V901 – Psychotherapy Rates and Access to Care

The maximum rates that may be charged by most health care providers, in the context of an accident benefit claim, are detailed within the Professional Services Fee Guideline. For those providers who are not listed in the Guideline, we are simply directed that the amounts payable for services are to be determined by the parties involved.

Although registered psychotherapists are not listed in the Guideline, they have historically succeeded in having their services approved at the rate afforded to psychologists and psychological associates. With this, psychotherapists are often paid $149.61 per hour for service to non-catastrophically impaired clients and $179.29 per hour when service is provided to the catastrophically impaired.

In recent years, we have witnessed an alarming trend in the industry in that insurers have been imposing reduced rates upon psychotherapists. While we can certainly recognize the need to be conscientious in the use of medical and rehabilitation coverage limits, such reductions have caused significant problems in terms of variability of approvals and access to care for our clients.

With partial approvals sometimes being rendered at rates as low as $58.19 per hour, it is unsurprising that psychotherapists have struggled in their ability to accept accident benefit related referrals. Some have withdrawn from the industry, others have reduced their capacity for such referrals, and still others have had to charge clients for the balance of their fees. The outcome is such that our clients have been challenged to access care within their communities.

We are pleased to see that the LAT has recently decided a case as related to this psychotherapy rate issue. In 18-007991, J.V. and Intact Insurance Company, Adjudicator Kimberly Parish was asked to consider whether the proposed psychotherapy service ought to be paid at the rate of $149.61 or at a reduced amount. In this case, the adjudicator recognized that the psychotherapist in question, Ms Donna Barefoot, is a registered psychotherapist who specializes in cognitive behaviour therapy and is registered with both the Canadian College of Professional Counsellors and Psychotherapists and the College of Registered Psychotherapists of Ontario.

In rendering her decision, Adjudicator Parish recognized the plain language meaning of the Guideline. She confirmed that registered psychotherapists are not listed within or covered by the Guideline. She acknowledged that the rates payable are therefore to be determined by the parties, or if the parties cannot agree, by an adjudicator. With this discretion afforded to her, she concluded:

“I accept Ms. Barefoot is not accredited within the Province of Ontario to provide all of the services which a psychologist or a psychological associate can provide. Ms. Barefoot is providing cognitive behaviour therapy which is not outside of her scope of expertise, or services which can be provided by a registered psychotherapist. Therefore, I do not find she should be disentitled to be paid at the same rate as a psychologist, or psychological associate within the Guideline for providing a service she is qualified to provide which is the same service which can also be provided by psychologists and psychological associates.”

This positive outcome confirms that registered psychotherapists, acting within their scope and expertise, ought to be entitled to the same rate as otherwise afforded to a psychologist or psychological associate. We are optimistic that insurers will recognize this decision and revisit their processes for approving psychotherapy treatment plans. We may hope that with rate acceptance, we will see improvements for our clients in terms of access to care in the communities.

Official Decision:

18-007991, J.V. and Intact Insurance Company

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