A question I often get is why I do not accept insurance in my practice. I often take a deep breath before I respond, as my answer can be lengthy and emotionally charged.

As a consumer, I understand the importance and necessity of being able to use health insurance for medical appointments. However, I truly believe that mental health services fall under a different category and way of operating.

In order to use your insurance for therapy, I would need to justify your need for the services to the insurance company, which includes diagnosis, daily functioning and behaviors, and other very personal information. Not only does this divulge sensitive material to a third party, but it also means that this material is being judged to qualify you for their aid. For example, insurance companies do not cover some diagnoses. That means that many therapists select a diagnosis based upon which ones will be selected for coverage. I chose not to have my hand forced to diagnose or misdiagnose for the sake of possible coverage.

Furthermore, if coverage is approved, insurance agencies itemize and constrict therapeutic goals, treatment plans, and even length and frequency of services allowed. Often treatment is time-limited through insurance, regardless of how long you may actually need for your treatment. I have never found it helpful when a third party payer has a say in your care and services when they are not involved in your actual treatment and have no understanding of your needs. It can begin to feel intrusive and can jeopardize confidentiality, which is the cornerstone of therapy.

On a selfish note, it is truly a hassle to deal with insurance companies, especially in terms of reimbursement. It is a very costly and lengthy process, and payment is never timely. It takes time and energy away from focusing on your treatment and care. I will not stand for that. Time spent with insurance companies are lost hours with no compensation and often leads to a cycle of discrepancies.

Furthermore, insurance companies almost never reimburse the therapist’s full rate, which means you are either responsible for the rest, or your therapist doesn’t earn their full fee for the work that they provide you. Most clients are upset when they hear this because they value their therapist and the work they do. In addition, it seems that clients who pay out of pocket for their sessions tend to find more reason to be committed and invested in therapy.

For these reasons, I believe that accepting insurance has the potential to do more harm than good to the therapeutic relationship. I value my work and the relationship I have with my clients, and I do not want to allow anything to compromise it.

If you have any further questions, please feel free to ask!

I practice a more long-term, integrated approach to therapy that combines different theories and techniques in my treatment with clients, including psychodynamic, attachment, systems, and client-centered approaches. What that means is that I believe in looking at the whole person and their relationships, and tailoring my approach to meet their unique needs and goals.

I tend to focus on the unconscious patterns and unresolved conflicts that may contribute to current difficulties. I look at how early relationships and childhood experiences may impact your current relationships and view of yourself. I also believe that while I may have the right knowledge and tools to guide you, you are the expert in you! So rather than giving you the “correct” answer or solutions, I aim to help guide or facilitate you to better understand your own thoughts and feelings, and to develop greater self-awareness and insight. I believe that the most important factor in therapy is the relationship between the therapist and the client, and that by creating a collaborative, safe, and supportive space, we can work together to explore your thoughts, feelings, and experiences in a way that helps you to achieve greater emotional well-being and healing. I also bring my most honest and authentic self to each session, because I would hope that my clients feel safe and comfortable enough to do the same.

Sometimes we laugh, sometimes we cry, and sometimes we do both. My sessions with each of my clients look different because each person and relationship is different!

It takes a lot of courage to try something again when you have had negative experiences with it in the past. Especially something as challenging, vulnerable, and a financial investment such as therapy. It is understandable that you may feel discouraged and hesitant about trying again! It is important to keep in mind that not all therapists are the same, and therapeutic approaches can differ as well. Just because you had a negative experience with one therapist or therapeutic approach in the past doesn’t mean that all therapy will be unhelpful or uncomfortable for you. It is also possible that you may be in a different place than you were when you tried before!

If you didn’t feel comfortable or supported by your previous therapist, it is possible that you weren’t a good match for one another. By trying therapy again, it gives you the opportunity to find a therapist who is right for you and may better fit your needs. Therapy is a personal journey, so it is important to find a therapist who makes you feel comfortable and supported. If you decide to try therapy again, take your time in finding a therapist who is a good match, and don’t hesitate to ask questions or raise any concerns you may have. And above all else, you should try again because you are worth it!

Your first therapy appointment is an opportunity for you to get to know your therapist and for your therapist to get to know you. It is an opportunity for both the client and therapist to make sure they are a good fit for one another. Every therapist’s approach may vary based on personal preference, style, and therapeutic approach and modality. But generally, here is what you can expect in your first session:

1. Introductions and reviewing paperwork- Typically your therapist will begin with introductions, and will explain the process of therapy and what to expect from treatment. They will likely also review all intake paperwork/questionnaires.

2. Discussing goals and concerns- Your therapist will ask you about why you sought out therapy, and what you are hoping to get from therapy, including current challenges, symptoms, and goals.

3. Gathering background information- Your therapist may ask about your background information, including family history, medical history, previous therapy experiences, and any pertinent life events or experiences you may have had that may be contributing to your current presenting problems.

4. Assessing your therapeutic needs and creating a general treatment plan- Based on the information you provide, your therapist will work with you to assess your needs and develop a treatment plan.

5. Building rapport and setting expectations- Your first session is an opportunity for you and your therapist to build rapport and establish a working relationship.

Overall, the first session is a “getting to know you” session and gives your therapist an opportunity to understand your goals and work collaboratively with you to create your goals and treatment plan for therapy. It is normal to feel nervous and unsure before your first session, but your therapist should help you to feel supported and comfortable.

Typically, I meet with clients on a weekly basis for 50-minute sessions. I have found this frequency of sessions to be most effective for most clients, especially since so much happens over the course of a week, that anything less frequent tends to be less fruitful for the client. But since every therapy relationship and every client’s therapeutic needs are different, I typically take a lot of things into consideration when planning frequency and duration of sessions, and work collaboratively with clients to figure out what would be best for them.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

• Your health plan generally must:

o Cover emergency services without requiring you to get approval for services in advance (prior authorization).

o Cover emergency services by out-of-network providers.

o Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.

o Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact Dr. Jenn Samstag at 626-385-7793 or drjennsamstag@gmail.com. You may also contact the California Board of Psychology at https://www.psychology.ca.gov/.

Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.