Frequently Asked Questions

On the most basic level, all mental health professionals work with you to improve your emotional and mental health. However, they differ with regard to their level of education, length of formal training, areas of expertise, and the scope of services they provide.

CLINICAL PSYCHOLOGISTS

Clinical psychologists are specialists in providing diagnoses, developing highly specific treatments for a given diagnosis, and conducting psychological testing/evaluations. Based on this level of expertise, they tend to work with more severe mental illnesses and psychopathological disorders, including psychosis, schizophrenia, and bipolar disorder. Many clinical psychologists have trained and work within a hospital environment, while others work in mental health services groups or in private practice.

On average, it takes 10 or more years of education beyond high school to become a clinical psychologist. After earning a bachelor’s degree, they go on to earn a master’s degree, followed by a doctoral degree focusing on theory, research, and advanced clinical practice. These additional years of focus culminate with the conferral of a Ph.D. (Doctor of Philosophy) or Psy.D. (Doctor of Psychology). After earning a doctorate, many psychologists obtain additional post-doctoral fellowship/residency training for the sake of specialization and/or to meet licensure requirements.

PSYCHIATRISTS

Psychiatrists are medical doctors (M.D. or D.O.) who specialize in assessing the mental and physical aspects of psychological problems. Their treatment approach centers on reducing symptoms of psychiatric disorders through medication and/or other specialized treatments such as brain stimulation and electroconvulsive therapy (ECT). While some may provide talk therapy, they often focus on medication management. It typically takes 12 years of education beyond high school to become a general psychiatrist.

MASTER’S-LEVEL COUNSELORS AND THERAPISTS

Other mental health professionals such as licensed clinical social workers (LCSW), licensed mental health counselors (LMHC), licensed marriage and family therapists (LMFT) and licensed professional counselors (LPC) are master’s-level (i.e., they’ve earned a master’s degree) professionals who are trained to provide counseling/therapy for common mental health issues such anxiety, depression, and stress. Some may offer general counseling services, while others may practice within a specific scope. For example, an LMFT has special education and training in marital and family therapy, while a LSCW has education that focuses on therapy, case management and social advocacy. To become a master’s-level therapist, it typically takes five to six years of education beyond high school, followed by a specified period of supervised clinical training for licensure.

The no-frills answer is: Therapy works when you do the work.

There’s nothing “magical” about therapy. In other words, spending time in the therapy chair isn’t what brings results. Feeling better is highly dependent on how you respond to the process of therapy. People start to feel better because the interactive work helps build a foundation that supports well-being.

Targeted therapeutic approaches can help you:

• Gain insight into childhood experiences that contribute to problematic coping.

• Identify unhelpful thinking and behavioral patterns that stand in the way of functioning well in the world.

• Master skills that enable you to build and maintain heathy relationships with others.

• Improve the relationship you have with yourself by increasing levels of acceptance and self-compassion.

• Learn to identify, monitor, alleviate, and/or prevent symptoms of diagnosed mental health conditions.

• Develop skills that will help you cope and interact differently with the world.

We conduct our teletherapy sessions via video using a HIPAA-compliant videoconferencing platform. Not only have we made efforts to protect your privacy, we aim to provide the same level of quality care as would be provided during an in-office visit.

According to research, teletherapy is as effective as in-office therapy for a wide range of mental health concerns. But despite the many advantages--flexibility, convenience, and effectiveness—teletherapy isn’t right for everyone. In general, it works best for individuals who have mild to moderate symptoms, are comfortable using technology, and can secure a private place to have their sessions.

Telehealth is often not a good fit if you are experiencing mental health difficulties requiring a higher level of care. For example:

• You are currently in crisis.

• You are having, or recently have had, thoughts of harming yourself or someone else.

• You are experiencing hallucinations, delusions, or other sensory disturbances.

• You are actively engaging in self-destructive, self-harm, or other self-sabotage behaviors.

• You are in an active stage of addiction to alcohol or substances.

• You are being treated for an eating disorder that requires your weight to be monitored.

In these cases, inpatient, intensive outpatient (IOP) , and/or in-office services are likely more appropriate.

In addition to the conditions mentioned above, telehealth may not be a good fit for certain practical reasons, such as:

• You struggle with maintaining attention and focus and/or are easily distracted during sessions.

• You have vision or hearing difficulties that would make it difficult to participate in videoconferencing.

• You have an unstable or unreliable internet connection, or have difficulty using the technology independently.

• You are not able to guarantee having a quiet, private space where you can speak openly and without distractions.

• Your situation involves legal concerns that require documentation based on professional observation and evaluation.

In these instances, in-office services would be a much better fit.

To maximize the effectiveness and comfort of your telehealth sessions, review the following best practices:

• Ensure you are in a quiet, private, distraction-free space where you can focus and feel comfortable discussing personal topics.

• Arrange for childcare and secure pets ahead of time.

• Wearing headphones can help block out background noise.

• Make sure your electronic device is charged and that your internet connection is stable

• To minimize interruptions, silence your phone (or utilize the “Do Not Disturb” setting).

• Make sure your camera, microphone, and audio settings are on and working properly.

• Keep a notebook handy so you can take notes. Sometimes people find it harder to remember things when meeting over a screen.

• It might also be helpful to have comfort items nearby, such as a weighted blanket, stress ball, aromatherapy candles, essential oils, and/or a beverage (non-alcoholic).

Finally, to ensure safety, we will not conduct sessions while you are driving. Please ensure you are parked prior to initiating the session. If you are driving when the session begins, you will be asked to either pull over or reschedule.

Hi, I’m Dr. Irvin :-)

First, I would like to congratulate you on taking an empowering first step toward feeling and living better!

Second, let’s check in on how you may be feeling about this wonderful first step. For many people, starting therapy for the first time can be anxiety-provoking. You’re likely unsure of what to expect from something you’ve never done with a person you’ve never met. Therefore, you may be especially nervous about the first therapy session.

It may be helpful to frame the first session as a mutual opportunity to gather information and learn more about each other. As your potential therapist, I’m interested in learning more about who you are and what brought you to therapy. I aim to establish an understanding of the difficulties you’ve been experiencing in your daily life. You are free to share as much about your life as you are comfortable, along with initial thoughts about your goals for therapy. The first session is also a time for you to assess whether my experience, style, and treatment approach feel comfortable for you. Toward the end of the session, we will check in about how the session felt, and determine whether working together feels like a good fit.

During the immediate follow-up sessions, we will continue to discuss your history, symptoms, and social experiences. We will identify and refine your goals for treatment, ultimately leading to the creation of a personalized treatment plan. Future sessions will then center on active therapeutic work.

If you have spent any amount of time searching for a qualified mental health provider, you have likely noticed that psychiatrists and clinical psychologists commonly do not accept health insurance. Instead, many opt to use a private- or direct-pay service model. At this point, you may be wondering why it is so difficult to find a provider who will take your insurance.

Although I can’t speak for all practitioners, I am willing to share the reasons behind my decision not to accept insurance at Irvin Psychology & Wellness. Weighing the benefits and drawbacks, it came down to concerns relating to confidentiality, ethics, quality of care, and time.

CONFIDENTIALITY

Whether you work with a clinical psychologist, psychiatrist, or other type of mental health professional, their services involve sharing private information that most would prefer be kept confidential. Although you receive assurance that your sessions are private and confidential, insurance claim processing requires that your diagnoses and other aspects of treatment be shared with your insurance company.

To be fair, it is important to acknowledge that insurance companies play a crucial role in ensuring that covered individuals have access to essential health services. This also places them in the position to make sure patients receive only the treatment they absolutely need. Their review of progress notes helps them determine whether to approve, extend, or discontinue a particular course of treatment. On one hand, this oversight protects you from unnecessary services, contains healthcare costs (for both you and the company), and prevents insurance fraud. On the other hand, it can limit your access to extended, adjunctive, or specialty services that the insurance company deems as unnecessary.

ETHICS

Many people seek therapy for problems that don’t meet criteria for a formal mental health diagnosis. It’s not uncommon for individuals to seek therapy for personal growth and wellbeing, or to manage temporary stressful situations. In these cases, a clinician may use a Z-code from the ICD-10 (e.g., Z63.6 - Dependent relative needing care at home) to indicate the presence of a stressor impacting the patient’s quality of life. Although these codes provide important qualitative information about treatable situations, they typically aren’t acceptable as principal diagnoses and aren’t always covered by insurance. This can be problematic because for your therapist to submit an insurance claim, they must provide a billable mental health diagnosis. Despite not having a diagnosable mental health condition, your practitioner faces the ethical dilemma of creating one, which then becomes a part of your permanent mental health record.

QUALITY OF CARE

Insurance companies may mandate the types of treatments you are eligible to receive. Therefore, to ensure they can be paid for their work, your providers must be aware of and limit their services to those that are covered by the health insurance plan. This can become problematic for individuals who have multiple diagnoses or complicated clinical presentations requiring specialty care. As previously mentioned (see confidentiality), when providers suggest adjunctive, extended, or specialty treatments, the health insurer may request to review your records to help them determine whether to approve or deny the recommended treatment.

You should also be aware that insurance companies often regulate the number of sessions a patient is allowed to have. In the event you need or desire additional care beyond the predetermined number of sessions set by your insurer, your insurer could choose to deny coverage for them.

TIME

Working with insurance companies requires both time and expertise. Large medical offices typically hire a full-time staff that is well-trained to verify insurance coverage, submit claims, manage denials, facilitate requests for clinical review, and receive payments. Each health insurer has their own set of policies and procedures, which requires attention to detail. Many psychiatrists and clinical psychologists choose to work in small private practices. As hands-on treatment providers, many choose to forgo the insurance panels because it simply isn’t practical for them to allocate such a large percentage of their work week to administration and management of insurance. Instead, they choose to reserve their time for face-to-face clinical work with their patients.

MISSION AND COMMITTMENT

After much deliberation, I have decided not to accept insurance. Instead, I am choosing to work directly with my patients to determine the care that best fits their needs. This decision aligns with our commitment to provide evidence-based care in a manner that makes sense for each person, and in a manner that promotes whole-person wellness.

Understandably, you may be worried about paying for services for an out-of-network provider. However, reimbursement for out-of-pocket costs is often available from your insurance provider. If you decide to seek treatment with us, or any other out-of-network provider, I recommend contacting your health insurer to find out if you qualify or out-of-network reimbursement and at what percentage.

For guidance on what to ask your insurer, be sure to review the frequently asked question: “How can I find out whether my insurance reimburses for out-of-network providers?”

If you have questions about out-of-network coverage, contact your health insurer directly via the customer service phone number (which is typically located on the back of your insurance card). The answers they provide will help you make an informed decision about initiating therapy services with an out-of-network provider.

When speaking with the representative, consider using the following sequence of questions to guide the conversation. It’s probably best to review them PRIOR to making the call:

1. Do I have out-of-network mental health benefits?

2. What is my out-of-network deductible?

3. Is this deductible combined with my in-network deductible, or is it separate?

4. How much of this deductible has been met to date?

5. Are out-of-network services by a licensed clinical psychologist covered?

6. If I have out-of-network benefits, do I have to select a mental health provider from a list, or can I choose any provider?

7. What percentage of the cost for a therapy session (or psychological testing) is reimbursable once my deductible has been met?

8. What is my out-of-pocket maximum? How much of it has been met to date?

9. Do out-of-network mental health services require any type of preapproval under any circumstance in order to be to be reimbursed?

10. Will I be reimbursed the stated percentage on the full amount I paid, or only a portion of the amount? (They may refer to the allowable amount or reasonable and customary fee)

11. For psychotherapy: Do you cover procedural codes 90834 (Psychotherapy, 45 minutes with patient) and/or 90837 (Psychotherapy, 60 minutes with patient)? (If the rep says yes, ask what is the reasonable and customary fee for 90834 or 90837 in my area?)

12. For psychotherapy: Is teletherapy (online therapy, video conferencing, etc.) by a licensed psychologist covered?

13. For psychological testing: Do you cover procedural codes 96130 (Psychological Testing Evaluation Services by Professional) and/or 96132 (Neuropsychological Testing Evaluation Services by Professional)? (If the rep says yes, ask, “What is the reasonable and customary fee for 96130 or 96132 in my area?”)

14. What is the process for seeking reimbursement for out-of-network claims? Do I have to fill out a special form? Do I mail, email, fax, or submit my documents through an online portal?

15. What is the time limit for submitting an out-of-network claim?

Yes, but on a very limited basis. Each quarter, we reserve space for one or two new patients who demonstrate financial need. If you are in need of lower cost services, please contact the office directly to inquire, preferably prior to your initial consultation.

Clinical psychology is a recognized specialty in professional psychology and fees have been set accordingly. If you would like to learn more about fair costs for services in your local area, visit FairHealthConsumer.org or HealthcareBluebook.com. They will require that you enter your zip code, the procedure code, and whether you are inquiring about in-network or out-of-network costs. For your search, you should enter the following procedure codes:

• 90834 (Psychotherapy, 45 Minutes)

• 90837 (Psychotherapy, 60 Minutes)

• 96130 (Psychological Testing Evaluation Services)

• 96132 (Neuropsychological Testing Evaluation Services)

(Note: The zip code for Irvin Psychology & Wellness is 33401)

FYI: There isn’t a code for couples therapy; it typically is not covered by health insurance. Couples therapy is not considered a “medically-necessary” service unless the need for couples therapy arises from a diagnosed mental health condition. Even then, it can be difficult to receive coverage.