Moving Notice 4/1/18

Starting April 1st, 2018, I will see clients in the Hobart Building. This move is just a block away, so it will be of minimal disruption to current clients. I am hoping that by choosing to stay in Financial District, I am allowing more access to those from the East Bay and Berkeley, as well as other parts of the city.

I know I’ve been neglectful with my blog in the past few months, I will soon be writing again. Stay tuned!


Coping with Tragedies

Coping with Tragedies

A lot has been happening locally and globally. It may feel like these devastations are happening in higher frequency than before, and perhaps they are. While it is disheartening to see that these tragedies are occurring, let us not forget that there are many ways to grow from it, help our community and contribute for the greater good.

It is normal to struggle with how to feel and what to think when tragedies happen. If you need to take some time off from thinking about it, that is okay. There is no right way to be as you try to grasp what has occurred. Allow yourself time and space to process how you think and feel. You can do this by talking to others about what happened and share what is on your mind with a trusted friend.  Allow room for some reflection about your own life. Perhaps journaling, painting or using art as a medium to express your emotions. Then, decide what you want to do about it. The act of “doing” doesn’t necessarily mean you only have to give your time or money to places that create change. It can also mean a mental shift in your own world view. Perhaps you want to practice more gratefulness, mindfulness and overall acknowledgement of the life you are leading. You might want to limit the amount of social media and news you consume.  Maybe you want to spend more time volunteering with the affected communities. It is so very important for each of us to gage our capacity to give both mentally, physically and financially and act accordingly to our abilities.

More resources below:


Cultivate Your Happiness

Cultivate Your Happiness

The top reason my clients begin therapy is to seek relief from high levels of stress and anxiety. When people are asked what they want to get out of therapy, most respond with just wanting to reduce their symptoms or not feel so overwhelmed and exhausted. While that is a great initial goal, I also want to focus on the importance of actively cultivating a balanced life. One that involves not just financial success or social capital, but also practicing contentment and acceptance of what is happening in the present. This means to take the time to really notice and acknowledge when things are going well and taking the time to celebrate these moments. 

Happiness is a ubiquitous term that is often thrown around with the assumption that we all want it. However, one person’s perspective of happiness can differ greatly from another. Thus, it is important to really get specific about what exactly it is that makes you happy. The more detailed you get, the easier it is to make this a tangible goal.  Happiness can be large goals like finding a loving partner or be as simple as seeing a happy dog and its owner play.

The more you practice seeing happiness in different forms, the more you’ll be able to see how happiness is often attached to feelings of love, contentment and lightness. This practice in itself is so simple, yet so difficult to achieve when we are busy with our daily tasks and chores. It does require some intention to highlight the good things that happen throughout your day. You can make a nightly ritual to remind yourself of three things that happened that brought a smile to your face. This activity take about 3-5 minutes, and with consistent practice, can bring you much closer to that feeling of happiness that everyone is searching for.

Suggested Reading: Four Well-being Workouts

Insurance Jargon

Insurance Jargon

Access Issues to Mental Health: Part 4

Insurance benefits can puzzle and confuse many members because of all the unfamiliar jargon and numbers. This blog will focus only on mental health benefits, which are often a separate coverage in addition to medical health coverage. These are the most often used terms that clients should know about their coverage.

In Network Provider: a therapist who has agreed to a contract with an insurance company to provide services and for its members. Billing is included and clients often only have to be responsible for their copay/co-insurance.

Out-of-Network Provider: a therapist who does not have a contract with an insurance company. Clients usually pay the therapist’s full fee and will receive a statement called “Superbill” to send to their insurance for reimbursement. Rates of reimbursements can range widely, depending on the plan. Clients often have to coordinate payment issues with their insurance.

Deductible: the amount that the member must pay before their insurance policy will apply their benefits. This amount is renewed at the beginning of their annual cycle. Some plans will waive the deductible for mental health services.

Co-pay: a fixed rate that the member is responsible for at each visit. This amount usually ranges from $10-$40 depending on the plan.

Co-insurance: the percentage of the fee-for-service the member is responsible for at each visit. ie: Session cost is $100 and the member has a 30% co-insurance. The member would have to pay $30, insurance will pay $70.

Pre-approval/Authorization: the process of approving a member for mental health services. Some plans require that members get a referral from their primary care physician before approving. Other plans only need the member to call ahead of time and ask for an “authorization” before receiving mental health services.

Explanation of Benefits (EOB): mailed statements of dates of service and payments

Out-of-Pocket Maximum: the maximum amount that the client is responsible for per calendar year (only for approved services)

Other notable information:

  1. For private practice therapists, location of services is “office” or “11”.
  2. OON reimbursements are usually at 20-80% of what the insurance plan considers the usual and customary rate (UCR). This rate is usually close to your therapist’s full fee rate, but not always. Most OON benefits require a deductible to be met before they will reimburse members.
  3. Carve outs: some plans will contract with another company for mental health services, make sure you get the name of the plan (ie. Magellan, Beacon, CareFirst, etc) and ask your therapist if they are “in-network” with the carve out plan. If they are not, you may not be able to access in-network benefits.
  4. EOBs are almost always sent to the subscriber’s address unless otherwise requested. If you are not the primary subscriber and you want complete privacy of your services, using insurance may not be ideal. Some plans may allow EOBs to be sent to the person receiving services instead. Call your insurance representative to inquire. More info: Young Adult on Parents’ Insurance

I hope that this four part blog series have been informational and helpful in helping you begin to understand your mental health benefits. The amount of information require some time to get used to, so don’t hesitate to ask your insurance rep for clarification. I want my clients to be well informed, so I always strive to make room for questions when discussion their insurance benefits. Clients are ultimately responsible for understanding their individual plan as each plan varies greatly from the next. Therapists can learn the basics of each company, but it is impossible for therapists to know each client’s plan inside out. It is better to get a quick start on learning the terms of your plan and avoid future headaches. If you  enjoyed this series and/or have other ideas for other topics, please let me know with a comment below!

The Cost of Access

The Cost of Access

Access Issues to Mental Health: Part 3

In 2011, 62.3% of Californians who needed mental health treatment did not receive this service (see link to data below). While insurance companies are required to provide mental health benefits, access to these benefits can range widely. Cost is a major barrier to access, even with the help of insurance benefits. Clients with spouses and/or families on their plan are often burdened with high deductibles before they can access benefits. This means that clients often have to pay out of pocket for services for months until their deductible is met and their benefits are in effect. Some deductibles are so high that it won’t be met until the last month of the year, if at all. The trend tends to be that when the monthly payments for insurance is lower, the higher the deductible rate. For individual policy holders, employer sponsored plans and university sponsored plans often have reduced deductibles to $0 deductible. More on insurance benefits in Part 4: Understanding Insurance Jargon.

Tips on managing costs for mental health services:

  • Before subscribing to an insurance plan, make sure you:
    • Understand the benefits (See Part 4)
    • Find at least 3 providers who are accepting new clients within this network
    • Estimate the medical costs and mental health costs and choose the plan that best fits your need
  • Budget and prioritize your expenses for the month/year
  • Access employer sponsored EAP services: usually 3-8 free sessions per year
  • Be prepared to pay full fee for services if you see an Out of Network therapist
  • Ask your employer if they have Health Spending Account/Flexible Spending Account options. This money is taken out pre-taxed and can be used towards mental health services.
  • Reduce chances of missed appointments or late payments with reminders
  • Ask your employer about options to make up missed work without loss of pay
  • Remember that not all quoted benefits by insurance reps are guaranteed payment, so plan for possible extra expenses.

When a therapist accepts insurance, they are providing services at 30-50% of their regular fee with required additional administrative tasks. Because of the managed care requirement, therapists often cannot see more than a set number of insurance clients per week. To do so may reduce quality of care. In addition, the standard of care is sometimes reduced to what insurance deems medically necessary rather than what the provider recommends. Additionally, most insurance plans do not cover relational issues, such as couples work. When they do cover couples, one person often must be identified as having the mental health issue to which couples therapy will help resolve. Thus, providers often opt out of working with insurance due to theses limitations. It is important to acknowledge that the medical model for mental health can be successful with certain populations, but it does not fit with all mental health issues.

The financial burden both for therapists who accept insurance and clients who need to use their insurance is a real issue that continues to go unresolved. What is clear is that more and more people are seeking therapy, thus demand continue to rise and supply continues to dwindle. It would be interesting to see where California legislation will change as talks of a single payer system is currently in the works. For more reading and data on this matter, see links below.