“Am I Covered?” : Understanding Your Counselling Options

When it comes to enquiries about counselling services, the question, “am I covered to see you?” is one of the most frequent and important questions I get.  For many people if affects how much counselling they can receive, if at all, especially if money is tight. Unfortunately, counselling is not a universal health care benefit.

Knowing The Options

If you search for counselling services on Google, you will receive numerous search results, especially for Vancouver. Most of these results will fall under one or more of the following categories.  Some will not even appear on a search engine, for example, options available under some individual extended health plans:

And I’ll warn you: some of the following options are unfair in the cosmic scheme of things.  Some of you will have several counselling options available, others much fewer.

Subsidized Counselling

What

Such counselling may be free, fixed low cost, or charged at a rate according to your household income (AKA sliding scale).

Providers

Such counselling is typically provided by community agencies, post secondary institutions or the public mental health system. Occasionally private counselling practitioners will offer their services at a reduced rate and criteria for determining that rate vary from counsellor to counsellor.

Counsellors and Qualifications

Counsellors come from a range of backgrounds and disciplines. Subsidized counselling may be offered by a master’s level counsellor, a practitioner with a PhD, a lay counselling provider, a counsellor with a diploma or counseling course and quite commonly, student interns. Students should always be supervised by an experienced and credentialed counsellor.

Access

Typically, amongst subsidized counselling options, there is a waiting list, often significant, although not necessarily so.  It’s always good to check in with the agency regularly to see where you are on the list.  Sometimes the squeaky (but polite) wheel does get the grease.

Employee Assistance Program (EAP) Benefits

What

If you are employed and have extended health benefits, your employer may have purchased counselling services provided by an employee assistance provider.  This service is offered at no additional cost to you and there is typically no financial transaction between you and your EAP therapist.  The number of sessions available to you depends on what your employer has paid for, often ranging from as little as 3 to as many as 12. If more sessions are needed beyond the session limit, the EAP counsellor will often refer the client to a private psychologist, a therapist in the community or a community counselling agency.

Generally, the focus for EAP counselling is on short-term counselling, crisis management or assessment and referral to another counsellor for longer-term counselling, if needed. You may reach your session limit before resolution of the issue(s) you are seeking help for and companies’ policies differ as to whether you can continue with your same counsellor if you were to pay them out of pocket.

Access

To access EAP counselling, employees typically telephone a call centre and speak with an intake staff person who arranges an appointment with a counsellor who is part of the EAP company’s network of in-house or satellite service providers.  An appointment is usually available between 24-72 hours after the time of the initial call.

During the initial phone call, clients may request a gender preference for their counsellor or also request a therapist with experience in a particular area. Clients may even ask to work with a therapist that they met with previously. Sometimes clients are assigned to whichever counsellor is available, particularly if it is a time-sensitive situation.  Clients may be able to have their EAP counselling provided by a private practitioner of their choice, up to a certain amount of sessions, if that therapist is willing to sign on with the EAP company as a network provider.

Counsellors and Qualifications

Traditionally, the industry standard has been that counselling is provided by counsellors with a minimum of a master’s degree plus five years post-graduate experience.

If you have not had a good experience with your EAP counsellor, I always encourage people to phone the call centre back and ask for a different counsellor. It’s most useful to do this early in the process so that you don’t have to start all over again with a new therapist and conclude your sessions almost as soon as you got started again, just because your sessions have run out.

Third-Party Funding

What

Again, you may not be paying directly for your counselling but may be in a situation where counselling services may be available to you.  You may be able to choose your own counsellor or the third party payer may have their own network of counselling service providers.

There is typically a funding limit to which third parties will pay; it you are considering going this route, it is good to know this beforehand and whether the issue you are needing help with can be helped within the funding limits.

Providers

Examples in British Columbia may include, but are not limited to:

Access

Wait times will likely vary, depending on the availability of the counsellors contracted to provide the service.

Counsellors and Qualifications

Again, programs may vary in terms of what they accept for qualifications from their counsellors.  Typically, the therapist will have a PhD or Master’s degree in either social work or counselling.

Private Counselling and Psychotherapy

What

Also sometimes know as fee-for-service counselling.  The therapist does not receive any funding from outside sources; you pay her or him directly according to their fees.  In most cases you would pay up front and the counsellor will provide you with an official receipt for either income tax purposes (if your counselling qualifies as a medical expense), or for you to submit for reimbursement to your extended health plan, if you have one.

Counsellors and Qualifications

Counsellors qualifications vary widely; most commonly, counsellors will have a master’s degree in social work or counselling. There are also many psychologists available in Vancouver, who have PhDs.  Other available counsellors in the community have a diploma in counselling and a minority have no training at all. It is important to do your research.

Fees and Funding

Current counselling fees among private counselling practitioners in Vancouver range widely from $60-$200 hourly, usually depending on the counsellor’s level of training and experience. Expect psychologists to be in the upper end of the range, usually $160 hourly and up, while most master’s level practitioners are in the $100-$130 range.  But buyer beware: price is not necessarily an indicator of training and experience.  There is no legislation around this – anyone with any or no counselling experience can call themselves a counsellor and charge whatever the market will allow.

If you have an extended health plan and are submitting under that, be sure to know what type of counselling professional you are eligible to meet with.  Almost all plans are covered for registered psychologists and from there, it is a mixed bag between registered social workers, registered clinical counsellors and others.

It is also important to ask your insurer is what your yearly maximum is.  If you cannot afford any counselling on your own and you are limited to, say $500 a year, be sure to tell your counsellor so that she or he can plan appropriately with you.  There’s almost nothing worse for clients than opening up about a painful issue and then having to terminate counselling abruptly.

Access

Typically in a private counselling situation, clients choose their own therapist, often interviewing several to find the right match.  Sometimes the service is arranged by a concerned family member of friend.

Access to counselling is often more rapid, although if a therapist in your community is popular and sought-after, there will be a waiting list.  One way of often getting an earlier appointment in such situations is to ask to be added to their cancellation list if they have one, and to stay in touch with the counsellor to continue to indicate your interest.  If you have a problem that can’t wait, ask that therapist for a referral to another counsellor.

If there is a counselling option I haven’t thought of, please let me know. I am always pleased to answer questions about accessing counselling in general or with me personally.  Please be in touch!