ReEnvision Counseling has always placed top priority on open, honest, and clear communication between therapists and clients. We do that not only from a values-based approach but also from a research-backed principle, since the therapeutic alliance is among the most important aspects of effective clinical therapy. The therapeutic relationship provides a safe space for clients to be seen and heard, practice relationship skills, and have healthy boundaries modeled and encouraged. 

 

At ReEnvision Counseling, all financial conversations and exchanges are handled directly between therapist and client. Our informed consent  has always included discussion regarding the following:

 

·       costs and options for clients at the outset of counseling as well as throughout the process,

·       the difficulties counseling can present as people begin to grow and change, 

·       the importance of managing expectations for one’s journey in counseling,, and 

·       the collaborative nature of the therapist-client relationship in setting goals for therapy and 

     keeping ongoing communication about this as the journey unfolds.

 

All therapists at ReEnvision are trained in the delivery of trauma-informed practices, which involve helping clients feel safe in the amount of control and voice they hold in each aspect of the therapy process. Clients are always encouraged to voice their thoughts and preferences, including choice of therapist, session length, types of interventions used, and focus of each session. Therapists are tasked with providing clinical and financial feedback to clients about various ways to reach these goals and reasonable expectations concerning the parameters clients desire.

 

During the pandemic, Congress passed something called a “No Surprises Act”, which was intended to help protect people from surprise medical bills that come from various out-of-network doctors, hospitals, or other providers they didn’t choose (please see https://www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022/). In the counseling setting, it would be highly unlikely for clients to “inadvertently” receive care from their therapist that they did not choose or anticipate. We want to do the best we can to comply with this act in the spirit for which it was intended while also protecting the integrity of the counseling setting and the necessity of not having it medicalized. Insurance involvement in counseling necessitates rapid diagnosing of mental health conditions and can limit the number of sessions and types of interventions used. This is one of the primary reasons we’ve chosen to not work with insurance companies at ReEnvision Counseling. However, we do want to provide clients with all information possible about fees for as long as they seek counseling on the variety of items with which they are presenting. With that in mind, please review the following:

 

·       Our fees (including late cancellation/no show fees) are listed in the intake paperwork and are predictable, requiring payment at each session. We do not carry balances, so the fee for one session must be paid before the next one starts. There will never be any unexpected charge. You will have no surprises here.

·       There are multiple factors that contribute to the length of time a person spends in therapy. Often the goals a person wants to prioritize at the start of their work shift as they learn more about themselves and what they are needing. Therapists must also communicate to clients what types of interventions they can responsibly recommend and implement at different points in the client’s journey. For example, certain approaches that tend to yield sudden change in a particular area can also introduce struggle in another; if a person does not have the internal resources needed to handle this outside of their sessions, it would be both unethical and unprofessional to implement  said approach. The counselor is the expert in the field, and the client is the expert in their own life. The counseling journey is a shared process between therapist and client at every turn of therapy, and it is neither practical nor possible for organic, healthy growth to occur if the therapist and client are continually tasked with re-writing an expense projection every step of the way.

·       Clients themselves often choose to extend their predicted time in therapy  simply based on the progress they experience and the realization that other areas of their lives could also benefit. It is our belief at ReEnvision that decisions to pursue health in a variety of areas should not be pathologized, or assigned a diagnosis as to what is “wrong” with them, but rather embraced as an empowering way to take control of one’s life. Again, the options as to how often and which therapeutic interventions might be most helpful to each individual - and the constraining factors they might have at work- are part of the ongoing conversation between therapist and client.

·       While we do strongly encourage weekly therapy for at least the first 2-3 months of counseling, we understand that some people are limited to every other week. We will accommodate that while also explaining the limitations of a 14 day gap  between sessions when trying to first implement a treatment plan that impacts day-to-day life. After the first few months of counseling, clients often transition to less frequent  appointments. When all desired goals are reasonably satisfied, clients typically choose to end therapy and contact their therapist as needed in the future, or schedule “tune up” sessions every few months to check in with their mental and emotional health.  

 

According to the American Psychological Association, “on average 15 to 20 sessions are required for 50 percent of patients to recover as indicated by self-reported symptom measures”. Additionally, they state that through the working relationship between the client and counselor sometimes the preference is for “longer periods (e.g., 20 to 30 sessions over six months), to achieve more complete symptom remission and to feel confident in the skills needed to maintain treatment gains”. https://www.apa.org/ptsd-guideline/patients-and-families/length-treatment)

 

Since the “Good Faith Estimate” requires providers across all fields to quote an exact estimate and not a range, our estimate reflects the highest number of sessions possible within a year of therapy at ReEnvision Counseling. Clients satisfied with initial goals often stop around the six-month mark (or shift to less frequent  appointments), although many do continue for a year. We prefer an overly cautious and conservative approach when asked to project a client’s potential expense. Therapy is not a journey that should be embarked upon lightly. 

 

Details of the Estimate

Here are the estimates for each tier of payment, quoted weekly for a year (minus 2 holiday weeks) at the 50 minute rate as well as the 80 minute rate. Estimated costs apply for 12 months from the date of the Good Faith Estimate (GFE) unless the therapist’s rates change, at which time a new GFE would be generated.

 

50 minute sessions (CPT code 90834) at Level 1 (counseling interns who are under direct supervision):

Intake session ($40) plus 50 minute therapy session ($40) for 50 weeks: $2,040

80 minute sessions (Add-on CPT code 99355) at Level 1:

Intake session ($60) plus 80 minute therapy session ($60) for 50 weeks: $3,060

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50 minute sessions (CPT code 90834) at Level 1
(counseling interns who are under direct supervision & trained in EMDR):

Intake session ($60) plus 50 minute therapy session ($60) for 50 weeks: $3,060

80 minute sessions (Add-on CPT code 99355) at Level 1:

Intake session ($90) plus 80 minute therapy session ($90) for 49 weeks: $4,590

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50 minute sessions at Level 2:

Intake session ($90) plus 50 minute therapy session ($75) for 49 weeks: $3,765

80 minute sessions at Level 2:

Intake session ($130) plus 80 minute therapy session ($115) for 49 weeks: $5,765       

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50 minute sessions at Level 3:

Intake session ($120) plus 50 minute therapy session ($100) for 49 weeks: $5,020

80 minute sessions at Level 3:

Intake session ($170) plus 80 minute therapy session ($150) for 49 weeks: $7,520

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50 minute sessions at Level 4:

Intake session ($155) plus 50 minute therapy session ($125) for 49 weeks: $6,280

80 minute sessions at Level 4:

Intake session ($215) plus 80 minute therapy session ($185) for 49 weeks: $9,280

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50 minute sessions at Level 5:

Intake session ($180) plus 50 minute therapy session ($150) for 49 weeks: $7,530

80 minute sessions at Level 5:

Intake session ($255) plus 80 minute therapy session ($225) for 49 weeks: $11,280

 

 

We at ReEnvision Counseling look forward to talking with you and answering any questions you may have about the “No Surprises” Act and Good Faith Estimates.