The following Notice of Transition to Private Pay letter has now been distributed to all current patients.
This letter is an explanation of what I just discussed with you in person, so that you can go home, read it, and come back with any questions or concerns that you may have.
It’s that time of year when I evaluate my practice. I value my relationship with all patients and love working together – and I want to continue that work. I must inform you, however, that as of [May 9, 2018 for Prominence and CDS Group and June 19, 2018 for Hometown Health, HealthSCOPE, and AmBetter SilverSummit], I will no longer be accepting your insurance as an in-network provider.
Your options at that time are:
- Self-pay – Come in, pay the session fee, and nobody knows anything about it. My hourly rate for therapy is not changing, and will remain set at $200 for each [50-minute individual and 75-minute couples] session.
- Out-of-Network Benefits – You can come in and use your Out-of-Network insurance benefits to reduce your out-of-pocket costs significantly. With this option, you will pay my full fee, up front, at each session. Based on your policy, your insurance carrier will send you a reimbursement check for a portion of the fee. As a courtesy for existing patients only, I will submit your out-of-network insurance claims on your behalf but will be required to continue providing your insurance with your privileged information, including a diagnosis of mental disorder.
- Referral – I will work with you to process the end of our relationship while assisting you in finding and establishing services with a provider who accepts your insurance as an in-network provider.
- Low-cost Clinic – The last option is to find a low-cost clinic where you don’t have to use your insurance. It is unfortunate that these facilities remain far and few between in Northern Nevada, but, if this is what works best for you, I will do my best to help you find a place that you can afford, find the therapist in that clinic who’s had mountains of their own psychotherapy, and then refer you to that person. You don’t have to use your insurance.
I have not come to this decision lightly. There are many factors involved in why I am making this change, including:
- I am regularly being forced by your insurance provider to turn away new, in-network patients who prefer to pay cash, rather than turn over their personal information to their insurance/employer.
- When you use your insurance, I am required to document and provide them with a mental disorder diagnosis for you. I believe that providing such labels is not useful to you and, in many cases, may have harmful, lifelong implications for employment, insurance coverage, finances, and overall psychological well-being.
- My time is better spent focused on you and your needs than tending to the insurance business’ needs and all that is required to remain in-network.
- The reimbursement rate of your insurance carrier no longer justifies the additional time that is required to obtain my payment from them. In the last quarter of 2017, I spent nearly 10 hours/week attempting to collect my fees from insurance carriers. This time would be much better spent assisting those in need.
I realize that this is a lot to take in. We have many weeks until any decisions or changes will need to be made, and we’re going to keep talking about this.
Please review the above options carefully. Write down all your questions, concerns, thoughts, and feelings about this, and bring them to your next appointment.
Ian L. Pritchard, Ph.D.