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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Solstice on April 12, 2011, at 18:19:50
Hi Everybody -
I know I've been absent for a while - I went through a difficult time and had to re-group.
But something came up this week that has me appalled. My son has been seeing a therapist for about six months. The therapist is one of several in a clinic that is owned by a psychiatrist. The therapist seems to be good - and my son has finally developed a good enough relationship with him. I've not personally spoke to the T because my son just reached legal age and I really wanted this to be his own thing.
Anyway - I've been troubled by my son having these random appointments. Never the same day of the week, and never at the same time - and some weeks he tells me they didn't have a spot for him. I've asked him to tell them he wants a standing appointment, but I've thought he just didn't know how to ask for it because he's so young and isn't one to speak up for himself.
A few weeks ago I had to take him to his appointment because his car was in the shop. While he was in his apt, I asked the front desk people about a standing appointment. They told me that they could not schedule more than four apts ahead. ??? So when they looked at the calendar, it was going to be two weeks before he could have another apt! And then for the next four apts, they were these random times... and none of them were times that worked with his school schedule. I asked if I could talk to the therapist about it. He didn't call, because first my son needed to fill out a release.
My son finally had an apt this past Friday. He came home and said that he has an apt. for this coming Friday, but they wanted him to pay for it in advance, and it would be cancelled if he didn't pay for it. I was shocked! So I called and talked to the office manager, and she said that they have a 'new policy' - where they will only schedule four apts at a time, and all four appointments have to be paid for ahead of time! I was just floored! I told them I had never heard of having to pay for medical services not yet rendered. The whole thing just seems so profoundly counter-therapeutic, especially the random therapy appointment times. Making a client pay for appointments that are scheduled in the future just seems wrong. (They take insurance, so it's the $25 copay they are charging him for ahead of time.)
Does anybody know whether it's ethical to do such a thing?
Solstice
Posted by TherapyGirl on April 12, 2011, at 19:27:13
In reply to Paying for services not yet rendered?, posted by Solstice on April 12, 2011, at 18:19:50
Sounds very, very wrong to me.
Posted by Solstice on April 12, 2011, at 22:04:53
In reply to Re: Paying for services not yet rendered? » Solstice, posted by TherapyGirl on April 12, 2011, at 19:27:13
> Sounds very, very wrong to me.
*whew* Thanks TherapyGirl, I'm glad it's not just me. Has anyone else ever heard of such a thing? Being charged by a medical doctor for services not yet rendered by a therapist in the office? You can't have a standing appointment - you can only get arbitrary apts - and you have to pay to hold them! The whole thing just sucks the wind out of me.
Solstice
Posted by Daisym on April 12, 2011, at 22:44:28
In reply to Re: Paying for services not yet rendered?, posted by Solstice on April 12, 2011, at 22:04:53
I'm fairly sure the insurance companies would frown on this practice. You cannot bill for clients not seen so how can you ask for the copay?
I'd ask for the policy in writing with the rational and then decide what to do next. If this clinic is managed by a group, there should be a Board of Directors to go talk to.
Posted by sigismund on April 13, 2011, at 16:25:35
In reply to Re: Paying for services not yet rendered?, posted by Solstice on April 12, 2011, at 22:04:53
It is outrageous and inconsiderate.
Perhaps they should be congratulated on being so in tune with the shamelessness of the zeitgeist.
Posted by mtdewcmu on April 13, 2011, at 20:37:28
In reply to Re: Paying for services not yet rendered?, posted by sigismund on April 13, 2011, at 16:25:35
I used to go to this clinic for psychiatry, and I swear the people running it were the crazy ones. For my first few appointments, I showed up on time and I had to wait hours to see the doctor! The first time I waited 2 hours and left, and the next time I waited it out and finally got in. On these days, the waiting room was always full of people waiting around for hours (it served mostly low-income people, so they didn't complain much). Sometimes I would come for my appointment and they would just say, sorry, the doctor didn't show up today. The receptionists did not act professional, either. And then they liked to prescribe brand-name meds, even though I had no insurance and stated that I preferred a generic. Each month the nurse would go searching for enough free samples to fill my prescription. Sometimes there weren't enough free samples around, and I would have to sit there while he called around and tried to scare up meds. Sometimes they would call in a prescription at a local pharmacy. But I never knew how long it would take, and sometimes he told me to come back in a few days. I don't know what they had to do to get so many free samples. I always had the feeling that there was something shady going on. Eventually I found out, quite belatedly, that I was being charged a huge amount of money for the visits, and I thought the county was covering it. I was getting all these mysterious bills from the county that weren't clearly itemized and had seemingly random numbers as my balance. After about 6 months I found out that I was no longer eligible for subsidies and all those random numbers were not cumulative, but were for each visit! There is no way I would have knowingly paid huge sums for such a crappy experience. On the same day that I found out that I had been dropped from subsidies 6 months prior I told them I was discontinuing treatment there. And the girl was surprised. I did not know that such a clinic could operate in the United States. I could see it happening in some corrupt country like Afghanistan. I stopped paying the bills from the county because I couldn't, and I have not heard any more about it.
Posted by sigismund on April 14, 2011, at 2:26:29
In reply to Re: Paying for services not yet rendered?, posted by mtdewcmu on April 13, 2011, at 20:37:28
When I was young I was keen on therapy because I did not know how to live without hope.
I simply couldn't be bothered now.
I don't feel despairing and I have no hope at all. Time is great when you can bear it....everything passes, including me before too long.
I certainly am not going to be treated badly so I can pay people who pretend to have something to offer me so I can pretend to profit from it.
It would not even be worth it if I could pretend to pay them.I was reading "Life" where the Keith Richards says 'I have the gift of not being bothered'.
Posted by violette on April 14, 2011, at 20:01:59
In reply to Re: Paying for services not yet rendered?, posted by Solstice on April 12, 2011, at 22:04:53
"Has anyone else ever heard of such a thing?"
I've heard of similar things, and experienced them. It's called lousy mental health care. The place your son goes to sounds like a mill. Sorry to say, but if he were my son, I'd take him outta there. It may not be the individual therapist's fault and the individual therapist might even disagree with management, but that individual therapist is also likely supervised by those managing the practice. Or at least they have to go along with the priorities and policies of management. And one might even say that the individual therapists might be agreeing with those policies by merely working there.
The worst mental health practioners I've seen in the past had the worse administrative policies. But the best I've seen had reasonable policies. Making mistakes were not relevant-it's the upfront policies. It really reflects on their ethics, their (lack of) value in the relationship, and their priorities.
If I sound harsh, it's probably because I learned the hard way.
Posted by Solstice on April 15, 2011, at 20:12:58
In reply to Re: Paying for services not yet rendered?, posted by violette on April 14, 2011, at 20:01:59
> "Has anyone else ever heard of such a thing?"
>
> I've heard of similar things, and experienced them. It's called lousy mental health care. The place your son goes to sounds like a mill. Sorry to say, but if he were my son, I'd take him outta there. It may not be the individual therapist's fault and the individual therapist might even disagree with management, but that individual therapist is also likely supervised by those managing the practice. Or at least they have to go along with the priorities and policies of management. And one might even say that the individual therapists might be agreeing with those policies by merely working there.
>
> The worst mental health practioners I've seen in the past had the worse administrative policies. But the best I've seen had reasonable policies. Making mistakes were not relevant-it's the upfront policies. It really reflects on their ethics, their (lack of) value in the relationship, and their priorities.
>
> If I sound harsh, it's probably because I learned the hard way.
Hi Violette -Thanks for your comments. I have really been turned inside-out over this. I feel so trapped because it took a looong time to get my son to get the therapy he needs - and he finally - just recently - connected to this therapist. It's not his therapist making the policy. A psychiatrist owns the clinic - and it's private. There are several therapists. My son had an apt. scheduled for Friday - and when they sprang this 'new' policy on him last week, they told him that they would cancel it if he didn't schedule and pay for the next four apts. I called to verify that what he told me was true - and the girl said she was going to talk to his therapist - they wanted to work with Joseph (financially?) and they'd call him Monday. They never did. I called Tuesday, and they refused to talk to me. I got him to call on Wednesday, and they told him his apt had been cancelled because he didn't pay! This threw me into a tailspin. I was so angry - and crying. I honestly don't know what to do. I told them that it was wrong for them to spring this on patients in the middle of therapy - with no warning. They should have given them a three-month notice or something so patients had time to decide wither they wanted to deal with it - or transition to another therapist. It was like someone ripped a vital organ out to suddenly have to deal with this awful situation, and to feel trapped because my son has so much going on that trying to find another therapist so suddenly makes it so much worse. It's like being so thirsty that you have no choice but to drink poison.
I am just horrified that a mental health clinic can do something like this and get away with it. When I've called, and listened to their stupid self-promotion while on hold: "People with mental health problems that seek help are intelligent, not weak.. we care... we want to help you.. " - hot tears run down my face as I listen to that crap - it gives me a headache and makes me sick.
I made a special trip over there on Wednesday to make the next four random apts and pay for them so my son could maintain access to his therapist - - but this whole situation is traumatizing for me. May go back to the trauma of my own toxic therapeutic relationship.
Solstice
Posted by Solstice on April 15, 2011, at 20:53:24
In reply to Re: Paying for services not yet rendered?, posted by sigismund on April 13, 2011, at 16:25:35
> It is outrageous and inconsiderate.
>
> Perhaps they should be congratulated on being so in tune with the shamelessness of the zeitgeist.Sigi - You are so funny! Thanks for making me smile :-)
Solstice
Posted by Solstice on April 15, 2011, at 21:00:35
In reply to Re: Paying for services not yet rendered?, posted by Daisym on April 12, 2011, at 22:44:28
> I'm fairly sure the insurance companies would frown on this practice. You cannot bill for clients not seen so how can you ask for the copay?
>
> I'd ask for the policy in writing with the rational and then decide what to do next. If this clinic is managed by a group, there should be a Board of Directors to go talk to.I called the insurance company, and they told me that a provider cannot bill the insurance company for services not yet provided, but they can't interfere with the policies a particular provider sets for his practice.
I followed your suggestion (which I thought was great) and asked for their written policy - including how they will handle money they have collected for future appointments that don't take place due to illness, or the therapist cancelling, etc. They responded "It's hanging on the wall - you can have a copy of it if you come to pick it up." I felt so insulted! They refused to put a copy of it in the mail!
I'm going to talk to my son about it and see if we can't meet together with his therapist. I need to hear his therapist tell me that he thinks these crazy, random, unpredictable apts are therapeutically appropriate for my son, and I need to hear an explanation about his agreement with the office policy requiring his clients to pay for four appointments in advance.
Solstice
Posted by jane d on April 15, 2011, at 21:39:07
In reply to Re: Paying for services not yet rendered? » violette, posted by Solstice on April 15, 2011, at 20:12:58
I'm not sure it's a matter of ethics. The prepayment requirement sounds like they are trying to deal with the problem of a lot of no shows and cancellations that they believe are caused by people not having an economic incentive to show up.
I do sympathize with that concern. Otherwise either the therapist eats the cost of every cancellation if they are paid per client session (many are) and pretty soon they can't buy their groceries or, if they are salaried, the practice ends up raising everyones fees to cover it.
If they are "in network" your insurance company's contract with them probably determines whether they can charge a fee like this. I'd check with them. (And complain to them.)
That said I'd personally really resent paying in advance and would probably look for someone else.
It's never been important to me to have a fixed date and time. In fact I've sometimes suspected that the whole idea of having a specific time blocked out and treated as sacred was created for therapists' convenience and profit more than clients'. But if it's something that matters to your son he should try to work something out with his therapist. If he can't then he may be able to get the same results by making sure that each week he's scheduling the appointment for a month from now. Or, of course, go elsewhere if he can.
I hate to say it but I suspect that if this isn't already widespread it will be soon.
Posted by jane d on April 15, 2011, at 21:56:44
In reply to Re: Paying for services not yet rendered? » Daisym, posted by Solstice on April 15, 2011, at 21:00:35
> I called the insurance company, and they told me that a provider cannot bill the insurance company for services not yet provided, but they can't interfere with the policies a particular provider sets for his practice.They most certain can. They do it all the time! How nice that they have chosen not to do so this time.
>
> I followed your suggestion (which I thought was great) and asked for their written policy - including how they will handle money they have collected for future appointments that don't take place due to illness, or the therapist cancelling, etc. They responded "It's hanging on the wall - you can have a copy of it if you come to pick it up." I felt so insulted! They refused to put a copy of it in the mail!Rude. Amazingly rude.
>
> I'm going to talk to my son about it and see if we can't meet together with his therapist. I need to hear his therapist tell me that he thinks these crazy, random, unpredictable apts are therapeutically appropriate for my son, and I need to hear an explanation about his agreement with the office policy requiring his clients to pay for four appointments in advance.
>Even if doing so might permanently change your son's relationship with his therapist? What does your son need to hear? How does he feel about all of this?
I can only begin to imagine how you must feel watching your son have to deal with this. And how hard it must be to figure out when to give him the advantage of your experience and when to let him get his own. But I do know how incompetent I would have felt if my mother had involved herself in a situation like this when I was just barely an adult.
Posted by Solstice on April 16, 2011, at 8:20:54
In reply to Re: Paying for services not yet rendered?, posted by jane d on April 15, 2011, at 21:39:07
> I'm not sure it's a matter of ethics. The prepayment requirement sounds like they are trying to deal with the problem of a lot of no shows and cancellations that they believe are caused by people not having an economic incentive to show up.
That's what they told me.. (although they acknowledged there had been no such problem with my son).
My response was:
1) a punitive policy like that should only be imposed on those they have trouble with; and
2) their policy of not giving standard apts, and only allowing you to have four on the books, might be part of the problem. Haphazard apts prevent clients from being able to create their schedule around a fixed apt (like school schedules). I think the client population they are working with is being set up for failure-to-show because the apts are so haphazard - never the same... which makes it easier to forget.
> I do sympathize with that concern. Otherwise either the therapist eats the cost of every cancellation if they are paid per client session (many are) and pretty soon they can't buy their groceries or, if they are salaried, the practice ends up raising everyones fees to cover it.I sympathize with the concern as well - but I think there are MUCH more equitable ways to prevent themselves from taking massive hits. They can have a policy of "if you don't pay for your missed apt., then you can't schedule another apt. until you do" - - or some other thing - - but I think that particularly for anxious depressives like my son, haphazard - the anxiety of trying to keep track of inconsistent apts - the problems with the therapist sometimes being booked for two or more weeks out, where you have no choice but to wait - you can't get to your therapist on a regular basis - and you never know if you'll be able to get to him when you need him - - - I just think all of that is terribly counter-therapeutic and it just seems wrong to do it to someone who has not missed apts.
> If they are "in network" your insurance company's contract with them probably determines whether they can charge a fee like this. I'd check with them. (And complain to them.)
They are 'in network' - but although their contract prohibits them from charging anything other than the copay, the contract doesn't address other policy issues. Most providers are in many insurance networks - so it would no doubt be a nightmare if insurance companies had the power to set office policies like that.
> That said I'd personally really resent paying in advance and would probably look for someone else.I wish I'd known before he started seeing this therapist that they were going to spring this on us. There was no warning. No "here's a policy that will come into effect in three months." It was just - you go in for an apt, and when you leave, they tell you that you have to pay for the next four apts or they will cancel.
> It's never been important to me to have a fixed date and time. In fact I've sometimes suspected that the whole idea of having a specific time blocked out and treated as sacred was created for therapists' convenience and profit more than clients'.I think you might be the exception... I think most clients in therapy need the stability. I know when my world was in turmoil - there was something genuinely calming about knowing that there was this spot in the week - every single week - where I could escape the chaos around me and 'be' in a place that was stable. I knew what it would look like - I knew what it would be like - I knew the rituals. And it belonged to me. And it was 'for' me. I'm not kidding - the consistency was crucial... to my healing from trauma.
> But if it's something that matters to your son he should try to work something out with his therapist. If he can't then he may be able to get the same results by making sure that each week he's scheduling the appointment for a month from now. Or, of course, go elsewhere if he can.Problem with the scheduling is that everybody is having to do this - so there is no way to get four weeks of apts that are same day & time each week.
> I hate to say it but I suspect that if this isn't already widespread it will be soon.I hope the APA comes up with some guidance - so that therapists can be paid for their work consistently - without doing damage to crucial elements of therapy - like having a consistent day/time.
Solstice
Posted by Solstice on April 16, 2011, at 9:58:27
In reply to Re: Paying for services not yet rendered?, posted by jane d on April 15, 2011, at 21:56:44
> >
> > I followed your suggestion (which I thought was great) and asked for their written policy - including how they will handle money they have collected for future appointments that don't take place due to illness, or the therapist cancelling, etc. They responded "It's hanging on the wall - you can have a copy of it if you come to pick it up." I felt so insulted! They refused to put a copy of it in the mail!
>
> Rude. Amazingly rude.Yeah.. it really set off my anxiety and trust issues.
> > I'm going to talk to my son about it and see if we can't meet together with his therapist. I need to hear his therapist tell me that he thinks these crazy, random, unpredictable apts are therapeutically appropriate for my son, and I need to hear an explanation about his agreement with the office policy requiring his clients to pay for four appointments in advance.
> >
>
> Even if doing so might permanently change your son's relationship with his therapist? What does your son need to hear? How does he feel about all of this?It surprises (and kinda hurts) me - I mean it sounds like - without my saying anything to imply it and without your asking any questions - you've jumped to the conclusion that I am a bull in a china closet mother who is ready to barge in without any regard for my son. The only reason this thing bothers me in the first place is Because I am sensitive to my son's needs. He's a quiet, contemplative type - nonconfrontational - and is in a 'system' that I fear feels powerful to him... like he has no choice and well.... I need to remember that I don't need to explain myself to you..
> I can only begin to imagine how you must feel watching your son have to deal with this. And how hard it must be to figure out when to give him the advantage of your experience and when to let him get his own. But I do know how incompetent I would have felt if my mother had involved herself in a situation like this when I was just barely an adult.gee... it feels like I've been judged as a bull-in-a-china-closet mother - and I'm supposed to feel shame about being so insensitive (as if I am.) There's something about your approach here that is really hurtful. And I'm already hurting. I think part of my internal struggle over this issue is that I am Not inclined to involve myself. He is in school, lives at home, does not have a job (he's tried, but the economy sucks), so he is not self-supporting, and he is not self-protective. I hate for therapy to be the place where he has to learn to look out for himself... hence my pain. If anything, I feel bad about having been so hands-off... like I left him stranded to figure this thing out on his own - and because he's so young - he's unaware of the unusual nature of what's going on - and its potential to be counter-therapeutic for him. I've never spoken to his therapist. He has asked me to come with him at times, but he has never been able to get an apt time that I can make it.
I appreciate support at this time, and assuming the best about my intentions regarding my son would be much more helpful to me that challenging me 'as if' I am an overbearing, insensitive mother.
Solstice
Posted by jane d on April 16, 2011, at 12:22:03
In reply to Re: Paying for services not yet rendered?, posted by Solstice on April 16, 2011, at 9:58:27
>They are 'in network' - but although their contract prohibits them from charging anything other than the copay, the contract doesn't address other policy issues. Most providers are in many insurance networks - so it would no doubt be a nightmare if insurance companies had the power to set office policies like that.
True. But this does sound like a veiled way to charge (and possibly keep) copays even without the service.
>Problem with the scheduling is that everybody is having to do this - so there is no way to get four weeks of apts that are same day & time each week.
Still, everyone may not actually be booking the full 30 days ahead. Many people aren't that organized.
>I hope the APA comes up with some guidance - so that therapists can be paid for their work consistently - without doing damage to crucial elements of therapy - like having a consistent day/time.
I think it comes down to economics. Full cost non preferred provider therapists do seem to do this more often. Of course they don't have to worry about accomodating policies that pay for different frequencies of visits. Or authorization that doesn't come thru.
> It surprises (and kinda hurts) me - I mean it sounds like - without my saying anything to imply it and without your asking any questions - you've jumped to the conclusion that I am a bull in a china closet mother who is ready to barge in without any regard for my son. The only reason this thing bothers me in the first place is Because I am sensitive to my son's needs. He's a quiet, contemplative type - nonconfrontational - and is in a 'system' that I fear feels powerful to him... like he has no choice and well.... I need to remember that I don't need to explain myself to you..Nope. You don't.
>
> > I can only begin to imagine how you must feel watching your son have to deal with this. And how hard it must be to figure out when to give him the advantage of your experience and when to let him get his own. But I do know how incompetent I would have felt if my mother had involved herself in a situation like this when I was just barely an adult.
>
> gee... it feels like I've been judged as a bull-in-a-china-closet mother - and I'm supposed to feel shame about being so insensitive (as if I am.) There's something about your approach here that is really hurtful. And I'm already hurting. I think part of my internal struggle over this issue is that I am Not inclined to involve myself. He is in school, lives at home, does not have a job (he's tried, but the economy sucks), so he is not self-supporting, and he is not self-protective. I hate for therapy to be the place where he has to learn to look out for himself... hence my pain. If anything, I feel bad about having been so hands-off... like I left him stranded to figure this thing out on his own - and because he's so young - he's unaware of the unusual nature of what's going on - and its potential to be counter-therapeutic for him. I've never spoken to his therapist. He has asked me to come with him at times, but he has never been able to get an apt time that I can make it.
>
> I appreciate support at this time, and assuming the best about my intentions regarding my son would be much more helpful to me that challenging me 'as if' I am an overbearing, insensitive mother.
>Actually I think I was assuming the best. I was trying to throw out a bit of my experience for whatever it was worth. I assumed that you would consider it and then accept it or reject it based on your circumstances and your judgment of what you thought was best for your son. Of course. I'm sorry you took it differently.
This is the end of the thread.
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