Psycho-Babble Psychology Thread 769420

Shown: posts 1 to 22 of 22. This is the beginning of the thread.

 

Do we get what we pay for?

Posted by andromeda on July 13, 2007, at 18:00:04

Hey,
If you didn't have insurance, would you pay the going rate for your current therapist of psychiatrist? Would you shop around or demand better care?
Thanks

 

I do pay the going rate (nm) andromeda

Posted by Dinah on July 13, 2007, at 18:31:36

In reply to Do we get what we pay for?, posted by andromeda on July 13, 2007, at 18:00:04

 

Re: Do we get what we pay for?

Posted by my-cup-of-tea on July 13, 2007, at 19:08:57

In reply to Do we get what we pay for?, posted by andromeda on July 13, 2007, at 18:00:04

Me too, I pay the going rate athough a little discounted

 

Re: Do we get what we pay for? andromeda

Posted by sunnydays on July 13, 2007, at 19:37:05

In reply to Do we get what we pay for?, posted by andromeda on July 13, 2007, at 18:00:04

I don't have insurance, but I pay what he asks of me, which is the rate the college charges students.

sunnydays

 

Re: I do pay the going rate

Posted by TherapyGirl on July 13, 2007, at 21:05:51

In reply to I do pay the going rate (nm) andromeda, posted by Dinah on July 13, 2007, at 18:31:36

So do I.

 

Re: Do we get what we pay for?

Posted by Maria01 on July 13, 2007, at 21:23:49

In reply to Do we get what we pay for?, posted by andromeda on July 13, 2007, at 18:00:04

I worked with an intern at a sliding scale agency. I got exactly what I paid for. 18 mos. worth of work on my part, and a sudden termination on her part.

 

Re: Do we get what we pay for?

Posted by Racer on July 13, 2007, at 22:45:50

In reply to Do we get what we pay for?, posted by andromeda on July 13, 2007, at 18:00:04

Well, we're on a PPO, so we do get reimbursed for some of my psychiatric care. Not a terribly large percentage, though -- the insurance company pays something like 80% of their scheduled rates, and we pay anything over that. Well, my pdoc is -- not suffering from low self-esteem, as it related to rates. (He's far more expensive than any other I've seen.) My psychoterrorist is pretty much going rate, too.

The insurance drives me nuts -- they pay different amounts each time, pretty much, so we can't really plan on anything. But they do pay for 50 mental health visits per year, which is pretty stellar. On top of that, there's the FSA -- flexible spending account, which uses pre-tax earnings to pay the amounts beyond what insurance pays, which also helps.

But, honestly? At this point, if we lost our insurance, I would certainly still see both of them. I might not eat, but pathetic as this might sound, I think it's pretty clear to everyone concerned that I wouldn't be able to do without them.

If I had to give one up, though, it would be the pdoc. I can function, mostly, on the drugs I currently take. I'm still too fragile to do without my psychoterrorist, though.

 

Re: Do we get what we pay for? andromeda

Posted by OzLand on July 14, 2007, at 1:23:25

In reply to Do we get what we pay for?, posted by andromeda on July 13, 2007, at 18:00:04

Yes; I would pay his rate which is fairly high. He even suggested some things I can do with some private practice work when my insurance runs out this year. I have a PPO and 60 sessions per year, but I see him twice per week, and my last therapist caused me to get charged for two brief phone contacts of 30 seconds and a one minute message as two of my therapy sessions; plus I found out that the OP ECT (2 sessions) also counted toward my OP therapy sessions. I want to gag! So, yes I would pay, and I would find a way to pay. He is too good to let go of. He even suggested that if I were to ever lose my job, then he could help me find something, but since we work in the same field, I guess he would have the contacts. He really thinks I need to once and for all deal with the abuse stuff that I have put off for way too long. He's right. I tried, but definitely with the wrong person before him.

 

Thank you for replies

Posted by andromeda on July 14, 2007, at 10:59:51

In reply to Re: Do we get what we pay for? andromeda, posted by OzLand on July 14, 2007, at 1:23:25

I am sorry so many of you have to pay out of pocket. I have an HMO and pay $10 out of pocket plus a hefty monthly premium. The insurance company would drop me in a instance if they could.

I just find the health care system lacking.
For examle, I can get a expert with a B.S. in horticulture to look at any plant problems I may be having. If I am not able to bring in a sample of the problem to his office than he is able to make house calls. I don't have to have an appt. If lab tests need to be done to identify the disease or insect then it is sent off to the university. This is all at no cost to me. I feel like my tax money is being earned, he works hard and he probably could be paid more.
My vet sends birthday cards to my pets, reminder
postcards on check ups, she spends as much time as needed. I never feel rushed. She is thankful for my business. She calls back the same day or immediatly if needed. Her help loves helping. If it is an emergency I get in right away and don't have to wait 3 hours to get a few stitches for my dog. She will make housecalls and I will get follow up calls if surgery is done. She apologizes if I have to wait 15 minutes. She has the medicines available at her office and goes over in detail what to watch for. I feel like she earns her money, works hard and makes a decent living.
With health care, I have never have been sent a birthday card, a notice that I need shots or a check up (is up to me to remember). I always feel rushed. It has never been free and I have never had a housecall from my doctor or therapist. It takes hours to days to get a called back if at all. It can be a 8 hour wait if it is an emergency room or urgent care visit. Lab tests are charged. The good help is burned out and under payed. The other help doesn't care and lacking in empathy. Mistakes are being made. Appts. are cancelled and re-scheduled on a regular basis. I do think Dr and T's work hard, earn their money and make a decent living.
The health care system seems to be working for the insurance companies instead of the consumer. I the consumer take what I can get becuase their is no choice and the fear of getting nothing if I don't pay to play.
Since denistry has gone with insurance that is getting to be just as big of a mess also.
It is a rip off.
I think the insurance industry and pharmaceuticals industry CEO's and top government officials don't earn their money, don't work hard and are getting filthy rich.
Besides that I don't think it should take 15 years to find the right combinations of meds and have a current condescending therapist and have to get everything approved by insurance. Plus crappy side effects.
I want what my other living things in my life get.
Sorry just venting.

 

Re: Thank you for replies

Posted by raisinb on July 14, 2007, at 11:41:00

In reply to Thank you for replies, posted by andromeda on July 14, 2007, at 10:59:51

It's interesting to think of all the ramifications of money stuff. All the issues show up.

My insurance provides unlimited sessions and I have a pretty low copay, but they pay my T's practice less than half of the regular fee. I constantly worry they'll cut me off or change something (I don't know if it's realistic, but still), and if they do, if she'd allow me to pay the discounted rate that the insurance pays (and if I could even afford that). Intermittently I feel guilty about how difficult and intense the therapy is, while she's getting less than half of the going rate.

 

Re: Do we get what we pay for?

Posted by OzLand on July 14, 2007, at 14:04:21

In reply to Do we get what we pay for?, posted by andromeda on July 13, 2007, at 18:00:04

I forgot to mention that even though I have a PPO and 60 sessions a year, my therapist does not take insurance, and this means the insurance ends up paying around 50% of the fee minus the deductible. I have a secondary insurance as well, and it only ends up paying the deductible for each bill. So, I pay around 40% of the bill. It should be just dandy when I have to pay close to $2000 per month when the insurance runs out. Since he will take time off at times, maybe it will come to more like $1600 per month with no insurance.

If I go on vacation and/or take a day off when we are supposed to meet, and he can not fill the time, then I have to pay for the time even though I am not there. Those are my reserved times. That is how my therapist does things. I am aware he is in high demand with a waiting list.

 

Re: Do we get what we pay for? OzLand

Posted by TherapyGirl on July 14, 2007, at 14:17:28

In reply to Re: Do we get what we pay for?, posted by OzLand on July 14, 2007, at 14:04:21

<<If I go on vacation and/or take a day off when we are supposed to meet, and he can not fill the time, then I have to pay for the time even though I am not there. Those are my reserved times. That is how my therapist does things. I am aware he is in high demand with a waiting list.>>

This part seems unusual and a bit harsh to me. I have never, ever, ever had to pay for a session I didn't attend. I would have to pay if I didn't cancel within 24 hours, but even then not if I'm sick. I don't understand this policy AT ALL. Does he pay you when he cancels?

Does anyone else have a T with this kind of policy?

 

Re: Do we get what we pay for?

Posted by raisinb on July 14, 2007, at 15:31:17

In reply to Re: Do we get what we pay for? OzLand, posted by TherapyGirl on July 14, 2007, at 14:17:28

I might be wrong, but I think I've heard that classically trained analysts, especially several years ago, commonly had policies like this. It makes sense in intensive psychoanalysis--since the client comes four or five times a week, s/he represents a significant portion of the therapist's income, which can't really be made up even if the cancellation is planned in advance. In once or twice a week dynamic therapy, though, I think it's pretty unusual and kind of behind the times. In the heyday of classical analysis, it's my impression that most clients were from high socioeconomic echelons, since those were the people who could pay out of pocket for 4 sessions a week.

 

Re: Do we get what we pay for? TherapyGirl

Posted by antigua3 on July 14, 2007, at 20:04:52

In reply to Re: Do we get what we pay for? OzLand, posted by TherapyGirl on July 14, 2007, at 14:17:28

yes, I used to have a T who did that. That's one of the reasons I quit seeing him; I didn't think it was fair.
antigua

 

Re: Do we get what we pay for?

Posted by Honore on July 14, 2007, at 22:37:36

In reply to Re: Do we get what we pay for? OzLand, posted by TherapyGirl on July 14, 2007, at 14:17:28

My T charges whether I come or not. no matter how far in advance I know. It's a fairly common practice for NY Therapists, although not universal. I think it depends a lot on their attitudes toward money and time, etc-- plus maybe how busy they are (and therefore whether they would theoretically have sacrificed income if they don't fill the time).

I wouldn't hold it against a T, because so many Ts do it that it doesn't seem like bad behavior, per se. It's like vacations-- enough NY analysts take super-long vacations that it's hard to hold it against one who does.


Honore

 

Re: Do we get what we pay for? raisinb

Posted by OzLand on July 14, 2007, at 23:40:04

In reply to Re: Do we get what we pay for?, posted by raisinb on July 14, 2007, at 15:31:17

My therapist is a psychoanalyst and has been in practice for 30 years. Yes this is traditional even these days in the Chicago area. I see him twice per week now, but he wants to add another day plus use the couch, and I am resisting that for now. Feels too threatening. So, he is already setting aside two times per week for me and later three. He would prefer four, but I can't afford that plus I really can't be taking that much time off from work.

Right now I go for appointments at 6:45 a.m. which means I have to catch the Metra train at 5:28 a.m. and ultimately end up getting to work at 9:00 a.m. So not bad, but I tend to be a night person as you can see, and so getting up at 4:15 a.m. there have been times I overslept and missed the train and had to go like crazy down the tollway toward Chicago. One time there was an accident, and I ended up being 30 minutes late. So I went all that way for a 15 minute session. I was not happy, but he has someone right after me, etc.

He is very experienced with eating disorders and sexual abuse issues. Eating disorder is not an issue so much anymore. Well that's not true, but not in the same way as when I was in high school and college and even after I started graduate school.

Otherwise, no he doesn't pay me when he is gone which was the case last Friday and will be the case this Friday.

 

Re: Do we get what we pay for? OzLand

Posted by annierose on July 15, 2007, at 8:43:00

In reply to Re: Do we get what we pay for? raisinb, posted by OzLand on July 14, 2007, at 23:40:04

I must say I was surprised to read this as well. I go to therapy 3 times a week, and use a couch. But if I give my therapist proper notice, I do not have to pay for missed sessions.

My t is a working mom like myself. And I appreciate how we are both flexible with each other.

If this is a common practice in large cities, it is easier to understand and not take personally.

 

Re: Do we get what we pay for? annierose

Posted by Dinah on July 15, 2007, at 13:55:53

In reply to Re: Do we get what we pay for? OzLand, posted by annierose on July 15, 2007, at 8:43:00

My understanding is that it isn't uncommon for therapists who assign a client certain time periods. Because those therapists only accept enough clients to fill the available time periods, and so the payment is for the time slot, and calculations are based on a time period for a year, divided up. I guess it leads to a steadier income for them.

My therapist makes no pretense of making appointments more than a week or two in advance, although he does mentally hold my usual time slots for me. So it's easier for him to move people around. It leads to a much more unstable income, and a reluctance to take vacations. But since he mostly does short term stuff, it's probably the best way to practice for him.

 

Re: Do we get what we pay for? Dinah

Posted by OzLand on July 15, 2007, at 23:42:54

In reply to Re: Do we get what we pay for? annierose, posted by Dinah on July 15, 2007, at 13:55:53

You are absolutely right Dinah. That is how it was put to me, that I pay for the time slot that has been reserved for me. He will try to fill the time slot, but if he cannot, then it is mine to pay for. It is my reserved time.

I don't think I would be able to manage a therapist who never scheduled more than a week or two in advance, not with my work schedule. It would not work. That would make me just crazy if my therapist did that.

OzLand

 

Re: Do we get what we pay for? OzLand

Posted by annierose on July 16, 2007, at 7:08:20

In reply to Re: Do we get what we pay for? Dinah, posted by OzLand on July 15, 2007, at 23:42:54

My standing three sessions a week are just that, the same three days/times each week. If I need to change a time or day, ongoing, I need to give her a few weeks to see if a standing appointment opens up. For example, I see her Tuesdays at 11:15 ... I don't like that time ... smacked into the middle of the day. I would like to keep Tuesdays, but switch the time. Right now, she doesn't have any openings on Tuesdays, but has jotted down my request and will let me know if something opens up. She offered a time on Thursdays, but I really prefer my Tuesdays.

However, if I have an urgent matter on a Tuesday, for instance, I had to go to court over a former employee on a Tuesday morning, she was able to accommodate me and see me later in the afternoon.

I do understand the logic a therapist would use but it also doesn't sound quite fair. He gets to take a vacation, but if I don't go when he goes (which would be impossible to schedule) I get charged for missing my sessions, even though I can give him/her a month's notice.

I guess it's part of the relationship I would have to work out so I could feel comfortable.

 

Re: Do we get what we pay for? OzLand

Posted by Dinah on July 16, 2007, at 9:20:12

In reply to Re: Do we get what we pay for? Dinah, posted by OzLand on July 15, 2007, at 23:42:54

Perhaps it's a case of knowing the advantages and disadvantages of what we do have?

I wouldn't mind either way, I don't think. He's so careful to hold our regular time that it's not unlike having a standing appointment. Except that if something comes up that he can't schedule at another time, or that I can't schedule at another time, we generally are flexible about accommodating each other. So I kind of appreciate it.

On the other hand, when he was going out of town a lot for his other job, I wasn't appreciative at all of his flexibility. :)

I think two more things are at work. He does mostly short term work so his client load is in flux. Sometimes he's fully booked and sometimes he's not. Even when he is, he'll squeeze me in somewhere if it's at all possible.

And although I hate my work in some ways, it does have the virtue of flexibility.

 

Re: Do we get what we pay for?

Posted by OzLand on July 16, 2007, at 23:00:50

In reply to Re: Do we get what we pay for? OzLand, posted by annierose on July 16, 2007, at 7:08:20

My therapist does long term treatment, and he also operates a residential treatment program for young adults. From what he said, I think he will do his best to try to accomodate me, but he cannot guarantee this. For example, when I had a pulmonary appt. from six months ago from before I even started seeing him and at the same time as our standing appointments, he got someone to take that time period and did not charge me. I think if I were going on vacation for two weeks, he would do his best to try to fill the time slots, but there is no guarantee he could. He was also going to give me a second time last week since we were going to miss Friday, but I could not fit it in my schedule. So, I think as much as possible he will try to accomodate me and others, but I can understand.

My last therapist would reschedule me to different times, not charge me if I was gone, etc, but he was in a group practice too and also someone who did mostly short term therapy. I just happened to be a more long term patient. It is so odd as my last therapist thought it would be bad for us to meet more than once per week, and my current therapist would prefer if we could meet three times per week, not just twice. But as I said my current therapist is a trained psychoanalyst, and my last therapist was not. Both are psychiatrists.


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