Availability
Opening in my practice often arrises one space at a time when people meet their goals. I do not maintain a wait list. Please send me an email to ask about current openings and if I can't offer an appointment for any reason, with your consent, I will share request with my professional communities (without sharing your identify information). I will follow-up with you with any responses I receive.
Please consider sharing:
- time of day and days of the week you're best available (usually sessions are once/week at regular time)
- telehealth or in person only
- if in person, what locations are accessible to you (cities and / or near public transportation)
- types of therapy or modalities, training of therapist desired (if known)
- identity of the therapist
- insurance and or fee range that's sustainable for weekly sessions
For those with insurance:
You may have been given a list of providers with openings and/or were referred to a website to search independently. While these lists are updated frequently, often times they're not accurate because there's rapid change in availability especially for private practice providers. If you have already found it difficult to find a provider that is a good fit for what you're seeking therapy for, consider asking your insurance company to make initial calls.
If you feel you're not being connected within a reasonable time period to a provider that can support you, consider asking your insurance company for a, "single case agreement." While the representative you speak to initially may not be able to support you with this, advocate that your request be escalated to someone that can support with this process of approving this since you're insured, there's a need for mental health services and you haven't been connected.
A single case agreement will allow you to work with a provider that is not contracted with your insurance company and is created when there's a need for mental health services that aren't met with available currently contracted providers. For example it may be problematic if the only therapist that is offered by your insurance company has appointments during your work hours and it heightens your stress to take off work or it's impossible to do so (and therapy is still needed). Also, there may be specialty that you know will support your wellbeing and there are no available contracted providers that have training. For example, you may have had positive experience with EMDR in the past so if you have a new recent trauma, it makes sense to return to the type of therapy that worked or there's "evidenced based"* treatment you feel would support you and no providers are available. For some, the identity of the therapist is an essential part of healing. If the insurance company is only able to identify an in-network therapist with someone that will make it difficult to open-up because of a past experience (the therapists license or training or desire doesn't create a safe space). Not having choice in providers could be more of a stress or cause harm and at the least not be effective. Therapy is a time to center yourself so you should have a therapist that is a good fit and sometimes a single case agreement supports this to happen.
More information about single case agreements:
It's not easy to share about your personal mental health experiences just to get an appointment with member service representative at an insurance company that you won't be working with ongoing. Even when people are excited to being therapy, it may not easily want to think or speak about challenges. Your insurance company however will need to understand there's "functional impairment" and how much you're impacted each day. For example, if you're feeling anxious consider sharing how the anxiety impacting your eating, sleeping, work, relationships etc. If there are any safety issues, as challenging as it may be, consider sharing your experience so they can understand the urgency to connect you with a provider.
After insurance agrees to single case agreement, you will need to identify a provider that is willing to contract with your insurance so your sessions will be covered. There are many free provider directories since as the National Queer and Trans Therapists of Color Network and the Bay Area Therapists of Color Directory.
Self-advocacy is needed and for many it's important to ask a trusted person to communicate in your behalf so that there's real access to the covered benefit of psychotherapy. This may be a time in life when the most tenderness and support is needed. Despite difficulty identifying a provider, you're absolutely deserving of quality care. The systemic issues of mental health care in this country shouldn't be your burden. Advocacy is often needed to demand, insurance company to approve a single case agreement so you don't have to wait indefinitely. Also when you do find a provider you want to work with, you may need to educate them about what single case agreement is.
Most private practice providers do not have administrative staff to work with insurance companies so many are not contracted. If you received approval to identify a provider with opening that will accept a single case agreement, it's not about you if they refuse to accept insurance. Insurance often pays lower rate for sessions to providers in network, there's paperwork required and the provider could get audited at any time and need justify why ongoing sessions are beneficial when there's not progress toward meeting behavioral health goals.
It may be helpful to share with the provider you find that they can negotiate their own rate with insurance company and there may be less paperwork required than regularly contracted providers. Each insurance company is different and the provider will have to be in contact with the insurance company directly. You can support this process by asking your insurance company for a direct contact that provider you identify can call.
You are the coordinator of your care and expert of your health. I encourage you to trust what you need and speak about it then following-up with persistence until you're connected with the right support. It's helpful to document communication form the time of your first contact with your insurance company asking to see a therapist. This is helpful if there's connection with a therapist that can support you or no single case agreement offered. If this is the case, it doesn't fix the issue but know you're not the only one. The CA Department of Managed Health Care, is a resource to share experience about issues with timely access to care. The complaint process is online or in mail and there will be an invitation for you to share what you've done so they can assist in following-up but holding insurance companies accountable.
Another resource is 211, the health and human service referral line with a live operator that may be helpful to identify mental health resources. Connections are likely to be to agencies that staff unlicensed staff but there is usually greater flexibility for sliding scale and opportunity to use insurance with organizations.
I was moved to share some of my experience as a person with intersecting identities that has benefited from therapy with provider with cultural responsiveness and some specific training that is a good fit for me. I can't say enough that everyone is deserving so I hope this information was helpful as you navigate this mental health system until you find someone that could support in the way you need.
What I have written was informed also by working under a for a number of insurance companies under a single case agreement and work advocating with people I serve as well as experience making a component to the Department of Managed health care.
My intention was to share as much information as possible and for some that may be alot to read so below is the short version with a few more details of information about single case agreements for people having challenges finding an in network therapist that's a good fit and also information for therapists that are considering accepting or are curious about single case agreements.
May you be well.
* Above, "evidence based" therapies was mentioned for the purpose of sharing language that can be helpful justify for a single case agreement with an out of network provider. While I use evidence based therapies in my practice, it is my opinion that it doesn't mean it's a better therapy for everyone because of the research/evidence. There are many healing practices that have evidence from practice in cultural communities. It is up to the individual to decide what therapy is best for them.
Please consider sharing:
- time of day and days of the week you're best available (usually sessions are once/week at regular time)
- telehealth or in person only
- if in person, what locations are accessible to you (cities and / or near public transportation)
- types of therapy or modalities, training of therapist desired (if known)
- identity of the therapist
- insurance and or fee range that's sustainable for weekly sessions
For those with insurance:
You may have been given a list of providers with openings and/or were referred to a website to search independently. While these lists are updated frequently, often times they're not accurate because there's rapid change in availability especially for private practice providers. If you have already found it difficult to find a provider that is a good fit for what you're seeking therapy for, consider asking your insurance company to make initial calls.
If you feel you're not being connected within a reasonable time period to a provider that can support you, consider asking your insurance company for a, "single case agreement." While the representative you speak to initially may not be able to support you with this, advocate that your request be escalated to someone that can support with this process of approving this since you're insured, there's a need for mental health services and you haven't been connected.
A single case agreement will allow you to work with a provider that is not contracted with your insurance company and is created when there's a need for mental health services that aren't met with available currently contracted providers. For example it may be problematic if the only therapist that is offered by your insurance company has appointments during your work hours and it heightens your stress to take off work or it's impossible to do so (and therapy is still needed). Also, there may be specialty that you know will support your wellbeing and there are no available contracted providers that have training. For example, you may have had positive experience with EMDR in the past so if you have a new recent trauma, it makes sense to return to the type of therapy that worked or there's "evidenced based"* treatment you feel would support you and no providers are available. For some, the identity of the therapist is an essential part of healing. If the insurance company is only able to identify an in-network therapist with someone that will make it difficult to open-up because of a past experience (the therapists license or training or desire doesn't create a safe space). Not having choice in providers could be more of a stress or cause harm and at the least not be effective. Therapy is a time to center yourself so you should have a therapist that is a good fit and sometimes a single case agreement supports this to happen.
More information about single case agreements:
It's not easy to share about your personal mental health experiences just to get an appointment with member service representative at an insurance company that you won't be working with ongoing. Even when people are excited to being therapy, it may not easily want to think or speak about challenges. Your insurance company however will need to understand there's "functional impairment" and how much you're impacted each day. For example, if you're feeling anxious consider sharing how the anxiety impacting your eating, sleeping, work, relationships etc. If there are any safety issues, as challenging as it may be, consider sharing your experience so they can understand the urgency to connect you with a provider.
After insurance agrees to single case agreement, you will need to identify a provider that is willing to contract with your insurance so your sessions will be covered. There are many free provider directories since as the National Queer and Trans Therapists of Color Network and the Bay Area Therapists of Color Directory.
Self-advocacy is needed and for many it's important to ask a trusted person to communicate in your behalf so that there's real access to the covered benefit of psychotherapy. This may be a time in life when the most tenderness and support is needed. Despite difficulty identifying a provider, you're absolutely deserving of quality care. The systemic issues of mental health care in this country shouldn't be your burden. Advocacy is often needed to demand, insurance company to approve a single case agreement so you don't have to wait indefinitely. Also when you do find a provider you want to work with, you may need to educate them about what single case agreement is.
Most private practice providers do not have administrative staff to work with insurance companies so many are not contracted. If you received approval to identify a provider with opening that will accept a single case agreement, it's not about you if they refuse to accept insurance. Insurance often pays lower rate for sessions to providers in network, there's paperwork required and the provider could get audited at any time and need justify why ongoing sessions are beneficial when there's not progress toward meeting behavioral health goals.
It may be helpful to share with the provider you find that they can negotiate their own rate with insurance company and there may be less paperwork required than regularly contracted providers. Each insurance company is different and the provider will have to be in contact with the insurance company directly. You can support this process by asking your insurance company for a direct contact that provider you identify can call.
You are the coordinator of your care and expert of your health. I encourage you to trust what you need and speak about it then following-up with persistence until you're connected with the right support. It's helpful to document communication form the time of your first contact with your insurance company asking to see a therapist. This is helpful if there's connection with a therapist that can support you or no single case agreement offered. If this is the case, it doesn't fix the issue but know you're not the only one. The CA Department of Managed Health Care, is a resource to share experience about issues with timely access to care. The complaint process is online or in mail and there will be an invitation for you to share what you've done so they can assist in following-up but holding insurance companies accountable.
Another resource is 211, the health and human service referral line with a live operator that may be helpful to identify mental health resources. Connections are likely to be to agencies that staff unlicensed staff but there is usually greater flexibility for sliding scale and opportunity to use insurance with organizations.
I was moved to share some of my experience as a person with intersecting identities that has benefited from therapy with provider with cultural responsiveness and some specific training that is a good fit for me. I can't say enough that everyone is deserving so I hope this information was helpful as you navigate this mental health system until you find someone that could support in the way you need.
What I have written was informed also by working under a for a number of insurance companies under a single case agreement and work advocating with people I serve as well as experience making a component to the Department of Managed health care.
My intention was to share as much information as possible and for some that may be alot to read so below is the short version with a few more details of information about single case agreements for people having challenges finding an in network therapist that's a good fit and also information for therapists that are considering accepting or are curious about single case agreements.
- You should have a therapist that's a good fit and now in CA there's a timely access to care law
- Your provider preferences are important but you must share with the insurance company why you can't see any in network provider. You may never have to share why you need therapy at this time and if it's urgent say so. There are many reasons a single case agreement can be approved. One that wasn’t mentioned was “continuity of care." One example is if you were seeing a provider that no longer takes your insurance it makes since benefit from seeing the same provider.
- Be persistent and get some support to do so
- Be prepared to identify a provider you want to work with that has openings and explain why they're a good fit.
- Be prepared to share with the provider what a single case agreement is
- If provider has opening and is not willing to work with single case agreement, or the insurance company denies single case agreement remember it's not about you, the mental health system needs some work
- Document everything and don’t stop (unless it’s helpful to do so). Use the Department of Managed Health Care a resource to hold your insurance company accountable and ultimately get connected.
- If someone is contacting you for a single case agreement, it's because they are motivated to begin therapy and have not been offered service they're entitled to. Resource of time and energy has been expelled to be at the point of escalating to need a single case agreement and their efforts should be acknowledged even if you decide it's not workable for your practice.
- The person wanting a single case agreement should initiate the process with their insurance company. It will save you time if they give you a direct insurance contact (number and person).
- You can give people seeking therapy your NPI so it’s available if the insurance company asks it will be available. (It's free to register for an NPI and will be necessary to submit insurance claim for reimbursement.
- Before you agree to contract, clarity about rate (self-advocacy applies so you’re compensated appropriately, what’s needed for documentation and the claims process. Usually a handwritten CMS-1500 can be submitted so know the address. Filling electronically can be done with the insurance company. Many insurance accept claims through Office Ally if they don't have their own system that's open to providers that aren't fully contracted. Office Ally is free and even if your submitting paper CMS-1500 claims, there's information about how to do so and many guides online.
- Once you agree to a single case agreement, know there’s usually a time limit of a year so saving contact information is helpful so you know who to contact if an extension is needed. Ask about how far in advance contact should be made for renewal. Also make sure you have the best provider support phone line and email if you have questions after you begin sessions.
May you be well.
* Above, "evidence based" therapies was mentioned for the purpose of sharing language that can be helpful justify for a single case agreement with an out of network provider. While I use evidence based therapies in my practice, it is my opinion that it doesn't mean it's a better therapy for everyone because of the research/evidence. There are many healing practices that have evidence from practice in cultural communities. It is up to the individual to decide what therapy is best for them.