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Negotiating a reduced fee psychoanalysis
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You have heard or read about psychoanalysis. You believe that it may be the treatment for you. But how do you go about paying for it. If you are like most people, no matter what your income, you probably haven't budgeted an extra 25 K to pay for this type of treatment. If you live in a major city, with a psychoanalytic institute, you might consider a pursuing a moderate or low fee psychoanalysis. If you need a reduced fee, you might consider asking an analyst to lower their fee. But, before doing that you make want to take a series of steps.
Take a careful look at your health insurance
I am not actually recommending a relocation. Rather, those individuals who live in proximity of two states ought to find out if there are differences in the laws with respect to "mental health parity". (The idea that insurers can not reimburse differently for mental health care than they do for other kinds of health care). At the present time, Maryland laws are said to be friendlier to the recipients of mental health care than those in Virginia. So, if you are seriously considering psychoanalysis, you may want to consider crossing the border.
A little bit of anxiety can be motivating. It can help us to go to work when we'd rather play, to clean when we'd rather relax and to carry out the responsibilities of our every day lives. But, how do we know when we have crossed the fine line between everyday anxiety and generalized anxiety disorder?
Find out exactly what sort of treatment is covered and with whom. Many insurers limit the amount of treatment that they provide to a paltry number of sessions, say 10 or 20. Others, limit it to certain providers. Many psychoanalysts do not participate in managed care because of managed care's continued intrusion into the treatment. If you have poor coverage, seek other insurance. Because group insurance premiums are established based on actuarial data regarding utilization, it is best join a group in which the other members are not likely to seek mental health care.
For example, engineers or computer scientists are less likely to seek psychotherapy than social workers or psychologists. Groups with lower utilization rates typically have better benefits. Why is this? Mental health professionals are known to practice what they preach. Thus, it is costly to provide them with a generous mental health benefit. If you are a member of the latter group consider to what other groups you might legitimately belong. Do you belong to any national associations through your hobbies or through an ancillary professional group? For example, perhaps you teach as well a practice. If so, explore the health coverage relevant teaching associations provide.
Take a careful look at where you live
I am not actually recommending a relocation. Rather, those individuals who live in proximity of two states ought to find out if there are differences in the laws with respect to "mental health parity". (The idea that insurers can not reimburse differently for mental health care than they do for other kinds of health care). At the present time, Maryland laws are said to be friendlier to the recipients of mental health care than those in Virginia. So, if you are seriously considering psychoanalysis, you may want to consider crossing the border.
Take a careful look at your own finances
When analysts reduce fees, it means that they have to work more hours. Similarly, low fee clinics have operating expenses. Therefore, prior to seeking a fee reduction you need to be aware of your income, your debt, your investments and your expenses. Be aware of how you spend your money and consider what kind of changes you might make to afford treatment. Can you work an additional evening or two? Can you buy a used car instead of a new one? Can you eliminate some discretionary expenses?
Is there a way that you can take responsibility for financing your own treatment? Good treatment is not a luxury. It can alter your life trajectory. Before asking for a fee reduction give some thought as to what steps you might take to afford your own treatment.
Give some thought to what a clinic or an analyst who reduces your fee will be underwriting and be prepared to explore it as a part of the treatment. Fees are not a separate part of the treatment. Rather, they are an integral, and some say, crucial, part of it. Fee reductions should be pursued purely on the basis of need. Yet many people, often unconsciously, seek reduced fees for other reasons such as an ambivalence about pursuing treatment, a wish to be taken care of, an uncertainty as to the value of treatment, a sense of entitlement or a wish to avoid the adult responsibility of paying for their own treatment. Therefore, it is important to understand the meaning of a request for a reduced fee treatment. Before reducing the fee, many skilled analysts will want to know what they are, in effect, underwriting.
After you have taken these steps, you will be in a position to talk with your psychoanalyst in a straightforward fashion about your request for a reduced fee. You will be well-informed about your financial reality and you will be equipped to know what you can realistically afford.
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© 1998 Lynn Friedman, PhD.
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