![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by All Done on April 7, 2005, at 2:13:56
My T and I had a fight today. At least, I think it was a fight. I can probably count the number of people I've ever fought with on one hand and I might not even have to use my thumb and pinky.
We were talking about how I feel disconnected to him and the possible reasons why. Insurance "just happened" to come up as one of the reasons. Hmm. Go figure.
Anyway, he hasn't called the insurance company or even looked at his contract. I don't believe he should be trying to tell me he is right until he has the facts straight. At this point, I don't even care if he is right or not. Just don't try to argue with me when I know more about it than you. You know?
Okay - serious potential for me to ramble here, I see. Let me try again.
I told him I was pissed.
I've discovered his "nervous laugh" (or whatever it is) irritates me when I see it too frequently within one session.
He's arguing that 1. we (he and I) had a contract prior to the insurance stuff, 2. the insurance company can't tell him what to bill, and 3. the fact that he's in private practice is first and foremost. The fact that he's an insurance provider is secondary.
I'm arguing that 1. I agreed to his fee not knowing he was an insurance provider, 2. the insurance company can tell him what to bill because he signed a contract with them, and 3. the fact that I'm an insurance policy holder is first and foremost. The fact that he's in private practice is secondary.We're going to get nowhere fast.
But, he told me he intends to read his contract before the next time we meet.
When I was leaving, I asked him if he was mad at me. This is a huge issue for me - I constantly worry that people are mad at me and I can't stand it when I think or know that they are. He laughed nervously (ugh) and I said, "forget it, I don't want to know." He said, "no. It's a good question we can talk about when we have more time."
Enough of the "therapeutic opportunity" BS. Just get an answer and let's move on. I'll talk about it all he wants after we come to some sort of informed agreement.
Oh, and at one point he made a seemingly casual comment like, "the insurance company my terminate my contract or I may terminate it." I told him that felt like a threat.
So much for keeping this short and concise. Sorry - I know I've repeated a lot of the issue. Just needed to get it off my chest, I guess.
Thanks for listening.
Laurie
Posted by alexandra_k on April 7, 2005, at 3:35:29
In reply to We had a fight, posted by All Done on April 7, 2005, at 2:13:56
Hmm.
How horrible / hard would it be for you to see someone else?
IMO you make very good points.
You should not be paying him $90 per hour to 'fight' about this.
You shouldn't even be paying him the ammount he is SUPPOSED to be charging you to 'fight' about this.Deja vu. Really.
I think it might be time to move on if that isn't too horrible for you.Feel free to ignore me if you like.
But in my head - alarm bells are ringing...
Posted by fallsfall on April 7, 2005, at 7:51:39
In reply to We had a fight, posted by All Done on April 7, 2005, at 2:13:56
I'm sorry, Alldone..........
My gut reaction is that you need to follow this through to completion. That you need to keep pushing your view (which seems right to me, by the way). That you need to explain to him why his procrastination and disregard of the contract he signed bothers you.
My therapist and I have agreed that my superego is much stronger than his. But I accept that his is probably reasonable. He has said that I have enough superego for both of us... We were able to come to agreement about the goal we were working toward (him getting "enough" money, me getting as much from the insurance company as possible - and my requirement that everything *I* do be by the book). I did have to allow that he had the right to choose to be less "ethical" (I hate to use that word, it is more that I need to follow the letter of the law, where he is OK with following the spirit of the law) - it was important for us to work out that his requirements *were* different from mine, and that neither of us had the "right" to force our requirements on the other. But that we needed to find a solution that would meet both of our needs. The process of working through that with him taught me about myself, about how other people can be, and about compromise. Excruciating, but valuable.
Of course, you may (when all is said and done) find out that your therapist has "morals" that you can't live with. But you've been with him for a while, right? And in general, he seems pretty good, right?
That period of time with my therapist was really, really, really tough. Dinah calls it "fighting to relationship". It is very much like that.
It is OK to be angry at him - for things like not calling the insurance company when he said he would. He deserves that. It was very hard for me to stand up for my beliefs against my therapist - I'm used to having him tell me what I'm doing that is "not helpful", and accepting what he says. But in this case, there were things that I *knew* were important (i.e. contracts) and I wasn't willing to compromise my values - I wasn't willing to purposefully do something that I knew was wrong. So we tried to figure out what was really important to each of us and were able to find a way to make us both happy.
Stick with it. Like you said before, there are an awful lot of topics rolled up into this issue. It is NOT comfortable, but I think that it will be beneficial in the end.
IM me if you want.
Posted by mair on April 7, 2005, at 8:21:51
In reply to We had a fight, posted by All Done on April 7, 2005, at 2:13:56
Laurie
This is all so unfortunate, and from the sounds of it, you couldn't drop this even if you wanted to. I think it's too big an issue.
What's really disappointing is his avoidance of the issue and use of what sounded like a threat. I think I wrote earlier that I had to work through pretty much the same issue with my T. (I wonder how many Ts ignore the terms of their provider contracts and simply bill the difference between their regular non-provider hourly rate and the insurance reimbursement) Ultimately she got fed up with dealing with my insurance company and she dropped them. I think it affected very few patients other than me. She discussed it with me fully before she did it and I was totally supportive because my insurer didn't require that I see someone in their network. So I continued to be reimbursed and the difference in cost was pretty minor. It meant I had to submit my own claims but the counterbalance was that I didn't have to listen to my T complain anymore about how difficult it was for her to get claims processed.
I hope this works out for you. He should be able to work through this conflict with you in a forthright and honorable way. If he can't, maybe he's not worth seeing.
mair
Posted by Miss Honeychurch on April 7, 2005, at 8:43:36
In reply to We had a fight, posted by All Done on April 7, 2005, at 2:13:56
Laurie,
That nervous laugh would drive me nuts. I used to do that and it was a BIG pet peeve of my T. I was cured of it within a couple of months, he would have none of it!
I don't think people realize how fake it sounds.
Posted by All Done on April 8, 2005, at 15:04:11
In reply to Re: We had a fight » All Done, posted by alexandra_k on April 7, 2005, at 3:35:29
> Hmm.
> How horrible / hard would it be for you to see someone else?
> IMO you make very good points.
> You should not be paying him $90 per hour to 'fight' about this.
> You shouldn't even be paying him the ammount he is SUPPOSED to be charging you to 'fight' about this.
>
> Deja vu. Really.
> I think it might be time to move on if that isn't too horrible for you.
>
> Feel free to ignore me if you like.
> But in my head - alarm bells are ringing...How hard would it be to leave? Well, it depends on what you mean by hard. I have quite a few Ts I could see that are providers under my insurance policy. And most of those would even be closer to my house, but...it would *feel* almost impossible to leave him.
Money matters aside, I'm approaching 2 years with him. Most of the time I feel pretty comfortable with him and I suspect that the times I'm not feeling comfortable stem from some of my old stuff that I need to be working on even harder.
All that said, my first reaction to your question was that it would be really, really horrible.
I'm not ignoring you, though. I realize it is something I might have to consider if I/we can't get past this. I think I just have to give us a little more time to work it out.
Oh, and since he considers much of this a "therapeutic opportunity" and, in part, I don't disagree with him, it would be very hard for me to argue that we shouldn't be talking about this on my dollar.
Thanks, alexandra. I really appreciate your input and I hope you are doing well.
Laurie
Posted by All Done on April 8, 2005, at 15:37:45
In reply to Re: We had a fight, posted by All Done on April 8, 2005, at 15:04:11
Posted by All Done on April 8, 2005, at 15:39:21
In reply to Re: We had a fight » All Done, posted by fallsfall on April 7, 2005, at 7:51:39
> I'm sorry, Alldone..........
>
> My gut reaction is that you need to follow this through to completion. That you need to keep pushing your view (which seems right to me, by the way). That you need to explain to him why his procrastination and disregard of the contract he signed bothers you.That's what my gut is saying, too. It's not even just his disregard of the contract anymore. I feel like he has no respect for my knowledge or, in general, for me. If he's so certain he's right, why won't he confirm that for me by talking to the insurance company? Doesn't it matter to him that he might be making an error that is negatively affecting me? He's reminding me a lot of my mom and that is enough therapy fodder for a lifetime. :(
> My therapist and I have agreed that my superego is much stronger than his. But I accept that his is probably reasonable. He has said that I have enough superego for both of us... We were able to come to agreement about the goal we were working toward (him getting "enough" money, me getting as much from the insurance company as possible - and my requirement that everything *I* do be by the book). I did have to allow that he had the right to choose to be less "ethical" (I hate to use that word, it is more that I need to follow the letter of the law, where he is OK with following the spirit of the law) - it was important for us to work out that his requirements *were* different from mine, and that neither of us had the "right" to force our requirements on the other. But that we needed to find a solution that would meet both of our needs. The process of working through that with him taught me about myself, about how other people can be, and about compromise. Excruciating, but valuable.
**How could anyone's requirements not include knowing what's the correct way, though? I mean, I understand if there are two correct ways of doing something, we may choose different ways, but to me, this is like 2 + 2. It only equals 4 (and you, falls, can't tell me it doesn't ;)). Do I have to learn to accept that he thinks it's 5 only because he won't look in the d*mn book for the answer?
> Of course, you may (when all is said and done) find out that your therapist has "morals" that you can't live with. But you've been with him for a while, right? And in general, he seems pretty good, right?
This is what I'm afraid of. I'm almost at 2 years with him and yes, in general is seems better than pretty good, to me.
> That period of time with my therapist was really, really, really tough. Dinah calls it "fighting to relationship". It is very much like that.I know. I thought about Dinah's expression when we were in the midst of arguing and it helped me to calm down a bit. I know there's something to benefit from here and, oddly enough, I think it's the connection I've felt has been missing for a little while.
> It is OK to be angry at him - for things like not calling the insurance company when he said he would. He deserves that. It was very hard for me to stand up for my beliefs against my therapist - I'm used to having him tell me what I'm doing that is "not helpful", and accepting what he says. But in this case, there were things that I *knew* were important (i.e. contracts) and I wasn't willing to compromise my values - I wasn't willing to purposefully do something that I knew was wrong. So we tried to figure out what was really important to each of us and were able to find a way to make us both happy.
See above** :).
> Stick with it. Like you said before, there are an awful lot of topics rolled up into this issue. It is NOT comfortable, but I think that it will be beneficial in the end.
>
> IM me if you want.Thanks, falls. I know there's all kinds of interesting stuff inside me that's coming out because of this. I just wish we could get the details ironed out and then we can discuss how it made me feel to our little hearts content.
Take care,
Laurie
Posted by All Done on April 8, 2005, at 15:45:44
In reply to Re: We had a fight » All Done, posted by mair on April 7, 2005, at 8:21:51
> Laurie
>
> This is all so unfortunate, and from the sounds of it, you couldn't drop this even if you wanted to. I think it's too big an issue.I don't think there's any way I could walk away from this right now. I feel like I need some resolution, even if it's not the one I want.
> What's really disappointing is his avoidance of the issue and use of what sounded like a threat.
> I hope this works out for you. He should be able to work through this conflict with you in a forthright and honorable way. If he can't, maybe he's not worth seeing.
>
> mairI know, his morals are really starting to concern me. At least I called him on the threat, though. I've noticed that when he says something he thinks might not come out the right way, he tends to think about it and apologize the next week (even if I didn't notice something wrong). I'm hoping he's thinking hard about that comment.
I hope he turns out to be a good guy in the end. Then, I won't feel so bad if I am still paying his full fee. Sigh.
Thanks, mair.
Laurie
Posted by All Done on April 8, 2005, at 15:49:34
In reply to Re: We had a fight, posted by Miss Honeychurch on April 7, 2005, at 8:43:36
> Laurie,
>
> That nervous laugh would drive me nuts. I used to do that and it was a BIG pet peeve of my T. I was cured of it within a couple of months, he would have none of it!
>
> I don't think people realize how fake it sounds.Miss Honey,
Typically, I actually think his nervous laugh is kind of cute. It was just happening too much the other day. I want to ask him what he's so nervous about. In fact, I may do that. It's probably not a good idea for us not to at least address the stuff he brings into the room if he's going to let it out (intentionally or not).
I have a nervous laugh, though, too. How did you stop yours?
Laurie
Posted by fallsfall on April 8, 2005, at 18:19:29
In reply to Re: We had a fight » fallsfall, posted by All Done on April 8, 2005, at 15:39:21
> He's reminding me a lot of my mom and that is enough therapy fodder for a lifetime. :(
*** Gee, my therapist is like my father....
> **How could anyone's requirements not include knowing what's the correct way, though? I mean, I understand if there are two correct ways of doing something, we may choose different ways, but to me, this is like 2 + 2. It only equals 4 (and you, falls, can't tell me it doesn't ;)). Do I have to learn to accept that he thinks it's 5 only because he won't look in the d*mn book for the answer?
*** Ah, but if the question is what is 1/2 + 1/2, the answer could be either 2/2 or 1. Both are correct, but depending on your viewpoint, either could also be incorrect.
*** So, your question for him is whether his "5" is really another name for your "4", or if they are materially different. If, for instance, his world says to round the number down to the next lowest even number, then his "5" *IS* your "4".
*** Of course, it is also possible that he thinks the answer is 5 and he is *wrong*. What you are asking is for him to check his answer, and if he still thinks it is right for him to explain to you why it is right.
*** My (belabored) point is that things aren't quite as simple as they seem.
>
> Thanks, falls. I know there's all kinds of interesting stuff inside me that's coming out because of this. I just wish we could get the details ironed out and then we can discuss how it made me feel to our little hearts content.
>
> Take care,
> Laurie*** Unfortunately, I think you have to talk about how it makes you feel *before* the details are worked out. The immediacy of the issue seems to make the emotions clearer.
(((((Laurie)))))
Posted by Dinah on April 8, 2005, at 21:01:47
In reply to We had a fight, posted by All Done on April 7, 2005, at 2:13:56
My therapist does a lot of insurance work and is familiar enough with the rules that he didn't think of trying to charge me the difference. He said in a plaintive tone "You do realize that I only get $70 from the insurance company, and they won't let me bill you for the difference." But then followed with "Oh well, that's the way it is." But I felt hurt (and told him so) because he's willing to see other people for $70 instead of $110. Am I so much more difficult that I'm not?
He of course said that he was perfectly willing to see me for $70, but then started some oblique blackmail (or at least discouraging) by telling me he would put down the diagnosis that I wouldn't particularly like as opposed to a half dozen other that would be just as technically truthful, but less embarassing. We passed that hurdle eventually too, after a big fight.
Fortunately, I was mistaken in thinking he was on my provider list. Because my treatment plan would definitely bring up things I'd rather not have brought up.
Money is so much more than mere money.
And I'm still a bit resentful that he charges me $40 more than he charges his insurance clients.
Posted by Miss Honeychurch on April 11, 2005, at 13:32:20
In reply to Re: We had a fight » Miss Honeychurch, posted by All Done on April 8, 2005, at 15:49:34
I stopped mine because my T would point it out EVERY time I did it, which was A LOT. By him pointing it out, I realized how much I did it. He also didn't call it "nervous" laughter. He would ask me why I was laughing when I didn't want to and look o so very concerned.
So I guess I wanted to please him. It worked though, I don't do it anymore.
Posted by All Done on April 12, 2005, at 15:41:09
In reply to Re: We had a fight » All Done, posted by fallsfall on April 8, 2005, at 18:19:29
*** Ah, but if the question is what is 1/2 + 1/2, the answer could be either 2/2 or 1. Both are correct, but depending on your viewpoint, either could also be incorrect.
*** So, your question for him is whether his "5" is really another name for your "4", or if they are materially different. If, for instance, his world says to round the number down to the next lowest even number, then his "5" *IS* your "4".
*** Of course, it is also possible that he thinks the answer is 5 and he is *wrong*. What you are asking is for him to check his answer, and if he still thinks it is right for him to explain to you why it is right.
*** My (belabored) point is that things aren't quite as simple as they seem.
Darn you, falls. I should have known better than to give you a math example ;). (And *you* are hardly the one belaboring this issue.)
Seriously, though, you gave me a lot of food for thought these past few days. I'm trying to understand why it makes me so angry that he isn't following the letter of the law (at least the way I've interpreted it). Why does it bother me so much that we are looking at the same issue and coming up with two different views or answers? Interestingly enough, though, I spend most of the time at my job researching state laws that are full of gray areas. I know that it is possible - even probable - for two people to read one section and come up with several interpretations. Then again, I spend the rest of the time at my job trying to convince others that my interpretation is the "correct" one.
*** Unfortunately, I think you have to talk about how it makes you feel *before* the details are worked out. The immediacy of the issue seems to make the emotions clearer.I can tell that's the truth. All of this stuff has been eating away at me for a week. Not necessarily the dollars and cents (I've realized with my flex spending account and taxes calculated, I'm arguing over about $13/week), but why I'm so angry at him...or my mom or whoever. I'm also feeling kind of sad that I don't think I'm important enough to him to try and get this straightened out. The only reason he's looking at the issue (if he is) is because I'm causing such a fuss. And even then, I still feel like he's saying it's his way or the highway.
Well, I see him tomorrow night. Wish me luck.
And thanks for your thoughtful response. You've been really helpful and I appreciate that.
Laurie
P.S. If his world says you round down, I'm not sure which planet he's living on. He's certainly not in my world of taxes, but then again, I think I already know that ;).
Posted by All Done on April 12, 2005, at 15:51:55
In reply to Re: We had a fight » All Done, posted by Dinah on April 8, 2005, at 21:01:47
> My therapist does a lot of insurance work and is familiar enough with the rules that he didn't think of trying to charge me the difference. He said in a plaintive tone "You do realize that I only get $70 from the insurance company, and they won't let me bill you for the difference." But then followed with "Oh well, that's the way it is." But I felt hurt (and told him so) because he's willing to see other people for $70 instead of $110. Am I so much more difficult that I'm not?
>
> He of course said that he was perfectly willing to see me for $70, but then started some oblique blackmail (or at least discouraging) by telling me he would put down the diagnosis that I wouldn't particularly like as opposed to a half dozen other that would be just as technically truthful, but less embarassing. We passed that hurdle eventually too, after a big fight.
>
> Fortunately, I was mistaken in thinking he was on my provider list. Because my treatment plan would definitely bring up things I'd rather not have brought up.
>
> Money is so much more than mere money.
>
> And I'm still a bit resentful that he charges me $40 more than he charges his insurance clients.I hear what you're saying, Dinah. I'm so worried that he is going to continue charging his full fee and it's always going to be on my mind. It's so hard not to take this stuff personally even though it is "just" a matter of business.
You know how airlines charge different amounts for seats on the same flight? Well, if I was arguing with them that they shouldn't be charging me the higher rate than the guy standing next to me, no one would think I was arguing because of my own "issues". They would think I was arguing over the dollars. And perhaps, rightfully so. I hate that this has gotten so intertwined with my therapy. But I digress.
I'm sorry you have to pay more than your T's other clients. Hardly seems fair. I understand how it must make you feel.
(((Dinah)))
Laurie
Posted by All Done on April 12, 2005, at 15:58:52
In reply to Re: We had a fight » All Done, posted by Miss Honeychurch on April 11, 2005, at 13:32:20
> I stopped mine because my T would point it out EVERY time I did it, which was A LOT. By him pointing it out, I realized how much I did it. He also didn't call it "nervous" laughter. He would ask me why I was laughing when I didn't want to and look o so very concerned.
>
> So I guess I wanted to please him. It worked though, I don't do it anymore.Miss Honey,
I think that would make me even more nervous to have my T pointing something out to me. On the rare occassions mine has mentioned one of my nervous habits, he follows it up with a comment about it being okay that I do it.
Just out of curiosity, am I remembering correctly that your T does CBT?
Laurie
Posted by fallsfall on April 12, 2005, at 18:18:18
In reply to Re: We had a fight » fallsfall, posted by All Done on April 12, 2005, at 15:41:09
Posted by mair on April 12, 2005, at 22:07:31
In reply to Re: We had a fight » fallsfall, posted by All Done on April 12, 2005, at 15:41:09
Laurie - I understand entirely that it's not about the money. It wasn't for me and the fact that I couldn't let go of it made me almost feel self-destructive. Like here I had found a T that I liked, and I was probably going to lose her because I got a little obsessed over the fact that I thought she was billing me improperly.
My insurance company confirmed for me that she wasn't supposed to bill me more than the co-pay on the approved amount and once my T got around to calling the insurance company, she was told the same thing. I think she was just naive. Ultimately, I agreed to pay her something in between. I guess it wasn't any more correct for her to charge me what I agreed to pay than it was for her to charge me the full difference between the approved amount and her regular hourly rate. But it did feel better to have faced the issue and reached a compromise and I appreciated the way she was willing to confront the issue with a really new patient, although again, I wasn't real impressed with her lack of understanding of how her own insurance contract worked.
These guys sign these contracts I guess because they want to be part of a network of approved providers. It does come at a cost which they are not allowed (at least by most contracts) to pass along to their patients. I think lots of T drop those contracts once they feel they no longer need the insurance referrals - that's certainly what my T did.
Let us know how it goes.
mair
Posted by Dinah on April 12, 2005, at 22:13:04
In reply to Re: We had a fight » Dinah, posted by All Done on April 12, 2005, at 15:51:55
Posted by gardenergirl on April 13, 2005, at 0:02:46
In reply to I'll be thinking of you tomorrow night. (nm) » All Done, posted by Dinah on April 12, 2005, at 22:13:04
Posted by All Done on April 13, 2005, at 0:32:54
In reply to Good luck tomorrow! (nm) » All Done, posted by fallsfall on April 12, 2005, at 18:18:18
Posted by All Done on April 13, 2005, at 0:50:18
In reply to Re: We had a fight » All Done, posted by mair on April 12, 2005, at 22:07:31
> Laurie - I understand entirely that it's not about the money. It wasn't for me and the fact that I couldn't let go of it made me almost feel self-destructive. Like here I had found a T that I liked, and I was probably going to lose her because I got a little obsessed over the fact that I thought she was billing me improperly.
I know what you mean. I'm pretty positive that my obsession with this matter is going to push him to drop his contract with the insurance company.
> My insurance company confirmed for me that she wasn't supposed to bill me more than the co-pay on the approved amount and once my T got around to calling the insurance company, she was told the same thing. I think she was just naive. Ultimately, I agreed to pay her something in between. I guess it wasn't any more correct for her to charge me what I agreed to pay than it was for her to charge me the full difference between the approved amount and her regular hourly rate. But it did feel better to have faced the issue and reached a compromise and I appreciated the way she was willing to confront the issue with a really new patient, although again, I wasn't real impressed with her lack of understanding of how her own insurance contract worked.
>
> These guys sign these contracts I guess because they want to be part of a network of approved providers. It does come at a cost which they are not allowed (at least by most contracts) to pass along to their patients. I think lots of T drop those contracts once they feel they no longer need the insurance referrals - that's certainly what my T did.
>
> Let us know how it goes.
>
> mairI'm trying as hard as I can to be ready for the fact that we may have to work on a compromise as opposed to just him changing his fee. It would be better than nothing and I think I could handle it since at least he would be accepting some of the responsibility. Right now, though, he's not, and that makes me pretty upset.
If we do work out a compromise, I'm going to have to tell him that it feels to me like I have to take care of him because he made a mistake and that's one of the gazillion issues I have with my mom.
Thanks, mair. I will definitely let you all know how it goes.
Laurie
Posted by Miss Honeychurch on April 13, 2005, at 10:00:02
In reply to Re: We had a fight » Miss Honeychurch, posted by All Done on April 12, 2005, at 15:58:52
Yes, he does CBT.
And I was mortified every time he pointed it out. Not only did I have nervous laughter, but I would smile all the time, no matter what I was talking about. I was pretty fake.
This is the end of the thread.
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