Background and History

Like everyone’s life and career, my story and my journey to becoming a therapist has its place in our country’s social, cultural, and even medical history.

By the late 1980’s, I had had extensive training and experience as an actor, including earning a Bachelor’s Degree in Theatre at UCLA, one of the leading theatre schools in the United States (with peers/colleagues such as actors Michael Stuhlbarg, Tim Robbins, and Mariska Hargitay of “Law & Order: SVU”).  Like other young actors, I sought opportunities in the “teen coming-of-age” movies characterized by that period.

However, that period was also characterized by the height of the AIDS crisis, which was a medical, psychological, social, and cultural trauma, and as a young gay man coming out in Los Angeles in 1985, I lost many friends, teachers, and acquaintances to the carnage of the AIDS epidemic.  After some frustrations in getting a lucrative acting career off the ground, I grew restless with its seemingly insipid priorities, compared to what was happening all around me in the AIDS crisis.  I couldn’t stand by and do nothing.  I had to do my part in the fight.   As a young, ambitious man, I got frustrated that my mind and talents weren’t being used for anything beyond “burger boy” roles with a very modest impact on society.

Fired up by this frustration, I decided that I wanted to do more with my life.  If it had been the 1940’s, I would have been in the military at that age to fight in World War II.  In the 80’s, I “enlisted” in the war against AIDS, not as a physician (I didn’t have the background to pursue the Doctor of Medicine), but as a trainee in mental health — first in psychology, then in clinical social work.  I volunteered at AIDS Project Los Angeles as a “Phone Buddy,” providing phone counseling to people with AIDS.  And I noticed that the guys who had more mental health support survived longer, and better, than their peers with poorer mental health.  Later, formal research proved this observation.

My own diagnosis as HIV-positive in November, 1990, led me to abandon the pursuit of long (5+ year) Ph.D. Psychology programs, because at that time I was literally afraid that I would not live to see the completion of a doctoral program, and I was far too obsessive-compulsive to die with a half-finished degree.  I chose to pursue the two-year, full-time MSW (Master of Social Work) program in the Mental Health Concentration at the University of Southern California  (USC) School of Social Work, where my internship training right from the very beginning emphasized the population I wanted to work with most (at the LA LGBT Center), and to do my part in the fight against AIDS  At the LA LGBT Center, I co-facilitated a group for gay and bisexual male incest/sexual abuse survivors.  Later, I got very interested (in love, really) with helping people with more severe psychiatric disorders, or “chronic mental illness,” and completed a clinical internship at Pacific Clinics Pasadena, specializing in assisting persons with schizophrenia and other severe/persistent mental illness and developing a model for care called Psychosocial Rehabilitation and Assertive Community Treatment.

After two years (3,200 hours) of formal, supervised training, I earned my California state license to practice psychotherapy, which is the LCSW (Licensed Clinical Social Worker), with special additional training as a psychiatric social worker, which qualifies me to discuss medications and their use in more depth, but not as precisely as an MD psychiatrist. I later earned the credentials of Certified Sex Therapist from AASECT (American Association of Sex Educators, Counselors, and Therapists), and Consensual Non-Monogamy and Polyamorous Families from the Sexual Health Alliance. 

Most people don’t know that in the United States, the majority of psychotherapy and counseling services are provided by clinical social workers, not psychologists as might be expected. I was licensed as an LCSW on my first attempt in 1997 (LCS#18290, verifiable at http://www.bbs.ca.gov), after completing 3,200 hours of clinical experience in not less than 24 months of work, supervised weekly by an LCSW, and rigorous written and oral exams (with an approximately 30% pass rate).

The University of Southern California (USC) Suzanne Dworak-Peck School of Social Work is accredited by the Council of Social Work Education (CSWE) and was often one of the top 5 schools of social work in the United States. It was here that I started my specialization in working with gay men, gay male psychology, gay mental health, HIV mental health, and community research and advocacy. At USC, I was Chair of the LGBT Student Caucus. Before USC, I completed nearly two years of post-baccalaureate courses in psychology after graduating from the University of California, Los Angeles (UCLA) (BA, 1987).

In addition to providing psychotherapy for gay men, I have over 10 years experience in non-profit organization administration and over 7 years in qualitative business research and business/industrial psychology.  I have taught field internships for social work interns, supervised mental health, case management, treatment advocacy, peer support, home health care, and other social services programs, including over five years of service in programs for homeless people with severe mental illness as well as substance challenges and HIV/AIDS. 

Prior to expanding my practice to full-time, I was the Associate Director, Clinical Services for Los Angeles Family AIDS Network (LAFAN), and Clinical Director of SPECTRUM, the HIV social services clinic at Charles R. Drew University of Medicine and Science. I have also worked in other areas of community advocacy, organizational consulting, and teaching. I served as a consultant to the UCLA/Pacific AIDS Education and Training Center, where I co-wrote a national training curriculum in HIV and mental health, and was a member and Co-Chair of the LA County HIV Mental Health Task Force for nine years, co-chairing its annual conference for mental health professionals for 8 years. I was a teaching consultant to Abbott Laboratories, Bristol-Myers-Squibb Virology, and LipoWear, Inc. on HIV mental health and other strategies for successfully living with HIV/AIDS.  I developed and presented an 8-hour continuing education course on HIV/AIDS for California registered associate therapists pursuing licensure, presented at USC.

I served on the Board of Directors for LAGPA (the Lesbian and Gay Psychotherapists Association) for four years. For two years, I wrote a monthly column for A&U (Art & Understanding), America’s AIDS magazine, on HIV mental health. I wrote a chapter published in the book, AIDS and Mental Health Practice: Clinical and Policy Issues (Shernoff, Haworth Press, 1999), in addition to regular contributions to the gay magazines Poz, Instinct, Frontiers, and IN LA. I have served as a regular advice columnist for LGBTQ youth called “Dear Trevor” for The Trevor Project website (http://www.thetrevorproject.org). I make regular TV and radio appearances on mental health, HIV/AIDS, and gay rights issues, including as a commentator on the much-repeated “50 Wickedest Women of Prime Time” on E! Entertainment Television.

Personal History

I was born and raised in the area of Washington, DC, and I have lived in Los Angeles since 1983.  I have been successfully living with HIV since 1990. Together since 2002, I am legally married to my wonderful husband, and we were one of the first 18,000 same-sex couples to be legally married in California.  I live in the same community that I serve, having an active, visible, social, and civic role in the gay male communities of West Hollywood and Los Angeles to “walk the walk” and “talk the talk” of my practice, empowering gay men to lead fuller lives — psychologically, professionally, emotionally, physically, sexually, politically, socially, and spiritually.

How to Become a Client

My job is to provide you with a private, safe, confidential space to come each week, at a time set aside just for you, with my undivided attention, where you can work toward goals that are important to you and that would relieve you of burdens or improve your quality of life. Everything we talk about is strictly confidential, except for the most extreme legal situations (like if you were suicidal and a few others I could explain).

Many people think they have to really “need” therapy to come in; that’s not really true. Our work can begin whenever you want it to. There is really no such thing as people who “need” therapy versus people who don’t. Everyone could benefit from knowing themselves better and setting goals to improve their life.

The most common technique I use is called Cognitive-Behavioral Therapy. This is a very interactive technique to change the way you think about yourself, which changes the way you feel, which changes your behaviors, which then changes your life in all kinds of positive ways. Where appropriate, I also draw from more of a “life coaching” and Positive Psychology model, where you learn how to get more things done, deal with anger, manage your time, deal with drinking or using, make a budget, plan your career, feel better about yourself, or communicate better with others.

I utilize Developmental Psychology, Existential Psychology, Positive Psychology, and Executive Coaching/Life Coaching models, as appropriate for your individual situation.  I am not an “old-school psychoanalyst,” silent and passive.  My style is active, verbal,  interactive, and attuned to your specific cultural considerations.  I help you do the work you need so that your gains are your achievements to own, implement, and benefit from, for a lifetime beyond after your work with me concludes.

I deliberately keep my practice small and “boutique-style” to ensure that I provide you prompt accessibility to me and specialized attention.

I engage in ongoing professional self-improvement via continuing education opportunities that add value to the skill sets I offer you.  I conduct ongoing clinical research in my specialty areas, reading academic journals and articles, attending local and national conferences, and investing in paid consulting, coaching, workshops, and accredited Continuing Education Units to keep my skills current and sharp to help with your specific issues with the latest data in the field.  I provide customized, individualized approaches to treatment for each of my clients, based on your needs and goals.

I am accessible to my clients via email and phone calls promptly between sessions (up to 15 minutes) free of charge, to ensure continuity of care and accessibility to you.

This focused, “boutique”-style of service, along with my specialization and extensive experience (over 32 years) that bring additional value to your therapy/coaching sessions, are why my fees are higher than most newcomers to the field who “accept insurance” or charge lower fees to get established.  I believe that “experience counts” and that additional credentials bring value to the work and help you’re seeking.

I realize therapy requires a significant financial investment for anyone who undertakes it.  You are not only paying for my time at your sessions, but also for the extensive and varied overhead costs required for therapists to offer clinical services in a private practice setting.  You access to the benefit of many years of experience and perspective, having helped many others just like you.  Hopefully, you find the investment in yourself, quality of life, future, and the value your therapy brings to your life is worth any personal budget re-arranging and prioritizing you might need to do to make access to private therapy possible.

Phone sessions or webcam sessions are available for local residents and residents throughout California (therapy and coaching), and for US/International clients (coaching only).  Please ask for details on these programs.

How to Use Out-of-Network Insurance Benefits

Ken Howard, LCSW, CST and its professional corporation are considered an “out of network” provider for health insurance plans, which means we have not contracted with health plans such as an HMO.  But if you have a PPO style health plan with out of network benefits, you might be able to get partial reimbursement for your fees for sessions. 

Several aspects of your health insurance plan factor into if you will have any reimbursement, how much, and when.  It’s important to learn an understanding of the terminology the health insurance industry uses. 

You can often find a lot of information on the Explanation of Benefits form that your insurance plan will send you after you a submit a claim, or in a summary of benefits booklet that they sent you when you first enrolled in your plan.  If you don’t have this, contact your health plan (check for phone numbers on your membership card), or your employer’s human resources/benefits department might have this as well, or your health plan’s website. 

Premiums

A premium is basically the monthly fee that your health insurance plan charges you (or your employer, or a combination of the two, often through a “pre-tax” or paystub deduction) to enroll in their health plan, often at “open enrollment” season each year.  Usually, the higher the premium paid to buy into the plan, the higher the benefits they afford you.  Often, employers with a large number of employees offer health plans with lower premiums and/or better benefits than employers with fewer employees, because they are spreading out their risk among a larger number of people. 

Deductibles

A deductible is the amount of money one must pay out-of-pocket before insurance benefits kick in and typically reset on a yearly basis. Deductibles vary depending on plan and insurance company. They are also often different for in-network and out-of-network services, and can range from $0 to $24,000. Any healthcare payments that you make for out-of-network services and file with your insurance company count towards your deductible.  You should always ask your plan what deductibles you have, including if you have a separate out-of-network provider deductible. 

Coinsurance

Once your deductible has been met, the coinsurance rate will be applied to the cost of services, which reduces your total responsibility as the patient. If you have a coinsurance rate of 30%, that means that you are responsible for paying 30% of the cost of your appointment and your insurance company will reimburse you for the remaining 70%. For example, if your therapy appointment costs $100 and you have a 30% coinsurance, your insurance company should cover $70.

Seems straightforward enough, right? Not quite — there is one more piece of the reimbursement equation, and this is where things get tricky. This is the “allowed amount” also known as, “eligible expense” or “negotiated rate.”

Allowed Amount

Often the most difficult parts to understand about insurance benefits is the allowed amount. The allowed amount is a predetermined, maximum cost of different health service. This value is set by your insurance company, and often varies by zip code, service, and provider type.

For example, the same client might have a $130 allowed amount for a 60-minute therapy session in San Francisco, but a $120 allowed amount for a therapy session in Oakland — even if the cost of your appointment was always the same at $190. Unlike deductibles and coinsurance, this number is neither listed nor made readily available by insurance providers, making it extremely hard to quickly understand your benefits.  Insurance companies (strangely) consider the “allowed amounts” a “trade secret,” and will not reveal what these are until you submit a live claim, when they are forced to reveal these amounts.  This makes it harder to budget for your out of network claims out-of-pocket costs until you submit your first claim and it is processed, issuing you an Explanation of Benefits form that reveals what they paid. 

The allowed amount means most insurance companies severely undervalue out-of-network health services, and clients are stuck paying the difference between the actual cost and the allowed amount for their services. We’ve seen a wide variance in allowed amounts (from $60-$300), which means actual reimbursement varies significantly from client to client.  For some clients, with more generous employers (especially ones who are “self-insured” for all medical claims), they pay “100 percent of charges.” 

For example, for a $305 session fee, if you have an allowed amount of $120 and a coinsurance rate of 30%, you are responsible for paying (30% of $120 = $40) + ($305-$120 = $185) = $225 per appointment after you’ve met your out-of-network annual deductible.  While insurance companies won’t disclose our clients’ allowed amounts to us, we give our clients guidance on how to ask for allowed amounts from their insurance companies, so we can help you get the most accurate reimbursement quote possible.  Often, clients need to explain to their health insurance plan that a higher reimbursement is justified due to Ken Howard, LCSW, CST’s unique credentials that are above the average therapist, such as years of experience (over 30), in a specialized area (LGBT/gay men), with additional certifications (psychiatric social work, AASECT Certified Sex Therapist, CA Clinical Supervisor), academic experience (retired Adjunct Associate Professor from USC School of Social Work), published journal articles/books, internationally-known status, and high cost-of-living ZIP code (90069).   

Superbills

Unfortunately, reimbursement for out-of-network care is not instantaneous; clients must pay the full amount to their provider upfront, and then submit an insurance claim to get reimbursed, after the fact.

Like understanding benefits, submitting insurance claims is another challenging aspect of out-of-network care. Insurance companies have different processes, forms, and addresses, making the process hard to navigate. Especially in times of emotional and mental strain, filling out claims paperwork and ensuring that they’re sent to the right place can be frustrating.  Some clients have found it easier to submit the information on their health plan’s website or app. 

To submit your claim, you need a superbill, which is an itemized receipt you receive via email after your appointments.  You can receive a superbill after each session, after several sessions, or each month – but they must be received before the end of the calendar year.  Just request a superbill whenever you need it. 

Your health plan will review the superbill for its information and determine your reimbursement that they send directly to you (not to the therapist).  Sometimes, insurance companies will claim that the superbill is missing information that is actually there, in an attempt to avoid paying the claim.  When this happens, you just need to point out that the superbill contains the information they were looking for all along (such as a diagnosis code) and to re-process the claim so that it is paid. 

Some clients like to save their superbills for a few months, submit them, and then use the reimbursement they get on something special.