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1. How does a Private Pay Practice work?
2. Are there advantages to a private pay practice?
3. What happens in the intitial interview? (Adult patients)
4. What happens in the initial interview? (Child patients)
5. Why is it necessary for a parent to be present? (Child patients)
6. For More Information

1. How does a Private Pay Practice work?
   

   Fees for a private pay practice vary depending upon the type and length of the service. Make sure to bring your payment (check or cash) at the beginning of each appointment. Credit cards are not accepted.

   Some insurance plans will honor your receipt with partial or total reimbursment of your payment. Upon request, you will receive a receipt for your payment to present to your insurance company.

   Individual psychopharmacology appointment charges are typically higher than the cost of standard psychotherapy sessions.  This is because fees are commensurate with the training and expertise of the physician, time and conditions involved, and the predictive value of treatment outcome.

   However, please note that the overall cost per given time period of medication therapy is commonly equal to or less than the overall cost of standard psychotherapy for the same time period. 

   How is this so? This is because medication therapy requires fewer appointments per year than a standard weekly or bimonthy psychotherapy session schedule due to the structure of medication therapy protocols and the greater degree of certainty regarding process and treatment outcome.

   Unlike standard therapy, the results of most medication trials are known from two up to six weeks after starting a medication.  For certain conditions such as ADD, ADHD, sleep problems, and anxiety, the results of a medication trial can be known as early as a day or two from the initiation of treatment. The earlier in treatment the results become clear, the sooner we can begin to prolong the time between sessions. This reduces the overall cost in both time for appointments and session fees.

   It is common practice for the first two to four visits to be scheduled two to three weeks apart.  Once a person is feeling stable and free of symptoms, typical follow up visits are often scheduled every 1 to 3 months apart. This schedule may vary when indicated. For example, we may need to adjust the protocol during times of increased stress due to changes in health, seasonal variability, nutritional and hormonal fluctuations, employment, and family circumstances.

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2. Are there advantages to a private pay practice?
   

   To put it simply, yes.

   1. Time flexibility
      Although it is generally preferable to adhere to a specific time frame agreed upon for a given session, it would not be appropriate to “cut someone off” if, for an obvious example, he or she has just learned of a major loss, or a complex medical issue requires time to understand before an educated treatment decision can be reached. I therefore try to be somewhat flexible rather than adhere to a rigid, artificial protocol that does not always meet individual needs.
      
      You may be aware that psychopharmacologists often meet with their patients for the “15 minute session”. This meeting time has become standard, in large part because insurance plans commonly reimburse medication visits for no more than a 15 minute meeting. 
      
      I have learned that 15 minutes does not suffice. It is often not even a long enough time to "break the ice", especially when the discussion involves such complex and delicate matters as a person's emotional health. 15 minutes is not long enough to address a person's concerns, review progress in treatment, consider relevant changes since the previous appointment, or answer questions. 
      
      Thus, my minimum appointment time is 30 minutes, but can extend to 60+ minutes.
      
      
   2. Ease of access to evaluations and treatment.
      I endeavor to promise a waiting period no longer than 2  weeks for an initial visit, and 2-3 weeks for a follow up appointment as indicated. 
      For many large, insurance based practices, it is often difficult to schedule initial evaluations and follow up treatment in a timely fashion.  Due to high volume, it is not unusual for some practices to take weeks or months to schedule an initial or follow up appointment.
      
      
   3. Communication with other providers.
      I try to keep open and frequent communication with other treaters involved, for example, with primary care physicians and therapists as indicated. 
      
      Insurance plans do not reimburse for phone conferences or other communication among treaters.  The result of non-reimbursable services is underuse of those services, and therefore inadequate communication among service providers involved with a particular patient. For the patient, this means inefficient use of appointment time, duplication of assessment and treatment efforts, and delays in coordinating services relevant to the patient's situation.

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3. What happens in the intitial interview? (Adult patients)
   

   For adults, the first appointment is an opportunity for us to discuss the issues at hand, historical and medical information and current circumstances, and the results of previous evaluations and treatment, as well as to develop a diagnostic assessment and treatment plan.

   Although my specialty is medication treatment, it is usually not an exclusive focus, since there is far more to a person than symptoms or conditions. Therefore, when I meet with an individual, I consider the total health, growth and development, education, and environmental circumstances.

   Once we arrive at an understanding that encompasses the whole person, I may or may not ultimately recommend medication treatment. 

   Alternative or additional treatments including certain psychotherapy techniques such as cognitive-behavioral therapy, dialectic-behavioral therapy, and other protocols and settings may be recommended.

   Subsequent visits may vary from 30 to 60 minutes, depending on the therapy modality involved.  For medication therapy, visits may occur every two to four weeks or up to every one to three months as indicated.

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4. What happens in the initial interview? (Child patients)
   

   The first interview constitutes the initial visit.  I usually meet first with the child's parent(s) alone to discuss the situation, depending on the age and sensitivities of the child. This meeting tends to last at least 1 hour.

   The purpose of this meeting is primarily to assess the situation, gather historical and medical data, develop an understanding of the circumstances, review the results of any previous evaluations and treatment, and develop a diagnostic assessment and treatment approach.

   For the second appointment, lasting up to 1 hour, and for each subsequent visit thereafter, I meet with the child together with at least one parent. 

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5. Why is it necessary for a parent to be present? (Child patients)
   

   A parent must be present due to legal reasons, since children under the age of 18 cannot legally consent to medication or medication changes. In addition, since the child is brought to me by the parent, and rarely at the request of the child, it makes little sense to assess and discuss symptoms and treatment progress with the child alone.

   However, please note that in most cases, children are more aware, willing and able to cooperate and actively participate together with their parent(s) if approached with the proper sensitivity and attention to the child's own concerns.

   A fringe benefit of this format is that no one need be concerned that he or she is being talked about "behind his or her back".

   There are, of course, exceptions to this format, since the wide variation in ages and conditions of children and adolescents demands a certain flexibility.  For example, at times I find it useful to meet with parents alone as requested, or every two to four visits as indicated, for further clarification of parental observations and concerns, and of diagnostic and treatment rationale and process.

   By at least the end of the second or third visit, we have arrived at a diagnostic determination and treatment recommendation, and often have already initiated treatment.

   According to Massachusetts state law, only parents can consent to treatment of children under 17 years of age. At the age of 17, children can co-consent to treatment, but parental consent is still required. Of course this does not exclude a child of any age from active education and participation, depending on the child's condition, capacity for understanding and judgment, and level of maturity.

   Although my specialty is medication treatment, it is not an exclusive focus, since there is far more to a person than symptoms or conditions. Therefore, when I meet with parents and children, I consider the total health, growth and development, education, and environmental circumstances.

   Once we arrive at an understanding that encompasses the whole child, I may or may not ultimately recommend medication treatment.  Alternative or additional treatments including certain psychotherapy techniques such as cognitive-behavioral therapy, dialectic-behavioral therapy, and other protocols and settings may be recommended.

   What happens if medication treatment is recommended and initiated?

   Patients are followed closely while medication trials are initiated. This means weekly to bimonthly visits and other communication when necessary to address any concerns about symptoms, medication, medication side effects when relevant, and other issues.

   Once children arrive at a stable, symptom free condition and treatment regimen, monthly to quarterly sessions from 30 to 60+ minute meetings are the usual protocol (as distinguished from weekly visits with a therapist).  As explained earlier, with the exception of the first two to three appointments, it is not necessary to meet as frequently with me as with a therapist since it can take up to two to six weeks to assess a child's response to a particular medication regimen.  

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6. For More Information
   

   I hope that this information helps you to understand the process of assessment and treatment. Of course, in order for you to get a sense of my style, as well as for me to get a better sense of your needs, a face to face interview is necessary.

   Understanding that it is often very anxiety provoking to consider treatment for yourself or your child, please try to keep in mind that an initial visit is, first and foremost, a chance to see whether you, (or your family) and I, are a "good match", and whether my services can meet your needs. A first appointment is not necessarily a commitment to engage in treatment.

   To schedule an appointment, please register on line or call me at 617-848-2937.

   
   Anne Fenton, MD
   
   

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