Thank You For Your Support!

massprint.onlineI was recently featured in the Massachusetts Lawyers Weekly column Uncommon Law, in an article entitled Counselor at Law,” about my transition out of the law and the journey to becoming a social worker and therapist working with lawyers and professionals.  If you haven’t seen the article, you can read it here.

And here’s the letter I wrote in response to the great amount of positive feedback I received in the weeks since the article was published.

Dear Lawyers Weekly:

I am writing to let you know about the incredible response I’ve received to Brandon Gee’s Uncommon Law article “Counselor at Law,” in the February 24, 2014 issue.  Since the article ran, I’ve received an outpouring of support from friends and colleagues whom I’ve not seen in years, to people from all over the country, and as far away as Australia, Belarus, Italy and New Guinea!  I think Lawyers Weekly’s thoughtful treatment has touched a nerve out there in the legal community, which is why I wanted to let everyone know, and say, Thank You.

My story is not uncommon amongst attorneys, yet it only my story.  Every one has one and everyone’s is unique.  It is critical to understand that, though the pressures lawyers face have commonalities, each person handles those pressures in very different ways.  We all create adaptive mechanisms to deal with stress, anxiety and conflict, and for many in the profession, they are sufficient to make it through each day unscathed.

For others, as for myself, defense mechanisms may not be enough.  As the outreach I’ve recently received makes clear, there are many lawyers out there who are suffering in silence.  They are too busy, or proud, or downright afraid to ask for help.  It has long been a goal of mine to de-stigmatize mental health care for lawyers, and so to that end, I say to the profession: help is out there – you only need to ask for it.

Sincerely,
Andrew Kang, JD, LICSW

Searching for A Profound Experience

“At the center of your being you have the answer; you know who you are and you know what you want.”Lao Tzu

I recently visited the Elements Behavioral Health facilities in Malibu California.  These included Promises, Spirit Lodge (located in Texas) the Sexual Recovery Institute, and the Professional Treatment Program, among others.  Offered are top-notch progressive treatments for the various forms of chemical dependency, addictions, and dual diagnosis.  The tour was a full day, and as I scanned through the printed out itinerary, I noticed the “Experiential with Wolf Therapy” scheduled for 2:00-3:00 at the Main house lawn.  I figured it was a new type of treatment that I hadn’t heard of before and that wolf was another acronym to learn among the countless that the field so loves to use.  As the day progressed, I began to realize that when they said wolf, they meant wolf… as in the wild animal; as in the big wild dog with fangs and love of full moons (a misconception, we would later learn).  I began to get nervous.

You see, I’ve always had a bit of fear of dogs. Ever since getting bitten as a young boy by a neighbor’s dog, I’ve shied away from them.  It was just a nip, really, and one that didn’t even cause a mark.  But, nevertheless, that incident was the genesis of an ongoing fear that lasted at least up until the time I got my own dog as an adult.  Certainly, I believed that I had long ago come to terms with the incident and the fear itself.  So it was strange to feel those feelings again as the anticipation of meeting with the wolves that afternoon approached.   It wasn’t dread, really, but more of a mounting anxiety, maybe on the level of worry over an upcoming exam or an important meeting.  Of course, anxiety lives in the moments before, so even as I was really enjoying the rest of the tour and meeting with the clinicians, the feeling of impending something kept growing.

Sure enough, 2:00 arrived shortly after lunch.  We headed over to meet the wolves.  Wait, did you say wolves?  There’s more than one?   My mind was racing with thoughts of possibilities.  What would we do?  What is the wolf therapy anyway?  Surely, they would be trained and we would be protected.  Some of the other people on the tour started talking about those padded suits that trainers wear so they don’t get torn to shreds by rabid dogs.  We aren’t doing that, are we?  Outwardly, I tried my best to keep it together.  We were told to put on our sneakers (would we be running?), and sweatshirts (is that enough protection?) and gathered in a circle on the lawn.

I tried to channel calmness and let the experience come to me.  I knew I had no idea about what would happen.  So I went with it.  We were introduced to Teo Alfaro, the founder of Wolf Connection.  He sat with us in our circle on the lawn and spoke to us about wolves.  The calming effect was instantaneous.  Here was the person who would be leading us through the experience.  He exuded calm and something else… something like awe.  As Teo spoke about the wolves and his experiences rescuing them, training them, and then utilizing them for therapeutic purposes with people, it became apparent how deep the wolf connection could be.

Wolves and humans have a connection that goes back more than 100,000 years.  It is both a natural and spiritual connection.  Because of this it is inherent within both species in the form of mutual adaptation.  Teo told us that the bond between wolves and humans is very different from the bond between dogs and humans because dogs are domesticated animals bred by humans to serve humans.  That process interrupted the natural bond, creating something man-made instead.  This is not to say that the bond between dog and human is not real or deep; it’s just different.  Teo told us we would feel this difference today, if we were open to it.

After going through a few rules which were essentially along the lines that these were not dogs so you couldn’t treat them like dogs.  Don’t approach from above.  Don’t reach out or come towards them aggressively.  Basically, let them come to you.   They will choose to interact with you when they (and you) are ready.  Then he said.  If you have anger and fear in your heart, they will know, and they will not come.  Oh great, I guess they’ll figure me out pretty fast, I thought.  But if you have pain, they will try to help you.   Teo called for Maya and Max. Out they came with their trainers on large chain leashes.  They had clearly been through this before.   They stood silently as Teo spoke.  We all just looked at them in awe.

Maya.

Maya.

Right away, Max began to peruse the crowd, sniffing around, and offering to be petted by the first and bravest of us to stretch out their hands.   I was still nervous they’d sense my fear.  Teo got us on our feet and took us on a hike into the Malibu woods.  As we hiked, we did mindfulness exercises and tried to get into the mindset of the wolf.  We keyed in to each of our senses, including smells, sounds and touch.  And at each stop we learned a new Wolf Principle from Teo, heard stories of how the wolves had touched and helped people in pain, and more of us were chosen by Maya and Max to be friends.

The first Wolf Principle is: “Wolves are always totally OK with who they are.”  Wolves do not have self-doubt, do not care what other wolves think of them, or worry about their power.  These are distinctly human qualities.  And at that point, it dawned on me that my fear and anxiety and history were getting in the way of the experience.  I began to breathe more consciously.  I embraced the surroundings, smelled the strong fragrance of the eucalyptus trees, heard the crackling of twigs and leaves beneath my sneakers, and felt the sun on my face and arms.  I believe this is when I just let it go.  Because, sure enough, that was when Maya came over to me for the first time.

I knelt down next to her, put out my hand for sniffing and started scratching her neck.  I felt accepted.  I felt honored.  And I felt all of my fear melt away instantly.  At that moment, I was so relieved and aware of my relief that I was basically filled with a sense of gratitude, to Maya, to Teo and to everyone around me.  This was a profound experience.  It was happening and I was aware it was happening.  The feeling continued through the hike and through the rest of the day.  I was riding a wave of gratitude and new perspective.  It felt great.

I usually end with some sort of wrap-up lesson, but this time I’ll just let the experience speak for itself.  Because I can’t really describe it any better.  I don’t know how it happened or why it happened.  I just know that it happened and how I feel about it.  Maybe that’s enough.  Please check out Teo and his wolves.  If you feel like it make a donation to help him continue the work with the wolves.  It is really amazing what they can do.

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist.  His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts.  Contact him at andy@bostonprofessionalscounseling.com or visit his website at www.bostonprofessionalscounseling.com

Boston Professionals Counseling

Internalizing Freedom

“Remember, Red, hope is a good thing. Maybe the best of things. And no good thing ever dies.”  ~ Andy Dufresne.

I was flipping through the channels the other day, when I alighted on The Shawshank Redemption.  It’s one of those movies that I always watch regardless of where I am or what I’m doing, or even where it is in the course of the story.  It captivates me every time.  I never really stopped to think about why that is; I just figured I really like the movie a lot.  Tim Robbins’ performance as Andy Dufresne is probably his best, and Morgan Freeman as Red is equally spectacular.  But this time I realized that what draws me in is that it is fundamentally a story about freedom and hope, and how the two go together.  So, in the spirit of the 4th of July, I offer this perspective on freedom and wish everyone a wonderful holiday.

My favorite scene in the movie is the one in which Andy locks himself in the Warden’s office and broadcasts Mozart’s Marriage of Figaro over the PA system to the entire prison.  The scene captures the power of truly beautiful music as everyone in the prison stops what they are doing to listen, the faces of the inmates showing surprise, confusion and wonder as the track plays.  The moment is rudely and abruptly interrupted as the Warden’s henchmen break into the office and restore order to the prison.

Red narrates:

I have no idea to this day what those two Italian ladies were singing about. Truth is, I don’t want to know. Some things are best left unsaid. I’d like to think they were singing about something so beautiful, it can’t be expressed in words, and makes your heart ache because of it. I tell you, those voices soared higher and farther than anybody in a gray place dares to dream. It was like some beautiful bird flapped into our drab little cage and made those walls dissolve away, and for the briefest of moments, every last man in Shawshank felt free.
 

When Andy completes his punishment in solitary confinement, he explains the reason behind his act of defiance:

Andy: That’s the beauty of music. They can’t get that from you…haven’t you ever felt that way about music?
Red: I played a mean harmonica as a younger man. Lost interest in it though. Didn’t make much sense in here.
Andy: Here’s where it makes the most sense. You need it so you don’t forget.
Red: Forget?
Andy: Forget that…there are places in this world that aren’t made out of stone. That there’s something inside…that they can’t get to, that they can’t touch. That’s yours.
Red: What’re you talking about?
Andy: Hope.
 

I imagine these words would have even greater import if we were sitting in a prison cell.  And even though we are not, we often inhabit prisons of our own creation, within our minds.  We get trapped by and within limiting and self-defeating thoughts.  We are possessed by the confining belief that other people are in our way and to blame for our inability to move freely.  We think, if only I had this, or if only that would happen, everything would be better.  And we pace around furiously within this cage of thoughts, always focused outside of us, when the answer is and was always within.

Instead, why can’t we learn to embrace that freedom is a state of mind?  We don’t have to be in Shawshank to know that.  We only need to look inside of ourselves to that place no one else can touch, where the hope that things will be better resides.  We can be like Andy Dufresne and abide by the conviction of our belief that, regardless of our circumstances, we are truly free as long as we believe we are free.

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist.  His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts.  Contact him at andy@bostonprofessionalscounseling.com or visit his website at www.bostonprofessionalscounseling.com

Boston

Baseball Gods Answer – Happy Father's Day

Several years ago, I wrote this piece about one little league baseball game during the middle of a long season.  While my son, Joey, is now 14 years old and has made himself into quite a player, this moment stands out to me as a Dad.  Happy Father’s Day to all the dad’s out there. 

Proud Moments in Fatherhood

Along with the pain-in-the-ass of schlepping, scolding, and suturing, every now and again a moment comes along during the course of fatherhood that makes a guy feel… well, more alive.  Last night I had one of those moments.

Joey plays 10 year-old little league for the Natick Mets.  If I’m being completely honest, he’s not one of the better players on the team.  He missed a couple of years because he didn’t want to play which stunted his development.  He has trouble moving, and he seems to be developing a fairly serious case of myopia that has yet to be clinically addressed.  So it is that he has difficulty doing most baseball-related activities.  You know, throwing, catching, running, etc.

But despite these challenges, he really works hard at it and he manages to hit the ball with a level of consistency that amazes me.  He makes contact even though he probably can’t really see the pitch until it’s right on top of him.  I think this helps because he really isn’t afraid of getting hit.  So, unlike most of the kids his age, he never bails out on good pitches.  And, if he makes contact, he usually gets a hit.  Still, he spends a lot of time on the bench to let others on the 14-person team play.

This was the backdrop for last night’s game against the Tigers, one of the top teams in the league, due in no small part to their stacked pitching staff of heat-throwing 10 year-olds.  In the first inning, Joey gets up to bat, cap on backwards beneath his helmet, batting gloves on, and black Mizuno bat in hand, at the ready, to face a kid armed with a cannon.  He is seriously throwing like an adult.  The first 4 or 5 Mets barely even attempt to swing against the kid’s heat, plainly petrified of getting pegged by one of his wild fastballs.  So Joey steps in, measures his stance against home plate, like I taught him, and gets ready.  I like to think that he’s running the swing thought I gave him through his head, “stay back and swing hard.”  He offers at the first pitch and misses.  He connects on the second pitch for a grounder to third, which, combined with an error at first, turns into the team’s only hit through the first three innings.

Eventually, the baseball gods show the Mets some mercy and that pitcher is removed for a no-less-hard-throwing kid who looks like the second coming of Carlos Zambrano.  This guy, however, can’t throw strikes and the Mets soon mount a comeback to tie the game at 4-4.  Joey strikes out swinging against this kid somewhere in the fourth inning.

In this little league the games are six innings long.  It’s nearly 7:30 and the sun is setting quickly.  The spectating parents are cold.  The siblings are cranky and everyone wants to go home.  But it’s a tie game.  The Mets, as the home team, come to bat in the bottom of the 6th needing a run to win.  The mini-Carlos Zambrano has the Mets in a collective funk and believing that they will be the recipient of that night’s big red welt in the back or leg or shoulder.  Two of the team’s good hitters quickly go down swinging, obviously just wanting to get it over with and sit back down. Then, what should be a foul tip turns into a bunt and an erroneous throw becomes the potential winning run on second.

Joey is up.  From the on-deck circle, he looks over at me, and I nod.  “Stay back, swing hard, ” I mouth without speaking.  He steps into the box, digs in, measures his stance on the plate and awaits the pitch.  It’s about two feet over his head, but he flails at it anyway.  I groan, a little bit too loudly, and the other parents look over at me.  The next pitch is in the dirt and easy to lay off of.  “Good eye,” I yell with clipped enthusiasm.  The third pitch is a juicy offering.  Joey takes a hack and tips it into the backstop.  Oh, so close!  At this point, I am visibly agitated.  I can’t sit.  The entire crowd is rapt and at attention.  There is no noise.  There is nothing but the next pitch.  After an eternity it comes with what seems like smoke trailing from it.  Joey grips the bat, turns on it and, crack, a line drive to center.  In slow-motion, the ball sails past the shallow playing fielder, the man on second rounds third and cruises into home standing up.  The Mets stream out onto the field, leaping and screaming in sheer delight.  They mob the runner at home and then Joey as he comes trotting in from second, slamming him repeatedly on the helmet.  The other team stands on the field in stunned silence, dejected.  The game is over.

Amidst the continuing celebration that the coaches cannot quite quell, Joey looks over at me.  I’m standing and cheering.  I give him a nod and say, “you’re my hero.”  He nods back at me and then returns to his laughing teammates.  The coach gives him the game ball, which he brandishes with obvious pride.  All is right, and life is good.  I can’t help but feel like I should thank him, but of course, he wouldn’t understand what that moment means to me; at least not until he has a boy of his own.

Andrew D. Kang, 6/9/09, Father

Joey today - the player he worked hard to become.

Joey today – the player he worked hard to become.

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist.  His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts.  Contact him at andy@bostonprofessionalscounseling.com or visit his website athttp://www.bostonprofessionalscounseling.com

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Get Your Hopes Up – There's Little Reason Not To

“A strong mind always hopes, and has always cause to hope.” ~ Thomas Carlyle ~

I was talking to a friend recently who was telling me about a job opportunity she was interested in.  It sounded like a great job that would be a perfect fit for her.  After spending about 15 minutes or so talking about how much she wanted the job and hoped that the process would go well, she said, “I don’t want to get my hopes up.”  I just nodded.  I knew what she meant; after all, it is a common enough saying.  It is usually understood to mean that she didn’t want to be disappointed in the event that things didn’t work out.  The raised expectations would make the disappointment even worse.  Thus, if my friend did not literally raise her hopes too high, then if the outcome was unfavorable, she’d have less far to fall in terms of disappointment.  I know a lot of people think this way.  I know I do.  It represents a defensive instinct within us.  We think that we can prospectively protect ourselves by steeling against future misfortune.

Really?  Does it actually work that way?  Do we really not get disappointed in the end?  For that matter, do we even ever succeed in not getting our hopes up?  Thinking about this statement and the thought process behind it, it seems the opposite is true.  Decoding the language, saying “I don’t want to get my hopes up” is tantamount to saying, “my hopes are already up and I really want it to work out.”  The words are actually the opposite what what we really think and feel.  Then why not just say what we think and feel?  It’s more honest and it’s true.

Could it be the idea that if we say what we really want and reveal how much we want it, we will jinx it?  This is what we call in the therapy trade magical thinking.  Its the idea that what I think in my mind effects the outcome of unrelated events.  The classic example is wearing your lucky shirt on game day so the Patriots don’t lose.  It’s a nice illusion of control in which many fans (especially of the Patriot variety) participate.  But that doesn’t make it so.  The reality here is that not getting your hopes up does not increase the likelihood of a positive outcome.  In fact, the opposite may be true in a very real and verifiable way.  For instance, if my friend doesn’t get her hopes up and therefore acts blasé about the interview and fails to prepare as well as she might otherwise, then she could actually be hurting her chances of success.  Why would she do that?

The other thing this brings to mind is a bit of a Puritan ideology of delaying gratification.  (We are constantly running from what the Puritans taught us around here.)  If we enjoy less now, then when hell and damnation come calling, it will feel less bad because we expected it and prepared for it.  If we are good and get to heaven, then good for us for being good by suffering and expecting the worst!  Sorry, but I don’t buy it.  Hell and damnation are always bad.  So is disappointment.  Under no circumstances does it feel good, whether you expected it or not.  There is no savings of pain in the future.

We might say, well we didn’t really think it was going to happen anyway, but the truth remains, we hoped it would.  If it doesn’t we are in fact disappointed.  Now that is something we can control.  We can learn how to deal with disappointment.  We can learn how to create opportunity out of adversity.  We can learn to live more fulfilling lives based on hope and optimism.  And anyway why undercut the present hope if we don’t have to?  Seems like needless suffering and a waste of emotional energy to me.  Don’t we want more hope and optimism, not less?   Maybe that is what ends up giving us the enthusiasm that the interviewer perceives and sways the decision in our favor.

So, go ahead.  Be positive and hopeful.  Be true to yourself and what you want.  If it doesn’t work out, that’s life.  You can deal with that.  But what if it does work out?  Then you can say, I knew it all along.  Go ahead.  Get your hopes up and see what happens.

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist.  His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts.  Contact him at andy@bostonprofessionalscounseling.com or visit his website at www.bostonprofessionalscounseling.com

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Raging Against The Machine – Health Insurance v. Healthcare

“Insurance – an ingenious modern game of chance in which the player is permitted to enjoy the comfortable conviction that he is beating the man who keeps the table.” ~ Ambrose Bierce. 

When I was a lawyer I worked for several insurance companies in a defense capacity and got a first hand look behind the insurance company face at the actuarial reality.  Insurance is not all Good Hands and Geckos as it turns out.  Rather, insurance is about numbers, plain and simple; numbers of dollars, accidents, deaths, etc.  Insurance companies predict risk – how much it will cost when things go bad, and how much to charge customers to cover that cost and still make a tidy profit.  They are very very good at doing this.

Your insurance company knows about you because it has information on millions of other people with your same traits spanning decades.  Therefore, if you are a male aged 30-45, with a baseline of physical health and other indicators you will get quoted a certain rate for life insurance. If you are a smoker, that all changes and you get quoted a much higher rate which reflects the increased likelihood that you will have substantially higher medical expenses in the future.  It is not guaranteed, but it is enough of a statistical certainty that it justifies charging more.

Sound heartless?  Well, it is.  It’s got nothing to do with heart.  There is no room for caring in actuarial tables.   That is why, when dealing with insurance companies of any kind, we experience a startling lack of empathy.  In particular, health insurers consistently fail at relating to their customers in an appropriate way.  For most of us, health insurers are necessary evils.  They help pay for prohibitively expensive medical care when the need arises.  Frequently, when we are dealing with insurers, we are in crisis.  The last thing we want to do is wrangle with some senseless bureaucrat who couldn’t care less about the very real problems we are facing.  Add to that the bureaucrat’s institutionally mandated drive to pay the least amount possible, and the whole process leaves us balled up and shaking in the corner.

So, why do we need health insurance?  The conventional wisdom is that we need it because without it we could not pay for costly medical care.  But doesn’t this just sound like a deal between the insurance companies and the medical providers?  They charge really high prices so that no one can afford it.  Insurance companies then pay those high prices (but of course at a huge discount that regular people don’t get), and then charge their customers a monthly fee that is statistically guaranteed to cover the cost of any likely events.

But what if there was no insurance company taking its huge cut out of the middle?  If we paid our monthly premiums directly to the medical care provider, couldn’t the provider charge less?  And wouldn’t that solve the problem of insurers meddling in health care decisions?  And wouldn’t it be a system vastly more efficient?  Sadly, proponents of such a system do not have a billion dollar lobby.  The guys with the commercials do.  And so, the status quo continues even as the health care system spins wildly out of control.

Insurance companies are like the house in a casino.  The odds are always in their favor because they make the rules.  And they always win.  Consumers dutifully pay their premiums hoping that they never have to try to cash out on their investment.  When they do need it, more often than not they encounter resistance in various forms.

Probably the most significant of these is the Insurer’s right to approve treatment.  By approve, I mean dictate.  It’s right there in the insurance contract – if you want the insurer to pay for your treatment, you agree that the company gets to say if it is medically necessary or not.  And if its not, guess what…  So now, appropriate treatment is no longer only up to the patient, or the doctor, or the therapist.  It is once again up to the insurance bureaucrat.  The same one who had no empathy for the customer and who only cared about preserving his bottom line numbers for the calculation of his year-end bonus.  He gets to say whether a treatment is medically necessary, whether a particular medication should be used or whether a cheaper or generic one should be substituted, and how much treatment a patient should receive.  He gets to say that the company will pay for this treatment but not that one (that one is too expensive).  And he gets to say the company will only pay for this much treatment.  After that you’re on your own.

So what can you do about it?

1.  Know Your Plan Options.  While most people do not have a great deal of choice in the health insurance they have, any choice that is available should be examined carefully.  As a general rule, the less expensive the plan, the less it covers and the less autonomy the patient has. PPOs, for example, usually allow the patients to pick their own providers regardless of network.  So, even though that PPO may cost an extra few dollars per pay period, it could be worth it to you if it affords more autonomy in the decision making process.  Examine all options made available by your employer, but do not make the mistake of only looking at premium cost of the plan.  There is much more to it than that.

2.  Know The Type Of User You Are.  Have you and will you continue to need to see specialists?  Do you have an established set of out of network providers you want to see?  Are you likely to have recurring medical or mental health needs requiring ongoing insurance company involvement and payment?  If you answered yes to any of these questions, you may prefer to pay a little more for additional control over these decisions.  Match the type of user you are to the available plan that best suits you and your situation.  If you are a heavy user of health insurance benefits, you’ll probably be glad you paid a little more up front when it eases the hassles later on at the point of service.

3.  Know Your Rights.  When you do settle on a plan or if you already have one you are established in, read the policy.  It’s that thick booklet the insurance company sends you at the beginning of each enrollment year.  If you are like most people, you flip through it, realize that most of it is incomprehensible then file it away for safekeeping and prosperity.  Even though it is difficult reading full of archaic lawyer-created language, it is worth the time to slog through it.  Once you get the hang of the language, it becomes much easier to understand.  Go through it with a highlighter and mark passages or terms you don’t understand.  Then call the 24-hour customer service line and ask them what it means.  It is a lot of effort, sure, but you will be much better informed about what your plan does and does not cover at the end of it.  You will also figure out what the company will and will not do for you under the policy.  Perhaps most importantly, the policy will contain provisions regarding disputes, how those disputes are settled, and options regarding appeals, and external legal rights.  Then the next time you find yourself arguing with a company adjuster, you will be armed with more than just your rage against the machine.

4.  Get Your Providers To Help You.  Usually providers have been through it before with insurance companies.  Indeed, did you know that most hospitals have huge departments often of 100 or more people whose sole job it is to negotiate with insurance companies, patient by patient, treatment by treatment, 24 hours a day, seven days a week?  And we wonder why health care is so expensive when huge administrative costs like that must be built in?  Suffice it to say they’ve seen what you’re experiencing before.  And if you’re lucky they’ve figured out a way around it or through it that will minimize your frustration.

5.  Opt Out.  Ultimately, you do have a choice of whether to use your health insurance in any given instance.  Unfortunately, for most of us, the cost of what we need is usually beyond the range of affordable.  But not always.  Sometimes it may make more sense to try to pay out of pocket for certain services.  Often providers will work with patients and slide their fees downward if they are paying cash.  And, as of right now, paying out of pocket remains the only way to maintain complete control over healthcare decisions.

In the mental health area, there may be additional reasons for deciding not to use insurance.  For instance, the “medically necessary” analysis usually requires that your provider issue a medical diagnosis of a particular mental illness or condition, together with an evaluation of severity and a specific plan for treatment of the condition.  Although this might not seem unreasonable on its face, it can have other consequences for patients down the road.  The patient will be obligated to disclose such diagnoses in the future if applying for life insurance, for example.  Like for the smoker, a person with a history of depression is likely to be charged a higher amount.  And, of course, any diagnosis causes the creation of a record that follows the patient.  Those worried about the stigma of receiving mental health treatment beware.  Because health plans are often administered through the workplace, it is remarkably easy for supposedly protected confidential information to get back to the company, particularly where disputes over coverage or payment arise.  Where such sensitivities exist, or where it’s not worth the risk, the only real solution is to pay out of pocket and keep the insurance company (and your employer) out of the health care decision all together.

What do you think?   Do you have effective techniques for dealing with insurance companies?  Have you opted to pay out of pocket for more control?  What has worked for you?

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist.  His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts.  Contact him at andy@bostonprofessionalscounseling.com or visit his website at www.bostonprofessionalscounseling.com

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