Pediatric Behavioral Health

Frequently Asked Questions


Insurance

Q. Why don't you take my insurance?
Q. Why should I pay at PBH when I can use my insurance elsewhere?
Q. Isn't it a lot of money to spend?
Q. How do other practices that do take insurance survive?
Q. My insurance company says my PBH provider takes my insurance, but PBH says that isn't so. Why?
Q. Is testing covered by insurance or not?

Providers

Q.What is the difference between a Psychiatrist, a Psychologist, a Social Worker, and a therapist?
Q. What is a nurse practitioner?


Insurance

Q. Why don't you take my insurance?
A. It was a very difficult decision to limit the insurance plans we will work with.  We did so knowing, and regretting, that we would not be able to see some children that we would really want to.

The reality is that most mental health practices can't cover their own costs.  The reason for this is that many (but not all) insurance companies pay less for mental health services than it costs to provide the service!  Some companies try to make it hard to collect fees by using complex forms that are refused if not correctly and exactly filled out, by delaying payment, in some cases for years, by denying payment if the service was after the fact determined to be a "behavior problem" instead of a "mental health problem" or other little tricks.  Can you imagine what would happen if you called a plumber and said "my toilet is broken. Come over right away.  I'll pay you 80% of the cost of your plumbing supplies and half your usual fee.  I'll be sure to get the payment to you in the next two years, but only if you submit the correct form with the correct code on it.  If, after you leave, I determine it was not a plumbing problem but just a leaking water problem, I won't pay you at all."   You would probably be sitting there with a broken toilet for a long time.  We made the decision that at PBH we would only work with companies that are willing to pay reasonable rates and pay them reliably.

Insurance companies are also not necessarily careful with your personal information.  Insurance companies require that we make available your files to provide for "quality control."  The purpose of this is, presumably, the insurance company does not want to pay for treatment that doesn't work. However, the new HIPAA regulations allows for information to be released without your express consent to "covered business entities."  That means that the insurance company can send all its data overseas for analysis - perhaps to countries that don't have privacy regulations.  Insurance companies may also sell your information to advertisers so you can get personalized mailings regarding your child's problem.  We believe that the insurance companies we work with do not do these things, but in point of fact we have no way of knowing!  Therefore, many people feel more comfortable paying out of pocket and not allowing their insurance company to have this information.

Q. Why should I pay at PBH when I can use my insurance elsewhere?
A. Of course, you may want to use your insurance elsewhere!  But most of our patients have tried other places and find PBH to be a better fit.  At PBH you will get enough time to have your questions answered; a comfortable, pleasant atmosphere; a knowledgeable, professional staff; and a comprehensive and flexible approach to treatment.  You probably won't have to change your treatment provider as our staff turnover is very low and you may find services here that you can't find at another practice. At PBH you will find advocates and partners in treatment, not disconnected diagnoses and recommendations that can't be implemented.

Q. Isn't it a lot of money to spend?
A. Yes.  It is a lot of money, and it may not be the right thing for you, especially if you have a good provider elsewhere.  However, some people do spend a lot of money on their children, and for a child paralyzed by anxiety or sadness, treatment can make a world of difference. For comparison, here are some of the costs born by families we know at local facilities:

At Pediatric Behavioral Health Cost
10 Sessions of Cognitive Behavioral Therapy (CBT) $1250 - $2000
Psychopharmacologist (per month) $125

Common Costs for Parents Cost
Braces $5000
Music Lessons (per year) $1180
Black Belt Package at a local Karate studio (flat fee) $5000
Karate studio membership (per month) $125
Day care, infant (per week) $340
Day care, school age (per week) $150
Horseback riding lessons (4 lessons) $200
Summer camp, sleep over, (2 weeks) $1990

 Q. How do other practices that do take insurance survive?
A. Something has to compensate for the difference between the insurance payments and the costs.  Many institutions, like hospitals and community mental health centers, are subsidized by their other sources of income, government contracts and grants, and charitable donations.  Some practices pay their employees poorly or skimp on benefits, and so there is often a high turnover.  Some require their practitioners to severely limit the amount of time they spend with families, making it hard to get the necessary information about the child and answer your questions. 

Q. My insurance company says my PBH provider takes my insurance, but PBH says that isn't so.  Why?
A.  Please note:  if your insurance company tells you that a provider listed above is an "in-network" provider, be careful to check at which location.  Some of our providers work at other facilities, where they may accept insurance other than what is listed above.  That does not mean that they can bill the same insurance company for work at PBH: the facility holds the contract with the insurance company, not the provider. You are welcome to try to see the providers in their other locations, however, those situations are generally limited to a particular type of patient and a particular situation. For example, Dr. Dessureau is a neuropsychologist at UMass, where he takes a number of insurances not listed above. In this clinic, he only sees patients who have had a primary medical condition (e.g., cancer) for evaluations.

Q. Is testing covered by insurance or not?
A. Maybe.  It's best to call your insurance company and ask.  A simple evaluation for ADHD can be done as a part of a diagnostic evaluation and treatment planning consultation, which is often covered by insurance.  More complex evaluations for learning disabilities or other subtle educational or psychological difficulties is often not covered by insurance unless there are accompanying neurological issues (e.g. seizures) so that the insurance company deems it "medically necessary."  Call your insurance company for the most accurate answer to this complex question.


Providers

Q. What is the difference between a Psychiatrist, a Psychologist, a Social Worker, and a therapist?

A. Each professional has different training. The table below provides a quick overview. Scroll down for more detailed information. 

Clinician

Degree

Training

Scope of Practice

Psychiatrist MD or DO Medical School (4 years) plus 4-6 years practical training Diagnose illness
Prescribe medication
Perform psychotherapy
Psychologist PhD or PsyD Graduate School (5 or more years) plus 1-2 years clinical training Diagnose psychological disorders
Perform Psychotherapy
Psychological testing
Social Worker LICSW or MSW Graduate School (2 years) Perform Psychotherapy
Therapist No degree required None required Depends on training
  • A Psychiatrist is a medical doctor just like a pediatrician or a surgeon.  A Psychiatrist attends medical school, then undertakes 1 year of clinical training in Medicine or Pediatrics (internship) then 2 to 3 years of clinical apprenticeship training in Adult Psychiatry (Residency), where he or she works and studies under supervision of experienced psychiatrists.  A Child and Adolescent Psychiatrist spends 2 additional years in advanced training (Fellowship) learning about the complexities of treating children with mental illness.  Psychiatrists, as medical doctors, are competent to diagnose mental illness and prescribe medication.  Psychiatrists are also trained in several kinds of psychotherapy and non-pharmacological treatments.  Psychiatrists have MD or DO degrees.  They are licensed by the state Board of Medicine and are bound by the ethical standards and continuing education requirements of that board.

  • A Psychologist is someone who has attended graduate school and earned a doctorate in Psychology, either a PhD or a PsyD.  These programs are 5 to 7 years of intensive study and practical training in psychotherapy, psychological testing, and/or designing psychological research.  Psychology graduate students write a doctoral thesis in one particular area of expertise.  Psychologists have supervised clinical training in testing and treating patients throughout graduate school, but have intensive training during the last year of their program (internship), and then for a year or more after receiving their doctoral degree (Postdoctoral fellowship, or "Post-doc"). A Psychologist cannot prescribe medication but is an expert in the using non-medical techniques to diagnose and treat mental illness and behavioral problems.  Psychologists are licensed by the State board of licensing and must adhere to state standards for psychologists, including ethics and continuing education.  A psychologist cannot be licensed until after completing a postdoctoral fellowship.

  • A Social Worker has a masters degree (MSW or LICSW).  This is a focused 2 year degree during which time the social worker has intensive training in Psychotherapy.  Social Workers are experts in the techniques they use, but may not be able to use as many different kinds of psychotherapy techniques as psychologists.  Social Workers are licensed through the State Board of Licensing and are required to adhere to state standards for social workers.

  • A Therapist is a general term for someone who performs therapy.  A therapist could be hold an MD, a PhD, a Masters degree or in some states no degree at all. Therapists do not have to be licensed in Massachusetts and do not have to adhere to any educational or practice standard, except as required by their other professional designations.

Q. What is a nurse practitioner?
A. A Nurse Practitioner (NP) and a Registered Nurse Clinical Specialist are two similar but not identical designations.  People who are NP's or RCNS's have bachelors’ degrees in nursing, usually a minimum of 2 years practical nursing experience, and then a two year masters degree that includes both academic study and clinical experience in providing a particular kind of medical care, such a psychiatry, pediatrics, or neurology.  Both NP's and RCNS's can see patients and prescribe medication, but most states require them to be supervised by a medical doctor.