Psycho-Babble Psychology Thread 455868

Shown: posts 1 to 15 of 15. This is the beginning of the thread.

 

T's billing policies--moral?

Posted by smokeymadison on February 10, 2005, at 12:38:46

i am sick of waiting for the local crisis center to call me back--i know that i am on a waiting list, so i am going to see a private T. She charges $120 up front--then i have to file it w/ my insurance company to get 80% back. is this morally right? i can barely afford rent, let alone this. i am on six medications--each costing at least $40 a month. i am trying to get help w/ the meds, but i am so p*ssed at this T for insisting that i pay everything up front. she will have nothing to do with my insurance company; i have to file everything myself and wait a month and a half to get the 80% back.

how do your Ts handle the billing? Is this typical? Do i have a reason to be upset? she is a very good therapist, that is why i am going ot do this, but is it ethical to put that kind of financial pressure on somebody who is mentally ill and hasn't been able to work since Oct? comments, please!

SM

 

Re: T's billing policies--moral? smokeymadison

Posted by Dinah on February 10, 2005, at 12:50:39

In reply to T's billing policies--moral?, posted by smokeymadison on February 10, 2005, at 12:38:46

It's not un-typical. It would appear that many of the better pdocs and therapists have enough demand for their services that they aren't forced to deal with the insurance companies directly. My pdoc gives me a form that I can send to my insurance company but refuses to deal directly with them.

It feels different with therapy because therapy feels like a more personal relationship. But it really isn't in that respect. Some therapists make the decision that they want to spend their time in therapy, and not spend the time themselves or hire someone to spend the time, to do the incredible hassle of insurance billing. And they set a value on an hour of time, not unlike people set a value on any other commodity they offer. A car or a loaf of bread.

Most therapists do sliding scale work if they can, but I suppose not all do. Or maybe she already has several current clients who are paying a lower rate and can't afford to take on any more.

How many weeks lag time do you think it will be until you are reimbursed? 80% is pretty darn good. If you go once a week to therapy and there's a three week turnaround on reimbursement, for example, you'll be out that 120*3 for the duration of time you're in therapy. I'm aware that's a pretty big dent in the wallet.

Do you think your feelings about this will interfere with your therapy?

 

Re: T's billing policies--moral? Dinah

Posted by smokeymadison on February 10, 2005, at 13:13:34

In reply to Re: T's billing policies--moral? smokeymadison, posted by Dinah on February 10, 2005, at 12:50:39

the way you explained it, i feel a little better. she is a good therapist and she comes highly recommended. i am afraid that, yes, this will impact how therapy goes with her for a while. i can't help it, really. in the past i have had Ts who worked with me so that i could afford it. they always got the full amount when the insurance paid up. and i thought highly of them for their willingness to help me out. i suppose that i have to talk about this with her, don't i?

SM

 

Re: T's billing policies--moral? smokeymadison

Posted by Dinah on February 10, 2005, at 13:23:56

In reply to Re: T's billing policies--moral? Dinah, posted by smokeymadison on February 10, 2005, at 13:13:34

Yeah, I suppose you do. Otherwise it might get in the way of your work.

Her answer might be no, she can't change. But at least you'll be able to get a better feel for her "no".

 

Re: T's billing policies--moral?

Posted by Tabitha on February 10, 2005, at 13:33:53

In reply to T's billing policies--moral?, posted by smokeymadison on February 10, 2005, at 12:38:46

I see a private practice T and pdoc, and what I've found is that if they are an official provider for an insurance plan, they do the billing themselves. If they're not a provider, they give me a receipt and I have to bill insurance after paying them up-front. Both my T and pdoc dropped out of insurance plans b/c the amount of paperwork and hassle for them was too great. They had to keep writing reports justifying the treatment and documenting progress. The only motivation for a T to be an insurance provider is to get more business. Once their practice is going, there's no motivation for them to put up with the extra hassle of doing the insurance billing.

 

Re: T's billing policies--moral?

Posted by mair on February 10, 2005, at 13:40:07

In reply to Re: T's billing policies--moral? smokeymadison, posted by Dinah on February 10, 2005, at 13:23:56

When you say you have to pay her up front, do you mean prior to a session or prior to reimbursement?

My T used to be a preferred provider with my insurer and she never billed me until after she had submitted the claim. She stopped doing that because the insurer was so dilatory about paying claims and she didn't have many clients who used that insurer. So now she bills me and it's up to me to submit the claim for reimbursement. (Fortunately my insurer will reimburse me for sessions with a T who is not on its list). It's a litte more expensive because my copay is more since she's not on the list, but not that much more expensive.

I ordinarily operate on the assumption that all bills are due within 30 days of the date I get them. If I'm on top of things and submit my claim right away, I can get reimbursed before I have to pay my T. Ordinarily I don't wait that long, maybe because I'm not always great about getting the claim in as quickly as I should. The "float" is doable for me. There was a time a couple of years ago when my insurer really screwed up my claims and I didn't didn't get paid for about 5 months worth of claims. That was a financial nightmare until it was sorted out.

Mair

 

Re: T's billing policies--moral?

Posted by smokeymadison on February 10, 2005, at 14:23:04

In reply to Re: T's billing policies--moral?, posted by mair on February 10, 2005, at 13:40:07

It takes about a month and a half to get reimbursed by my insurance company. i just found out that they cover 70% for out of network providers, not 80%, but that isn't a big difference, i guess. so i have to pay the therapist $120 when i see her, upfront, and then wait a month and a half to get 70% back. this sucks!

SM

 

Re: T's billing policies--moral?

Posted by mair on February 10, 2005, at 15:44:05

In reply to Re: T's billing policies--moral?, posted by smokeymadison on February 10, 2005, at 14:23:04

Does that mean you have to submit separate claims for each session?

 

Re: T's billing policies--moral?

Posted by Sebastian on February 10, 2005, at 16:33:24

In reply to T's billing policies--moral?, posted by smokeymadison on February 10, 2005, at 12:38:46

I pay nothing up front, except the co-pay, if I want. You might want a different doctor. I have never seen a doctor who would not file with insurance before charging me. Maybe once, but it is unusual.

 

Re: T's billing policies--moral?

Posted by pinkeye on February 10, 2005, at 16:58:05

In reply to Re: T's billing policies--moral?, posted by smokeymadison on February 10, 2005, at 14:23:04

Is it possible to get another T who is in your network and who would handle all this insurance thing herself/himself? Even if the T is good, I would personally prefer not to do any of this insurance thing myself and would rahter settle for a not-so-good-a-T if they would handle all this for me.

> It takes about a month and a half to get r
eimbursed by my insurance company. i just found out that they cover 70% for out of network providers, not 80%, but that isn't a big difference, i guess. so i have to pay the therapist $120 when i see her, upfront, and then wait a month and a half to get 70% back. this sucks!
>
> SM

 

yes--separate claims for each visit (nm) mair

Posted by smokeymadison on February 10, 2005, at 17:14:36

In reply to Re: T's billing policies--moral?, posted by mair on February 10, 2005, at 15:44:05

 

Re: T's billing policies--moral?

Posted by pegasus on February 10, 2005, at 17:21:53

In reply to T's billing policies--moral?, posted by smokeymadison on February 10, 2005, at 12:38:46

In my experience, most Ts around here prefer not to deal directly with insurance. And I personally don't think that they're morally obligated to deal directly with insurance, or that it's morally wrong for them to expect to get paid for the work they do at the time that they do it. I know that those of us struggling with mental illness issues sometimes have a harder time dealing with administrative hassles and financial stress than other folks. But on the other hand, I also think it's darn hard work to be a T, and I don't see why it's fair to expect them to suffer the delay in my insurance's payments so I don't have to. They're delivering their side of the bargain in a timely manner. How I pay for it - if that's through insurance or my own dime - is really my own issue, IMHO.

Although when I write that out, it sounds like I'm saying that I don't think anyone is entitled to free therapy. But actually, I think we're all entitled to good mental health. Wouldn't it be great if there was just a therapy fairy that doled out appropriate therapy to all of us?

On the other hand, I've heard discussions about how it's actually good for the client to have to accept the burden of paying for therapy. Because then they have to make the decision that it's valuable to them. Otherwise, I guess there might be some danger that they wouldn't be very invested in it, or wouldn't recognize the value of it to them.

Which reminds me of a friend who's been through years of psychoanalysis, who said that she owns a mansion . . . inside her. She meant that she's invested so much in therapy and it has had a big effect on her financial status. But it was all worth it, because she has the mansion (=personal mental health and insight) that she really wanted.

pegasus

 

Re: yes--separate claims for each visit smokeymadison

Posted by mair on February 10, 2005, at 18:08:16

In reply to yes--separate claims for each visit (nm) mair, posted by smokeymadison on February 10, 2005, at 17:14:36

I'm not sure what she could do that would make this less of a hit for you. I get billed on a monthly basis, and generally rely on the reimbursement from the last month to help me pay the next month (unless of course I immediately submit the claim and wait to pay her until after I'm paid). But I have savings that can cover this until I get reimbursed, so it works ok for me. I would not like to have to pay separately for each visit, and by now, my T knows I'm good for it so she's not worried about me getting too far behind. I guess it doesn't work out that differently for you. If it takes 5+ weeks to get reimbursed, I assume you're out the equivalent of the cost of 4 or 5 weekly sessions at any given time. Would it work any better if she billed you monthly and you used the reimbursement from the previous month to cover the bill? It might mean less administrative hassle, but I think it still leaves you short by the same amount.

You should talk to her about this. Maybe there is a compromise, like paying part of the bill at the time of service instead of the whole bill.

Mair

 

Re: yes--separate claims for each visit

Posted by Speaker on February 10, 2005, at 19:35:34

In reply to Re: yes--separate claims for each visit smokeymadison, posted by mair on February 10, 2005, at 18:08:16

I have worked in many Dr. offices and ALL expect payment at time of service. Insurance is a benefit we pay for our benefit...not the Dr.s. The Dr.s that do file insurance do it as a service and are not obligated to do it...at least in my state. My T is 150 and I pay at the time of service and it takes my insurance company about three months to pay the claim. It is a pain but I don't see a way around it. Personally I prefer to file my own and I know it gets sent in right away. Good luck...once you get the initial payments taken care of it flows pretty well.

 

billing policies--moral? - Canadian Perspective

Posted by Camille Dumont on February 14, 2005, at 12:02:52

In reply to T's billing policies--moral?, posted by smokeymadison on February 10, 2005, at 12:38:46

Well, for me when I saw a psycholgist (covered 80% by my work insurance) I would give her a cheque after each visit for the full amount ($85 per hour) and she would give me a receip and then I would send those (usually waited till I had a bunch but you can send them as quickly as you want to) to the insurance company who in turn would send me back a cheque to reimburse me.

$120 sounds like a lot though ... especially if this is US$


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