Policies and Procedures
FEES, Insurance, & billing
Click below to watch Zach Meyer give a brief introduction to Neuma's fee and billing practices.
FEES. Our standard rates are as follows:
- 90-minute Psychological Assessment — $250
- 50-minute Psychotherapy Session — $180
- 30-minute Psychotherapy Session — $100
- 90-minute Group Therapy Session — $60
- Phone calls, paperwork, report writing, etc. lasting longer than 15 minutes — $180/hour
We provide our therapeutic services in a fee-for-service model, meaning you pay us directly at the time of your visit. We don't let clients run up a balance, because it strains the therapeutic relationship and distracts us both from the important work to be done. Clients with an outstanding balance will not be allowed to book further appointments until it is paid.
If you can afford to, we ask you pay our full fees. They are fair and customary for the quality of work we do and the experience we bring. However, there are a few ways we can help you control the costs of therapy with us if they are prohibitive.
While we do not offer a sliding scale, we do offer a limited number of scholarships for seasons of life that spread your financial resources thinner than usual. Based on your situation, and at our discretion, we will reduce your fee for three months at a time, at which point we will revisit your situation to see if the adjustment is still merited.
We review our fee structure every 6 months, and reserve the right to make changes as needed. If your fee for therapy will be changing, you will be given 90 days notice in writing.
INSURANCE. We are not in-network with any insurance providers. We are, however, out-of-network providers for several insurance companies. Contact your insurance provider to find out if you have out-of-network benefits. Generally, insurance companies are willing to pay an out-of-network provider about the same as they'd be willing to pay an in-network provider, but you are responsible for the balance of their full fee. At Neuma, we'd still ask that you pay our fee at the time of service, but then we'd send you home with a "superbill" — an official receipt from your session — that you submit to your insurance to have your cost partially reimbursed.
With virtually all insurance providers offering some kind of mental health benefits, you may wonder why we have chosen to avoid working with insurance. We have several reasons, which we would be happy to discuss with you in person, and which we will summarize here.
First, reimbursement from insurance companies to psychotherapists has fallen by about 70% in the last decade. To be frank, we both accepted insurance for years, and found that, even with a full caseload, we could no longer afford to run our practice the way we wanted, let alone our household. For our practice to have stability and integrity, we need to ask more for the work we do than insurance companies are willing to pay. We understand that this means therapy at Neuma is a significant investment for many, and we take that very seriously. We believe the work we do is worth it, and always invite your feedback on the care you are receiving.
Second, participating in insurance networks results in a dramatic increase in faxes, phone calls, and paperwork on our end that eat up our valuable time. Simply put, we'd rather be helping people!
Third, there are benefits to you for avoiding insurance's involvement in your therapy. Your insurance requires a diagnosis from your therapist before it would pay for his or her services. And medical insurance subscribes to the "medical model" of illness. Thus, if you come to therapy because you're depressed, you're in luck; there's a medical diagnosis for that, and insurance would reimburse me to treat that condition. At least, as long as they think it "should" take. But if you come to therapy with concerns about academic performance, identity, or a relationship, for example, well now we're likely in territory without an official medical diagnosis. Many therapists have gotten quite good at picking the diagnosis that "best" fits in these situations so that their clients can get helped and they can get paid. Altruistic, in a way? Yes. Insurance fraud? Possibly. And if your insurance provider ever decides it's unhappy with the care you're receiving from a therapist, or how long its taking, or the interventions he's using, they can choose to stop paying for it without your input or consent. When insurance is involved, they are ultimately in charge of the course of your therapy. Not you. Not your therapist. At Neuma, we'd rather put you in full control of your therapy and not worry about anyone's expectations but yours.
BILLING We can accept cash, check, or credit card. We can also accept payments from HSA accounts. Talk to your employer about this option that allows you to use untaxed money from your paycheck to pay for medical expenses. It often works out to a sizable discount in terms of money saved. For your convenience, we can keep a credit card on file at your request, allowing us to bill you for therapy without ever taking up time to do so in the session.
Psychotherapy is not easily described in general statements. It varies depending on the personalities of the psychologist and patient, and the particular problems you bring forward. There are many different methods we may use to deal with the problems that you hope to address. Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things we talk about both during our sessions and at home.
Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience.
Our first few sessions will involve an evaluation of your needs. By the end of the evaluation, we will be able to offer you some first impressions of what our work will include and a treatment plan to follow, if you decide to continue with therapy. You should evaluate this information along with your own opinions of whether you feel comfortable working with one of us. Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about our procedures, we should discuss them whenever they arise. If your doubts persist, we will be happy to help you set up a meeting with another mental health professional for a second opinion.
MEETINGS We normally conduct an evaluation that will last from 1 to 2 sessions. During this time, we can both decide if one of us is the best person to provide the services you need in order to meet your treatment goals. If psychotherapy is begun, we will usually schedule one 50-minute session (one appointment hour of 50 minutes duration) per week at a time we agree on, although some sessions may be longer or more frequent. Once an appointment hour is scheduled, you will be expected to pay for it unless you provide 24 hours advance notice of cancellation, or unless we both agree that you were unable to attend due to circumstances beyond your control. If it is possible, we will try to find another time to reschedule the appointment.
At Neuma, we try to make it very easy for you to keep your appointments with us. We offer complementary appointment reminders via text or phone call, and are happy to schedule standing appointment times.
We ask for 24 hours' notice if you need to reschedule or cancel an appointment. All late cancellations and no-shows are billed at the full rate, and you will be expected to pay for any missed sessions at your next visit. Sessions that you are late for will end at their originally scheduled time so that we can keep the rest of our day's appointments on time. Habitual tardiness or missed appointments will result in being discharged from receiving services at Neuma.
We understand that, occasionally, emergencies, inclement weather, and other unforeseen situations might prevent either one of us from making it to a scheduled appointment. We will not bill for these missed appointments unless they begin to become habitual.
Psychotherapy is required by Wisconsin law to be confidential for anyone over 12 years of age. That means, with few exceptions, written permission is required from a client to discuss their therapy with anyone. Those exceptions are as follows:
Our first priority is always your safety. If we learn that your life is in danger, we will do everything we can to keep you safe. Specifically, if we learn you have a plan to hurt yourself (or someone else, for that matter), we will break confidentiality and contact whoever we deem to have the best chance of keeping you safe. This might be a parent, or a higher level of mental health care.
Second, therapists are "Mandated Reporters." When we hear about any kind of abuse, we are required by law to report it. Especially if doing so has the potential to prevent further abuse to you or someone else, we will break confidentiality to report the abuse to the proper authorities. This includes consensual sexual contact between an adult and a minor.
Lastly, there are "grey" issues of safety, in which it is incumbent on us as therapists to use our clinical judgment to keep you safe. For example, while the use of illegal drugs is generally confidential information, telling us you have overdosed three times in the last week sounds like a safety issue that would make us much more likely to intervene.
For clients under 12, we will use our clinical judgment for what we keep confidential. In general, we will always err on the side of confidentiality because it makes for better therapy, and we will always inform you if we plan on breaking confidentiality.
In general, we will require your written permission each time you'd like us to discuss your therapy with anyone.
it is important to remember that many people receive therapeutic services at Neuma. You might see someone in the waiting room that you know from the community. We ask that you not disclose other clients' identities outside of Neuma. If we find out that a client has disclosed this type of information, it will be grounds for discharge from our practice in order to protect our other clients' confidentiality.
EMAIL We prefer using email only to arrange or modify appointments, as email is not completely secure or confidential. If you choose to communicate with us by email, be aware that all emails are retained in the logs of your and our Internet service providers. While it is unlikely that someone will be looking at these logs, they are, in theory, available to be read by the system administrator(s) of the Internet service provider. You should also know that any emails we receive from you and any responses that we send to you become a part of your medical record.
If you must send confidential information via email, we ask that you attach it as a password-protected .ZIP file (or similar), and leave us a voicemail with the password to open the file. This is the only way to maintain your confidentiality when using email.
FACEBOOK, ETC. We do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). We believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.
Neuma Psychological Services maintains a Facebook Page for the practice to allow people to share our blog posts and practice updates with other Facebook users. All of the information shared on this page is available on our website.
You are welcome to view our Facebook Page and read or share articles posted there, but I do not accept clients as Fans of this Page. We believe having clients as Facebook Fans creates a greater likelihood of compromised client confidentiality and we feel it is best to be able to say to all who may view our list of Fans that they will not find client names on that list. In addition, the American Psychological Association’s Ethics Code prohibits our soliciting testimonials from clients. We feel that the term “Fan” comes too close to an implied request for a public endorsement of our practice.
Note that you should be able to subscribe to the page via RSS without becoming a Fan and without creating a visible, public link to my Page. You are more than welcome to do this.
FOLLOWING We publish a blog on this site and post therapy related content on Twitter. I have no expectation that you as a client will want to follow our blog or Twitter stream. However, if you use an easily recognizable name on Twitter and we happen to notice that you’ve followed one of us there, we may briefly discuss it and its potential impact on our working relationship.
Our primary concern is your privacy. If you share this concern, there are more private ways to follow me on Twitter (such as using an RSS feed or a locked Twitter list), which would eliminate your having a public link to my content. You are welcome to use your own discretion in choosing whether to follow Neuma.
Note that we will not follow you back. We only follow other health professionals on Twitter and we do not follow current or former clients on blogs or Twitter. Our reasoning is that we believe casual viewing of clients’ online content outside of the therapy hour can create confusion in regard to whether it’s being done as a part of your treatment or to satisfy our personal curiosity. In addition, viewing your online activities without your consent and without our explicit arrangement towards a specific purpose could potentially have a negative influence on our working relationship. If there are things from your online life that you wish to share with me, please bring them into our sessions where we can view and explore them together, during the therapy hour.
INTERACTING Please do not use SMS (mobile phone text messaging) or messaging on Social Networking sites such as Twitter, Facebook, or LinkedIn to contact us. These sites are not secure and we may not read these messages in a timely fashion. Do not use Wall postings, @replies, or other means of engaging with us in public online if we have an already established client/therapist relationship. Engaging with us this way could compromise your confidentiality. It may also create the possibility that these exchanges become a part of your legal medical record and will need to be documented and archived in your chart.
If you need to contact me between sessions, the best way to do so is by phone. Direct email is second best for quick, administrative issues such as changing appointment times. See the email section for more information regarding email interactions.
USE OF SEARCH ENGINES It is NOT a regular part of our practice to search for clients on Google or Facebook or other search engines. Extremely rare exceptions may be made during times of crisis. If one of us have a reason to suspect that you are in danger and you have not been in touch with us via our usual means (coming to appointments, phone, or email) there might be an instance in which using a search engine (to find you, find someone close to you, or to check on your recent status updates) becomes necessary as part of ensuring your welfare. These are unusual situations and if we ever resort to such means, we will fully document it and discuss it with you when we next meet.
LOCATION-BASED SERVICES If you used location-based services on your mobile phone, you may wish to be aware of the privacy issues related to using these services. I do not place my practice as a check-in location on various sites such as Foursquare, Gowalla, Loopt, etc. However, if you have GPS tracking enabled on your device, it is possible that others may surmise that you are a therapy client due to regular check-ins at my office on a weekly basis. Please be aware of this risk if you are intentionally “checking in,” from my office or if you have a passive LBS app enabled on your phone.
BUSINESS REVIEW SITES You may find our psychotherapy practice on sites such as Yelp, Healthgrades, Yahoo Local, Bing, or other places which list businesses. Some of these sites include forums in which users rate their providers and add reviews. Many of these sites comb search engines for business listings and automatically add listings regardless of Social Media Policy. If you should find our listing on any of these sites, please know that our listing is NOT a request for a testimonial, rating, or endorsement from you as my client.
The American Psychological Association’s Ethics Code states under Principle 5.05 that it is unethical for psychologists to solicit testimonials: “Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.”
Of course, you have a right to express yourself on any site you wish. But due to confidentiality, we cannot respond to any review on any of these sites whether it is positive or negative. We urge you to take your own privacy as seriously as we take our commitment of confidentiality to you. You should also be aware that if you are using these sites to communicate indirectly with one of us about your feelings about our work, there is a good possibility that we may never see it.
If we are working together, we hope that you will bring your feelings and reactions to our work directly into the therapy process. This can be an important part of therapy, even if you decide we are not a good fit. None of this is meant to keep you from sharing that you are in therapy with me wherever and with whomever you like. Confidentiality means that we cannot tell people that you are our client and our Ethics Code prohibits us from requesting testimonials. But you are more than welcome to tell anyone you wish that one of us is your therapist or how you feel about the treatment we provided to you, in any forum of your choosing.
If you do choose to write something on a business review site, we hope you will keep in mind that you may be sharing personally revealing information in a public forum. We urge you to create a pseudonym that is not linked to your regular email address or friend networks for your own privacy and protection.