V1302 – Psychotherapy Rates: Why is the Debate Ongoing?

In July of 2019, we highlighted the alarming trend whereby accident benefit carriers were imposing reduced rates upon psychotherapists; rather than approving the typically requested rate of $149.61 per hour, as afforded per the Fee Guideline to psychologists and psychological associates, insurers were demonstrating variability in their approach to approvals of psychotherapists. With partial approvals sometimes being rendered at rates as low as $58.19 per hour, we witnessed impact to our clients in that they were challenged to access care within their communities.

With our prior release, we spoke to the LAT’s decision 18-007991, J.V. and Intact Insurance Company. The decision recognized that the psychotherapist in question was specialized in cognitive behaviour therapy, registered in psychotherapy, and acting within her scope and expertise.  Accordingly, the decision found that the psychotherapist ought to be entitled to the same rate as otherwise afforded to a psychologist or psychological associate.

Despite the LAT’s decision, we continue to experience persistent variability in terms of how insurers respond to psychotherapy treatment plans. The quality of the care, the extent of supervision, and the fees requested continue to be questioned and criticized; rates are frequently reduced and psychotherapists are often left unable to provide care in the absence of asking their patients to contribute to sessional costs. This disappointing trend is causing ongoing difficulty in terms of access to care within the accident benefits industry.

Recently, the LAT was asked again to review the psychotherapy rate conflict. In 18-012238, A.S. and Aviva Insurance Company, Aviva had approved treatment planning for psychotherapy services at the unregulated rate of just $58.19 per hour.

In analyzing the issue, Adjudicator Robert Watt acknowledged that psychotherapists are not listed within the Professional Services Fee Guideline, either within the context of regulated or unregulated providers, and that in such cases the Guideline instructs that the rate payable is to be decided by the parties involved. He recognized that the Ontario Association of Consultants Counsellors, Psychometrists and Psychotherapists (OACCPP) awaits response to its request to be added to the Guidelines as a regulated Health Care Profession or Provider; their request is to be added with the same rate given to the psychologists and psychological associates. He acknowledged that psychotherapists have been regulated since April 1, 2015 under the OACCPP.

In rendering his decision, Adjudicator Watts stated quite simply:

“Both Psychologists and Psychotherapists provide the same cognitive behaviour therapy. If they are providing the same cognitive behaviour therapy services, why is the rate different. I find that the hourly rates should be the same for the same services provided. I find that the applicant’s Psychotherapist, should be paid at the rate of $149.61 per hour for the work completed.”

Perhaps this will now put the issue of rate for psychotherapy to rest? In the absence of an eventual revision to the Professional Services Fee Guideline, we can certainly hope that it will.

Official Decision:

18-012238, A.S. and Aviva Insurance Company

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