SDC 2023 Updates

Seattle Direct Counseling and Coaching (SDC&C) has new updates for next year. Please read this post carefully, and if you are currently using my (Imei) services for counseling or coaching or you are considering one of my services in 2023 as a new client, please feel free to ask questions as to how they may apply to you.

Why are Therapists Turning Away from Third-party Payers?

The main reasons why more than a third of therapists in the U.S. do not accept any form of health insurance, or why they limit the number of health insurance programs they are credentialed with are summarized in an article on Here, I’ve taken three of the key points and added my experiences across nearly 23 years as an LMHC and over 32 years in healthcare overall.

  1. Low reimbursement rates. The insurance company sets the amount they will reimburse the therapist for the session, and then the client pays a co-payment. Unfortunately, most insurance companies have not raised the reimbursement in years, while the cost of doing business has increased. While it was helpful to accept insurance nearly 20 years ago, it isn’t as helpful now with the rising cost of goods, housing, and costs of doing business.

2. Dealing with insurance companies. In April 2022, one company decided to remove telehealth coverage suddenly, leaving unprepared clients believing their visits were covered. This is just one example in which I ended up staying on the phone with insurance companies going to bat for my clients. Because of where we are in the pandemic (it is most certainly NOT over, with more than 300 people dying of COVID-19 in the U.S. daily as of this writing), most health insurance companies wish to increase deductibles and remove telehealth coverage, passing more cost onto plan holders. That means that for many of them, they will be paying cash for as much as the first 20 visits of a year before insurance kicks in.

Therapists along with other medical practitioners have been doing their best to help clients understand the real costs of mental health services. Washington State passed a bill that requires practitioners to clarify that cost up front; the bill known as a No Surprise bill, put that responsibility on the practioner. However, when insurance companies can decide ad hoc to change their coverage, reimbursement rates, and even telehealth coverage, who is left holding the bag?

3. Supply and demand imbalance. Right now, the pandemic has contributed to high demand for therapists but not enough of us to meet that demand. In my case, I allot up to a certain amount of hours for seeing clients, and a certain amount of hours having to follow up on their insurance woes and paperwork, all for a lower reimbursement rate.

We all know that taking in a higher amount of income without increasing more hours buys us far more than trinkets and luxury items. With more stable income, we to being able to take better care of ourselves. Period.

In the current system with insurance reimbursements being lower than the going rate for therapy, a therapist would have to work longer and harder, often in the most sought-after hours (evening) to keep up with inflation and the cost of doing business.

A Solution in 2023: Hybrid Cash and Insurance

After careful consideration since April 2022, and with health insurance companies notifying us that telehealth coverage costs that had been waived in the pandemic will end on Dec. 31, 2022, SDC&C will pivot to a hybrid model. Of the 20 hours allotted per week for counseling clients, I will be holding:

*12 client hours per week for current clients who are using their employer based health insurance, until my contracts with the health insurance plans end (2024 and 2025)

*8 client hours per week for new clients who will be paying cash only for their sessions.

Of the remaining hours, I will be taking cash-only coaching clients (currently not covered by insurance) to help keep my practice healthy and balanced.

Eventually, the natural end of the contracts with these health insurance plans will give time to those who are already using their plans to pay for therapy to look ahead to what their needs might be and carefully anticipate what actions to take when the contracts end and I do not renew them.

How Will I Pay for Services Without Using My Health Insurance?

If you are coming on board into the counseling community as a new client of counseling or for my coaching programs (not currently covered by insurance), or you have lost your job recently and have pivoted to paying out of pocket, here is what I would ask you to consider:

  1. The cost of therapy is considered a medical expense that you can track for your tax return; therefore, you may qualify for a deduction at tax time to help offset the cost.
  2. If you are in economic hardship, you can discuss a plan with of me with what you are able to reasonably sustain for a time-limited period.
  3. If you choose to seek help through Public Health or other community settings supported by state funding, please feel free to ask about how to go about this.
  4. Good mental health care relies in part with timely and effective access. If you are in need NOW, putting off care until you perceive you can afford it may have more negative consequences. Even if I cannot directly meet your needs, I am a resource who has helped many find where to go to get their needs met in a timely way.
  5. You are always welcome to receive a referral from me for another practitioner who accepts your insurance. It would be fair to note that waiting times to get an appointment could be substantial, so I suggest you plan accordingly.

So… What Now?

In summary, the hybrid payment model goes into effect Dec. 31 2022. My office officially closes for the holiday season on Dec. 22 2022, with the office reopening on Jan. 9.

Traditionally, this time of year is very quiet as most of us prepare for various family gatherings, celebrations, and special traditions. I am doing the same, and always with a compassionate heart towards those who are seeking ways to improve their mental wellness and deep health concerns. While I may not be responsive during the break when the office is closed, please feel free to send forward any questions you may have either during your meetings with me or by email, and you will hear from me, just within a longer than normal time frame (approximately 3-5 days versus 24-hours).


Nutrition Coaching Services

“Do you offer coaching?”

I get asked this question often. Although coaching is a service that is not covered by American health insurance plans, I offer coaching services for a particular area of the health field that has seen high demand as we round the corner toward the third year of the COVID-19 pandemic.

Counseling vs. Coaching

To understand the increased demand, it’s important to understand the difference between Counseling and Coaching, and then to further differentiate Life Coaching from Health Coaching.

Professional Counseling involves:

  • state licensure required to practice
  • graduate level completed at an accredited school
  • meeting state requirements for hours of practice under supervision
  • scope of practice limited to psychotherapy, unless further certification and training is added (i.e. Chemical Dependency counseling, Sex Therapy Counseling)
  • a fundamental grasp of the DSM
  • ethics and legal trainings, with CEU’s regularly maintained
  • health insurance reimbursement (if the plan is accepted)


  • no state licensure required
  • certification encouraged but not currently mandated
  • scope of practice cannot replace the counseling scope of practice
  • CEU’s are not required at this time, but recertification may be required at certain intervals from a coaching training program
  • health insurance does not cover coaching

Health Coaching (with or without certification)

  • no state licensure required in most states (yet)
  • certification is required to call yourself a health coach; sitting for a national exam satisfies organization’s requirements
  • undergraduate degree completion preferred
  • scope of practice has stated limits that do not replace the advice of medical practitioners
  • recertification is often required
  • health insurance does not always cover health coaching, although some employers hire companies that offer Health Coaching, and add Health Coaching as part of an employee benefits package. If you are a Board Certified Health Coach, your services can be billed to insurance

What Kinds of Coaching Does SDC&C Provide?

In the past, I have provided weight loss, study skills, and relationship coaching. In 2020, I shifted my focus to coaching those with Autoimmune Disease by earning a certificate from Autoimmune Paleo as a Health Coach, and in 2022 I earned my certificate from Precision Nutrition as a Level 1 Nutrition Coach (Pn1-NC).

On October 15, 2022 I joined a cohort of people in a 20 week program to earn a Master Coach Level 2 certification with Precision Nutrition, and then I will know if/when I can sit for the NBHWC exam (National Board for Health and Wellness Coaching) with additional preparation.

Why Nutrition Coaching?

As I work towards finishing the writing of my book, “Making Food Fun Again” about living with Autoimmune Disease, becoming a Nutrition Coach is the natural progression of years of work understanding the basic elements of health and healing:



Rest and Circadian Rhythm



Mental Health

When any of these basic elements is negatively impacted, the other parts do not work effectively to bring the body and mind into balance, contentment, and vitality. To this list, I personally add the spiritual dimension, as our questions about our purpose, hope, the process of birth to death, and meaning can cause the body and mind to experience joy or despair.

My own personal journey with Food Allergies, Autoimmune Disease, low weight, and metabolic efficiency and inefficiency led me to focus on the one missing piece – Nutrition – for which I have always referred out to qualified professionals in the past.

Starting August 2022, I will be accepting Nutrition Coaching* clients. Look for this information on its own Page in the dropdown menu. Costs will range from $500 to $1500 (three months), with length of program, complexity, and number of checkins being determiners of cost. If you check current market value for the same services, I believe you will find this range reasonably competitive.

The initial interview cost will be approximately $175 and includes a thorough interview of goals, data collection, requests for appropriate medical testing and laboratory testing, and file set up costs.

The Coaching Page and fee schedule will include this year’s introductory pricing versus 2023. If you are thinking that Nutrition Coaching is something you could use to help you set your health in the right direction, I encourage you to take advantage of my introductory pricing.

Please note: Nutrition Coaching has different limits in different states in the U.S. In Washington State, Nutrition Coaches are not Registered Dietitians nor Nutritionists; we do not create meal plans, and we do not create specific meals to treat medical conditions directly. Instead, we work with the directives of medical professionals to help clients adhere to nutrition and lifestyle changes that help them achieve their health goals.


The Problem of Stress

Photo credit: Anthony Tran (Unsplash)

By Imei Hsu

Many years ago, I came into the doctor’s office complaining of heart pain (angina), fatigue, loss of appetite, and a lot of frustration. After weeks of symptoms appearing and disappearing and poor sleep, I dragged myself back to the doctor’s office for another visit.

He ran more tests. Even ran an EKG. Ruled out GERD. And then with concern filling his eyes, he asked me if I was under a lot of stress.

Well, of course I was under a lot of stress! Raised in a culture that places the burden of being a caregiver on its females, working as a healthcare professional, and having adopted a default belief that included quite a lot of “shoulds” – I should be pleasant, gracious, available to the needs of others, courteous, and beautiful – it would be more than fair to say that I was subjected to stressors all the time, and that my life choices favored stressful environments and beliefs.

It turned out that I actually did have a real medical diagnosis, which would take another decade to reveal. And at the same time, the doctor’s concern about my stress level was not wrong. It was so right.

The problem was this: I was under 30 years old, with a healthy heart, a normal weight, normal blood labs. Every test was coming back normal, no concern. But my hair was falling out, I was horribly tired, and I presented as a mystery to more than a few doctors. This doctor prescribed nitroglycerin, but I could tell that he felt uncomfortable with this “just in case” emergency medicine. His words matched my read of the situation: I was too young and healthy to need it. The very act of being prescribed Nitro at that age scared the bejesus out of me.

As people in the U.S. and around the world try to find our “new normal” in the COVID-19 pandemic, each of us needs to take a look at the impact of stress on our bodies and minds. Even as we treat overt medical fallout from COVID-19, the impact and effect of stress lurks in a body that keeps an account of what happens to it. There is truth in the title of the book, “The Body Keeps the Score” (Bessel van der Kolk). Let’s take a look at stress and how it manifests in the mind and body.

Three Kinds of Stress

The American Psychological Association identifies three categories of stress: acute stress, episodic acute stress, and chronic stress. What’s the difference between these three types of stress?

Acute stress is very familiar. You are experiencing acute stress when you are driving down the road and a wild animal bounds across the road. In your response to applying the brakes or swerving out of the way to avoid a collision, your heart rate elevates with a quick shot of adrenaline coursing through your body. That heightened sense of awareness, feelings of fear or danger, and increased respirations are all part of the acute stress response.

This stress response is meant to save your life! But if you stay in it and don’t exit this response, your body (including your mind) can get into trouble.

Episodic Acute Stress

Episodic Acute Stress is the above scenario, only on repeat. A job with project deadlines that happen multiple times a year is an example of episodic acute stress.

If your job typically pays less than the living expenses of the town you live in, monthly bill paying time could be another example of episodic stress if you anticipate more month than money.

Chronic Stress

Chronic stress is the kind of stress that happens over time. Sources of chronic stress in our society include the effects of the patriarchy, racism, poverty, war (look what is happening in Ukraine), and debilitating illness. Chronic stress can be a part of our relationships with a family member, a difficult neighbor’s behavior, or trying to help your child deal with bullying at school.

Chronic stress responses don’t get a lot of airplay in modern medicine. If you are showing effects of chronic stress, it doesn’t feel helpful to have your doctor tell you that you need to reduce stress. Why? Because many of the sources of chronic stress are external and systemic (translation: difficult to change, and often outside of your control). Change comes slowly, and yet the chronic stressors all around you bear down strongly, wearing you down.

Why the Goal Is Not a ‘No Zero’ Stress Life

Since high stress is linked to a plethora of serious medical and mental health conditions, is the goal to remove all stress from your life? Nope.

Besides the fact that it isn’t possible to live a stress free life, the bigger question is, would you want to? Growing up from a child to an adult requires stressful events to the body and mind, experiences that introduce stress as you fall in and out of love and relationships, starting a family and raising children, and even making the decision to not start a family can be stressful. It is stressful to care for ageing family members, interviewing and starting a new job, traveling to new places, and saying good-bye to loved ones as they succumb to the effects of time and disease.

Yet to truly live, you must be open to stresses that your body and mind respond to with everything from high amounts of adrenaline and cortisol to exhaustion as you rock a baby to sleep for the umpteenth time while you wish someone would hold and rock you to sleep for a change!

The most beautiful, terrifying, necessary, horrific, intimate, awe-inspiring, crushing moments in life require you to be willing to endure stressors – even embrace them – that include what would be considered good stress as well as stress that takes you into the “overwhelmed” zone. To truly live into the best that life can offer cannot be done with a “no stress” avoidance path.

Exiting the Stress Cycle

As the United States begins to return to a “new normal” while the pandemic outbreaks continue to be battled, it’s a good time to assess how you are handling the stressors of the pandemic and your plan on how to exit the stress cycle that those stressors have caused.

If you look at the SARS-CoV-2 virus as the stressor, and your area of the country is seeing cases going down, one might think that the source of stress — that is, the stressor called The Virus — is over, and therefore you are no longer experiencing stress as you might have at the start of the pandemic.

What nobody told me when I was a mystery to doctors is that even if they didn’t know what medical condition I had, I still needed to understand how to exit the Stress Cycle itself.

Let’s go back to the example of being in your car when you suddenly need to apply the brakes and swerve to avoid an accident. Let’s say you do all these actions and you avoid hitting anything or anyone. Phew! You make sure everyone is OK, and then you drive away.

Ten minutes later, you notice that your legs feel like Jell-O and you want to puke; you wipe your brow and are surprised that you are sweating! What is that? That is your body’s acute stress response. So you pull over, take care of yourself, breathe in and out a bit, and drive away. Later on that evening, you get ready for bed, yet when you close your eyes, your brain is replaying what happened. Your heart rate is still high. Maybe you manage to fall asleep but wake up in the middle of the night and have trouble falling asleep. The next day, you are groggy, irritable, and you stumble your way to the coffee maker or to a coffee shop and get yourself a double shot latte. More than one person raises their eyebrow at you as you mumble something about feeling like a battle axe, but the truth is that if one more thing gets put on your shoulders, you feel like you might just crack.

You are still in the Stress Cycle! And stress accumulates as you add more stress from different areas of your life. No amount of coffee makes the feelings go away. You try not to think about it, but every so often, the thoughts and feelings come back.

So, how do you exit this Stress Cycle you’re in? There are a number of things you can do to help your body/mind, and no one thing is the magic bullet or the automatic fix. Here are some examples:

-use meditation to still the mind

-learn how to nourish your body with food, not eat your emotions

-consistently move your body around, preferably with time outside in Nature (fresh air, sunlight, open spaces you can see sky, trees, and water particularly if you live in an urban setting)

-reframe thoughts and responses to stressful experiences

-reduce stressful inputs, including mindless scrolling of Social Media, news, and entertainment that isn’t “working” for you

– have time that is not scheduled for anything else but, “The Art of Doing Nothing”. Relaxing in a hammock, gazing out a window, and time where you aren’t demanding yourself to be productive is important for the body to de-stress and relax

-prioritize regular sleep, which is your mind-body’s way of repairing and recovering

In sessions, I cover these and other methods of exiting the stress cycle as a part of therapy. If you’d like to learn more about this, schedule a complimentary consultation and mention this post.