidential consultation to lawyers and law students, and offer presentations on subjects related to the lives of lawyers. Q&A questions are either actual letters/emails or paraphrased and disguised concerns expressed by individuals seeking LCL's assistance.