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).

ACA Counseling Health care Obamacare Therapy Washington

Obamacare and You

Affordable Care Act, Obamacare, Healthcare Costs

How will the Affordable Care Act, aka Obamacare, affect you?
How will the Affordable Care Act, aka Obamacare, affect you?

Just a few days before the Affordable Care Act, aka “Obamacare” is to be implemented in the quarter before the Jan. 1, 2014 deadline, the news hits us: the budget to fund Obamacare is threatened. Without funding, Americans may not be able to comply with the mandate to have health insurance by the first day of 2014 or risk a tax penalty.

Knowing whether or not Obamacare, mandated in 2010 by President Obama, will be funded only scratches the surface of questions regarding how the new healthcare mandate affects you. Whether you work for a corporation that already supplies a health insurance program or you are a self-employed or contracted employee in need of obtaining health insurance to avoid the tax penalty, it’s time to sort out your options and understand why in many cases you may be paying more for your insurance premiums than ever before.

Depression Mood Disorders Seattle Therapy Washington

How Facebook Can Affect Your Insurance Coverage

How Facebook Can Affect Your Insurance Benefits
by Imei Hsu, RN, MAC, LMHC

With over 500 million users of Facebook worldwide, you shouldn’t be surprised who is on Facebook these days. Your dentist, your employer, your friends and family, and even your health insurance company may have a presence on Facebook. While it’s fun to set up events, get-togethers, and give your social network a slice-of-life status update a couple of times a day, you shouldn’t be surprised who is looking at your updates. Here’s how Facebook updates can affect your health insurance coverage.

What could your Facebook updates and photos be telling your insurer?

Enter Natalie Blanchard, a 30 year old IBM technician from Quebec. She has released her story The Los Angeles Times in 2009 about a medical leave she took in 2008 on the recommendation of her doctor. She was being treated for depression, and her doctor had suggested that she go on vacation. While on medical leave, had been receiving monthly disability benefits from her insurance plan, but these were severed without warning after the first year. Blanchard claimed that her insurance company had crawled her Facebook page, discovering pictures of her on her vacation. As you can guess, most vacation pictures include sunshine, smiles, eating and drinking, and what most of us would consider the “high life”. Her insurer considered her ready to return to work, and therefore benefits were terminated.

In the lawsuit that is scheduled to go to court in January 2012, Blanchard claims her insurer assumed this was a case of fraud based on her Facebook pictures and status updates, and that the insurer terminated benefits with studying the background of her benefits. She also claimed her doctor was not contacted before the benefits were terminated. If you don’t know this, it is standard practice in medical cases that the treating physician or nurse is contacted by an insurer case consultant (often times a medical practitioner) to determine the need for benefit based on the medical history of the client.

As a therapist, I find this trend alarming. But even if you’re not a clinician, you should be concerned. The original articles were released in 2009 and 2010, yet I consistently see people using their Social Media updates such as Facebook without an awareness of who might be tracking their posts. I also find it disturbing because disease and dysfunction does not follow a consistant pathway of suffering 100% of the time in ways that can be detected from the smiling face of a person on vacation.

Case in point: a friend of a close friend spent time skiing, running, and sharing meals with my friend all the way up to about a couple of weeks before she took overdosed in a hotel room. Her suicide note indicated that she had been planning her suicide for some time, but her friends and family were shocked. The months before her suicide had been filled with smiley-faced pictures of herself traveling around the world, a brief but intense romance, and dreams of the future. At her wake, the guests were still in a state of shock and grief, and to this day, I am sometimes haunted by her vibrancy and verve.

During the years of her struggle with depression, she had done what so many others do: they fight it, they get professional help, they try to live life the best they can, and when there are moments when the depression lifts, they go on vacations, eat and drink, fall in love, and struggle on. Those momentary lifts do not mean the depression is over and done with. Clinicians understand that a lift in depression can also be a time when a severely depressed person has just enough energy to plan a thoughtfully executed suicide.

While the insurer of Natalie Blanchard claims they did not terminate her disability benefits based on her Facebook status updates and photos, they are not denying that these updates and photos were viewed. What should you learn from this?

1. Insurers can and do look at your Facebook status updates and photos, and you cannot legally stop them from this practice. They have the right to search for evidence of fraud or foul practice. Any business can do the same thing. In January 2010, Mark Zuckerberg declared to the world that privacy in the online age was over.

2. You can change your privacy settings on Facebook to limit who can see your posts. However, you should understand that your Terms of Use on Facebook does not ensure your privacy, and Facebook’s position has never been to ensure your privacy.

3. Educate your physician’s office. If you are using insurance benefits for your healthcare and need special coverage based on a medical condition, discuss with your doctor your concerns. Your doctor should be directly contact anytime your benefits are increased, decreased, or terminated based on your medical condition.

4. Take a moment to consider what it is you are sharing on Facebook, Twitter, and other Social Media platforms every time you type. Notice what ads come up on your page when you type in keywords like cancer. At minimum, bots crawl your pages and emails on certain platforms, using keywords to generate ads that are sent to you. Test this: mention that you’re watching your weight, and see how many ads come up for everything from P90x to weight loss yoga. In a similar way, insurers can sift through your public posts to see what you’re broadcasting, and this can be used as evidence against you in a similar way lawyers are using this for divorce cases and employers are using it when interviewing a potential candidate for hire.

This post is not about scaring the bajesus out of you. It’s about educating users so that you can enjoy the best that the Internet has to offer while protecting your best interests. Now go: Skype, text, update, and post your photos. Only be careful, and if you’re not sure how something will be construed, save it for your private enjoyment.

For another link to the story about Natalie Blanchard’s case, take a look at this law blog.