Written by: Tricia A. Spiler and Mario Spiler (Revised Mar 18, 2022)
The initial inquiries most individuals have when they contact Spiler Psychotherapy™ about our services relate to treatment fees and coverage, type and length of treatment offered, areas of specialization, the therapist’s qualifications, and years of experience. Some will refuse treatment at the outset because they do not wish to pay for the service or because affordability may be a factor. Others will consider treatment if a significant portion can be covered by a third-party payer, such as a family member or an insurance company through their employer’s benefits.
A challenge that regularly comes up around fee coverage is when the potential client suggests that another family member attend a portion of their session. Their request is so that the other member can be billed for their session, thereby potentially extending the number of sessions that they can attend and be paid by somebody else. A variation of this request is for the billing statement to be made out in to appear in another family member’s name without that member attending the session at all. At Spiler Psychotherapy™, we adhere to the ethical and professional standards as set out by the Ontario College of Social Workers and Social Service Workers, the professional standards and regulations of insurance companies, and other professional and legal requirements. Our best practices policy on the issue of coverage is that the potential client must address this issue directly with their insurance company about their specific request for covering therapy services. Individual insurance companies have their own unique policies and stipulations on coverage, such as total amount covered in a calendar or fiscal year, cap on amount covered per session, billing statements clearly identifying the name of the person whom is receiving the therapy service provided. There are also benefits that requires a doctors note and approval from insurance prior to scheduling your first session.
Clients may be required to request from their insurance company that they provide Spiler Psychotherapy™ additional clarification or written confirmation of approval for coverage for therapy service specific to individual, couple, or family policies. This seems simple enough if the individual is the only one who will attend the therapy session. When two or more individuals plan to attend the session, each attendee’s name will also appear in the billing statement. This reduces any confusion around requests from family members willing to attend a session meant for another family member so that the billing statement can be made out to another family member who may attend the session but not receive the therapy. Our guidelines are based on those who attend the session, their names will appear on the receipt.
For family sessions, we will create a profile for each family member and each person will be required to fill out the forms for intake and consent. For under age, we send the digital forms to the parents to fill out on behalf of their child/children. All receipts will show each family member that attended session. We cannot modify or make changes even if one family member has fully utilized their benefits.
We follow a specific process that begins with the following:
- Intake Phase, in which the potential client will initially contact our office and begin their inquiries about their specific request for our services. This is usually the time when a discussion about “coverage” issues occur, get clarified and resolved.
- Consultation Phase, in which an initial appointment is made for the purpose of gathering information about the client’s presenting difficulties, current circumstances, as well as predisposing and perpetuating events. This is another opportunity in which discussion about coverage and affordability occurs. This phase culminates with recommendations for specific therapy services either at Spiler Psychotherapy™ or a more specialized or different treatment or service in the community.
- Contract Phase, which takes place before any therapy can begin. This is a time when all the counseling parameters and expectations are identified, negotiated, and agreed upon by all parties involved. This is an additional opportunity for fees, the manner of payment, and charges for missed appointments are discussed.
We also encourage individuals to speak with their HR if they find that Master of Social Work is not covered under their current insurance plan. If you need our assistance, please call us and we are always more than happy to reach out to your HR Team and discuss coverage.
At Spiler Psychotherapy™ we take great measures to satisfy ethical, professional, and therapeutic standards to ensure clients receive high quality therapy services. Fees, billing statements, payment schedules, coverage, late payments, and unpaid fees are addressed and managed at the outset to reduce future complications, service interruptions, and potential negative impact on the therapeutic relationship.