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.