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).


Mindset Shift

In this New Year 2021, all of us across the globe have had to shift, adapt, and change as the pandemic slammed into large and then small towns across our nation.

And we are not done. As King 5 new‘s Brit Moorer discussed with me on camera where setting intentions fit within the path of a pandemic, I reminded our viewers that we are still in the middle of it. Instead of viewing the arrival of our first COVID-19 vaccine doses in Washington State as a sprint to the finish of this deadly virus, I reminded viewers to consider how riding out this pandemic safely is more akin to running a marathon than a sprint. And we are in the middle of that marathon, not the end.

With a marathon, you need to pace yourself. If you don’t, you hit the Wall and run out of energy to finish the race.

With people hitting “pandemic fatigue,” we are entering one of the most dangerous and deadly of times. Unfortunately, some people feel that nothing more can be done, and changing one’s behavior has little effect.

They are wrong. We have proved that if people follow the guidelines carefully to wear a mask when outside your home, stay socially distant from those who are not a part or your household, limit gatherings and avoid large public ones, and wash hands frequently, we can bend the curve of the pandemic wave and trend numbers of cases, hospitalizations, and deaths down.

We are close to seeing some light in this war against the pandemic, and it takes each one of us to take our social responsibility seriously. Yet to do that requires that each person change their behavior, and it’s this behavior change that has been the hardest part for us to bear. It requires that each person puts aside their individual freedom and rights in order to be a good neighbor.

In the later part of 2020, I rediscovered a song that I hadn’t heard for some time. Yet the lyrics are perfect for 2020, and for entering 2021 in terms of setting a mindset for change.

I’ve included the lyrics, below. May your mindset for change allow you to see the beautiful things amidst a difficult year.

Note: The SDC virtual office will be open again after January 12 2021. Due to a death in the family, office hours will also be changing.


Everything must change,
Nothing stays the same.
Everyone must change
Nothing stays the same.

The young become the old,
Mysteries do unfold.
‘Cause that’s the way of time
Nothing and no one goes unchanged.

There are not many things
In life you can be sure of.

Rain comes from the clouds,
And sun lights up the sky,
And humming birds do fly.

Winter turns to spring.
Wounded heart will heal.
Never much too soon
Everything must change

Rain comes from the clouds,
And sun lights up the sky,
And humming birds do fly.

[George Benson]


Taking Care of Your Mental Health While Traveling

Not every trip away from home is a vacation.

Even when it is a vacation, vacations have its ups and downs, highs and lows. I’ve lost track of how many of my clients, past and present, have mentioned the stress of preparing to get on a plane and be away from home, work, and routine, even though the point of their travel was to relax, unwind, recreate, and connect with their partner and family members.

As we enter the season of the Holiday Triad in America (Thanksgiving, Christmas, New Year’s Day), here are some thoughts on how you can take care of your mental health concerns while traveling.

1. Don’t pitch your routine. If something has been working for you, such as taking medicine at a specific time, regular exercise, avoiding alcohol or sweets, imagine what the stress of travel, whether for business or personal matters, might do to you body and mind. If that morning run needs to get moved to another time of day, that’s fine. Yet your body may grumble at you if you withhold something it has become accustomed to for days or weeks on end. Set a reasonable routine and stick to it.

2. Digital connection, but not all the time. You’re on a beach, watching the sunset while your bare feet rest in the sand. Is this the best time to bury your face in a smartphone, tablet, or computer? Keep in mind your purpose for travel. If it’s business, take care of business in an appropriate environment, and do your best to carve out private, uninterrupted time for you to enjoy the beach, trails, mountains, and ocean without being chained to your work. Your brain will thank you.

3. Rejuvenation, customized to you. Understand what helps you rejuvenate, whatever the purposes of your trip. If a business trip has back-to-back meetings during the day, it might not make sense to squeeze another event that goes late into the night. If you must give some face time at an optional happy hour that actually isn’t optional, come in with a game plan so you won’t walk away hung over, exhausted, and set up for poor night of sleep. Take advantage of hotel spa massages, a relaxing yoga class, nearby walking paths, and quiet time before bed.

4. If your travel time is lengthy, consider scheduling a telemedicine session (also known as online counseling) with your therapist. As long as you are not in a state that has state laws barring online counseling from a therapist across state lines, this may help keep you on track for taking care of your mental health needs during extended travel. If you can’t take advantage of an online session, ask your therapist to give you some structured homework that could help you while you’re on the road.

5. If you are traveling by yourself, schedule in meaningful social time. Dinners by yourself can feel isolating. Try booking a meal somewhere that hosts a community dinner or themed dinner, where diners share conversation while eating an interesting meal. Sign up for an activity you are interested in where you can be in a group of tourists, such as a trail hike, a boat or kayak trip, or a museum tour. When attending a conference, ask others if they’d like to join you for a meal.*

If it’s not possible to meet with others, arrange to talk with friend or loved one over the phone while you are having a meal. Do your best to replicate social stimulation and connection, while diminishing a sense of loneliness or isolation. If a time change makes this scenario unlikely, try taking your meals in a busy restaurant, and opt to eat by the windows to get natural lighting during the day as well as to take in any views.

For those who travel often, the romance and glamour of travel can hide the challenges of the navigating airports, staying in hotels, and trying to get your needs met. You’re certainly not alone if travel increases your experience of depression or anxiety, or a mix of both. Let friends and family know about your struggles, and make these struggles a part of your conversation with your therapist.

As a reminder, the SDC virtual office will be closed Dec. 23 2019 through January 12 2020 for the winter holidays. If you are thinking of starting counseling for the first time with us, this is a great time to get things rolling. I encourage you to get started while it’s fresh on your mind, and to not put off for tomorrow what you can start today.

* Of course, I urge caution for safety reasons.