Cost of Services

Why does it cost $xxx per hour of service?
The first surprise is probably the hourly rate that many psychologists will ask for. Being asked to pay $100 - $300 per hour for services likely seems ridiculously high. Doing the math, it would seem like all psychologists should be driving around in expensive cars and living the high life. In truth, the hourly rate is not what the psychologist takes home as pay. One problem is appointment cancellation and rescheduling. If a parents cancels or reschedules an appointment with short notice (for example, the day before the appointment), then that becomes a period of time during which no money was made (and the reason many psychologists charge a fee for no-show or late cancellations). Psychological services also have a lot of overhead to them, including:

• rent for the office
• paying support staff (such as a receptionist)
• malpractice insurance
• professional fees and taxes
• costs for continuing education
• buying test kits
• buying supplies (such as test protocols)
• advertising services
• and more.

Why won't this psychologist accept insurance? 
It may seem strange that a psychologist would refuse to accept insurance. One of the most likely reasons is because of the rate the insurance will actually pay. If a psychologist sets his rate to $100 per hour, the insurance may only pay $50 per hour. If you consider that the psychologist charged $100 per hour to cover all of the expenses listed above, then when the insurance pays 1/2 to 1/3 of what the psychologist needs, it becomes impossible to maintain the service. Accepting insurance in that case becomes somewhat charitable because the psychologist may actually be losing money for each hour.

The problem above is a bad situation for the psychologist, but it can be much worse for everyone when the insurance company also decides how long services should take and what kinds of services are needed. Insurance companies may decide that a certain test requires only 30 minutes or an hour to administer, but in reality it may require one to two hours (it often depends on the child). Similarly, insurance companies may decide that certain tests are not necessary for evaluating a disorder. For example, a psychologist evaluating a child for ADHD may request a diagnostic interview to collect information about the child's history and a cognitive evaluation to check for specific processing deficits, but an insurance company may only cover the diagnostic interview and no further testing. The psychologist then must either ask the parents to cover the cost out of pocket, or suffer a loss of money on the remaining services.

What am I really paying for?
The last problem is lack of clarity in billing, and this is actually the psychologist's fault. The cost of services can become very confusing and it is very rarely itemized. It may simply indicate "office visit 2.00", which means that the bill is for two hours worth of office visit time. It does not describe what happened during that office visit. Similarly, if there was a test administered, then that is not described in clear terms either (it may say, "psych eval 1.50"). And finally, the actual process of scoring and interpreting the results of an evaluation, making a diagnosis, and writing it all into a report takes time, which may simply be added on to the "psych eval 1.50" rather than listed as a separate item. This lack of clarity is something that should probably be addressed by psychologists (some psychologists are better than others at this). In the meantime, parents should also feel comfortable asking for an explanation of the bill. If something is unclear, it is alright to ask.

What should I expect from the actual services?
Knowing what to expect from psychological services is important. Many parents do not know what to expect and therefore may be surprised by the cost and time involved. Psychologists have a responsibility to explain what to expect at the beginning of services. However, when a psychologist engages in the same procedures day after day, they are likely to forget to explain certain parts of the process because it is so routine. The following information is provided to try to help clarify the purpose of certain services and what happens during them:

Academic Evaluation
Typically used to assess academic performance for identifying learning disabilities or for educational planning.

Developmental Evaluation
Typically used to evaluate for a possible developmental disorder, such as Autism Spectrum Disorder, Developmental Delay, Intellectual Disability, or to assess for potential neurological problems.

Behavioral Evaluation
Used to evaluate the presence and severity of particular behavior problems and potentially assess for a behavioral disorder such as Attention-Deficit/Hyperactivity Disorder.


Behavioral Consultation
A treatment program for specific behavior problems. This approach emphasizes parent and teacher education and training to give them the skills necessary to address the behavior at home and school.


Emotional Evaluation
Evaluating a child for an emotional disturbance or emotional disorder can be complicated. Emotions cannot be directly observed and therefore cannot be directly measured. However, there are many behaviors that are likely good indicators of certain emotions (for example, crying may be a sign of being upset). Therefore, evaluations examine these behaviors, collect information from parents and teachers, and attempt to determine if there is a "clinically significant" effect from the emotion.