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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 48. Go back in thread:
Posted by alexandra_k on March 15, 2005, at 19:54:35
In reply to Re: More money stuff :( » alexandra_k, posted by alexandra_k on March 15, 2005, at 19:53:04
I shouldn't have posted that.
This is one issue that really gets me wound up.
My issue.
Having been unable to get adequate treatment because I can't afford private rates and all...Best for me just not to talk about it.
Sorry.
Posted by gardenergirl on March 15, 2005, at 20:00:07
In reply to More money stuff :(, posted by All Done on March 15, 2005, at 10:17:53
Wow, this really is a sticky situation. I think I might approach it from the standpoint of "I don't want to get you in trouble, but there's something you should know..." and let him know what you found out. Act as if you think he doesn't know this, and you know he doesn't want to lose the contract. I think if you approach it as doing HIM a favor by bringing it up, it might not seem so hairy.
But yuck all around. Sorry you are going through this. You are entitled to this money from the insurance company. You are right. That is why you have insurance.
gg
Posted by All Done on March 15, 2005, at 23:32:16
In reply to More money stuff :(, posted by All Done on March 15, 2005, at 10:17:53
annierose, alexandra, falls, and gg,
Thanks so much for your advice and support. Money is always a difficult topic no matter who is involved, I think. I'll talk (I wish I had my T's e-mail, alexandra - that would be easier) to him about all of this and I'm sure we'll come to a decent resolution. I guess I'm just crossing my fingers that he doesn't stop accepting the insurance completely because then I have to explain to my hubby why I've gone from paying half back to paying the full fee. I've been through that discussion with him before and that's a tough sell, too.
Anyway, thanks again. As always, I really appreciate all of your help.
Take care,
Laurie
Posted by All Done on March 15, 2005, at 23:40:23
In reply to Re: More money stuff :( » All Done, posted by TofuEmmy on March 15, 2005, at 18:37:59
Emmy,
I'm sorry. I do consider myself lucky in lots of respects and money is one of them. I didn't mean to come across as ungrateful. I know there are many who are in tougher binds than myself and I did think twice about posting this. Probably should have thought three times, though :(.
I'm really sorry about your situation. It sucks and I wish things were different for you. I know it's not a substitute, but please don't forget that we're here for you if things get rough.
Again, I know it's not a great substitute, but are there any Ts in your area that accept managed care insurance?
I'm sorry, (((((emmy))))).
Take care,
Laurie
Posted by TofuEmmy on March 16, 2005, at 10:06:46
In reply to Re: More money stuff :( » TofuEmmy, posted by All Done on March 15, 2005, at 23:40:23
No pookie....I'M sorry. I was having a pity party for emmy. Kind of in a funk over this topic.
Yes, I could see someone else. But, he IS allowing me to use up my alloted insuranced visits for this year. Those will be up shortly. So whoever I go to at this point, I will have no insurance. This is the joy of living in a non-parity state. It does not matter how nuts I get...unless I go inpatient. I think I have 30 days of inpatient care available. Yippee. So, basically I guess that should be my goal? See my T until the paid visits run out, then do something drastic enough to end up inpatient.
Yes, I have a baaaaad attitude.
em
Posted by gardenergirl on March 16, 2005, at 10:18:41
In reply to Re: More money stuff :( » All Done, posted by TofuEmmy on March 16, 2005, at 10:06:46
If anyone wants to know how they can help make parity happen on a national level, please babblemail me. I will send you a link for writing your legislators. Lets make it happen this year!
gg
Posted by All Done on March 20, 2005, at 12:38:17
In reply to More money stuff :(, posted by All Done on March 15, 2005, at 10:17:53
I don't exactly know where to begin. It was a quick hour but a packed hour.
I tried to explain things very matter of factly. Didn't work so well as I was fidgeting and tense, but I think I got my point across. I told him what the insurance company was telling me. His first instinct was to say that the insurance company can't tell him what to charge. I told him I thought maybe they could because of his contract. He also kept mentioning the fact that we (him and I) had/have an arrangement we already agreed upon. Well, I told him I agreed to that not even knowing he was a provider with my insurance company. He's been a provider since before I met him. Our agreement was made without him telling me he was a provider. Anyway, I just kept asking him to review his contract and call the insurance company. He's going to do that and we'll talk again.
You might like this falls - The only time he seemed to be flustered about all this was when he made a comment about me being the most informed one in the room and laughed nervously.
Now...all the other stuff. Please know I'm paraphrasing and trying desperately to remember what was said and how it was said.
He thinks working out payment is an important part of therapy and it can open lots of areas for discussion, which it did.
He said making a financial investment in therapy might aid the overall investment in therapy. Thinking about this, though, I get kind of mad. Does he think I'm not invested enough without paying more? Or even paying at all, for that matter? No one is making me go to therapy. And I certainly don't drive an hour and fifteen minutes each way to hear myself talk for an hour.
We talked about how I hated bringing all of this up because it was kind of his stuff. Normally, I can look at someone (anyone but him for that matter) and tell myself that they are just another person, like me. It makes it easier to have things like difficult business conversations or inverviews sometimes. Well, what do you know...I don't put him in the same category with the rest of humanity;). He's a T 24/7 right? He doesn't leave his office ever. I hate even seeing him in the hall. As a matter of fact, I hate knowing that he has clients other than me. He didn't know I felt like this.
We talked about the way I deal(t) with confrontation with others (especially my parents). I will typically put everyone else's needs and wants before mine. Even at my own expense. I mentioned that my mom is NEVER wrong, so I gave up confronting her. I felt like he has a little bit of that attitude. When he started sounding like that is when I told him he needed to talk to the insurance company before we talked about it anymore.
Sheesh! There was more. I just can't think of it right now. I believe we got at least a year's worth session topics out of this one.
Oh. And I paid him $90 when I left.
Posted by fallsfall on March 20, 2005, at 14:04:40
In reply to Re: We talked and talked and talked, posted by All Done on March 20, 2005, at 12:38:17
*** Deja vu!!! The only reason I know we have different therapists is that mine is a provider ONLY for Medicare.
>His first instinct was to say that the insurance company can't tell him what to charge.
*** Mine's second instinct was to say that the insurance company *wasn't going to" tell him what to charge.I told him I thought maybe they could because of his contract. He also kept mentioning the fact that we (him and I) had/have an arrangement we already agreed upon. Well, I told him I agreed to that not even knowing he was a provider with my insurance company. He's been a provider since before I met him. Our agreement was made without him telling me he was a provider.
*** Good for you! It is so hard to tell a therapist that they are wrong. Maybe they are just trying to be "assertive", but it sure feels more like intimidation/control. Maybe we are extra sensitive because money is the thing that we give to the relationship, so we are torn between wanting to "do our part" and needing the money to pay for other things.
Anyway, I just kept asking him to review his contract and call the insurance company. He's going to do that and we'll talk again.
*** This is more than my therapist would do, I ended up finding the name/phone number he needs to contact and telling him what he needs to say to them.You might like this falls - The only time he seemed to be flustered about all this was when he made a comment about me being the most informed one in the room and laughed nervously.
*** I think one reason that this kind of discussion is so full of issues is because they really do care about getting paid (we all want to have enough money to live on). But they sure are more interested in Psychological theory than they are in the "business" aspects of things, so the tend to be underinformed. Are most of their patients really so uninformed that we are the only ones who challenge them on these things?
He said making a financial investment in therapy might aid the overall investment in therapy. Thinking about this, though, I get kind of mad. Does he think I'm not invested enough without paying more? Or even paying at all, for that matter? No one is making me go to therapy. And I certainly don't drive an hour and fifteen minutes each way to hear myself talk for an hour.
*** Maybe he was speaking generically - "a" financial investment *in general* makes people more dedicated. This is one of the tenents of therapy (it seems to me). Perhaps he was just going over this as background info. So he doesn't look like so much of a money hungry shark - he is saying that paying a (reasonable) fee is important to *you* as well as to *him*.
We talked about how I hated bringing all of this up because it was kind of his stuff. Normally, I can look at someone (anyone but him for that matter) and tell myself that they are just another person, like me. It makes it easier to have things like difficult business conversations or inverviews sometimes. Well, what do you know...I don't put him in the same category with the rest of humanity;). He's a T 24/7 right? He doesn't leave his office ever. I hate even seeing him in the hall. As a matter of fact, I hate knowing that he has clients other than me. He didn't know I felt like this.
*** Therapy enters a different realm when you are talking about fees. I think they are the only area (except, perhaps for suicide) where the therapist really *does* care what we do (I think they can care about us while accepting that we can choose what we will do with our lives - caring about/for us is different from caring what we do). For the rest of things, I think they say that it is our life and our choice - so they can be happy either way it goes. But with money, it is like the intensity is rachetted up a notch - and this brings out subtleties in the relationship that stay hidden the rest of the time.
We talked about the way I deal(t) with confrontation with others (especially my parents). I will typically put everyone else's needs and wants before mine. Even at my own expense. I mentioned that my mom is NEVER wrong, so I gave up confronting her. I felt like he has a little bit of that attitude. When he started sounding like that is when I told him he needed to talk to the insurance company before we talked about it anymore.
*** Ah, yes. My therapist and I got into a spot where I was "teaching" him, and this prompted some important discussions about teaching and learning (for me, a way big to show that you care about someone is to teach them something - knowledge is one of the ultimate goals). Usually, he is the one "teaching" me. It is interesting how we each pull from our past in this way - so my experience of the fee conversation is different from yours, because we have had different experiences in the past.
Sheesh! There was more. I just can't think of it right now. I believe we got at least a year's worth session topics out of this one.
***And it went on for a couple of session for me... But very productive. Anxiety provoking, but productive.
Oh. And I paid him $90 when I left.
*** Yeah, mine got his way, too. But he was able to convince me that he was doing his "part" as far as the fees went (i.e. he was being ethical/moral). This is definately a "growth" topic. Sounds like you handled it really well.
Posted by gardenergirl on March 20, 2005, at 22:26:43
In reply to Re: We talked and talked and talked » All Done, posted by fallsfall on March 20, 2005, at 14:04:40
Good for you, Laurie. I'm so proud of you for bringing this up. It sounds like it must have been really tense in the room for a bit. And it definitely sounds like it was productive.
I'm so glad they teach us about managed care (at least the basics...each company is SOOO different) in school. Does your T have an office manager? That would certainly help things. Also, he could get in touch with his state organization. I'm sure there is someone there who can help him figure out what he needs to do and can advocate for him if he needs it.
And stick to your guns. You really deserve back claims reimbursement, which means he is going to end up losing some money. I'm sure that the amount he charges you is more than the amount he agreed to charge based on his contract. That's a sticky situation, but you are entitled to have this remedied. It has NOTHING to do with therapy. It's business. It's insurance.
Yes, there are theories that say that a financial committment to therapy makes an impact, but you are too far along for that to mean diddly squat at this point. I pay nothing, and for me it's the investment in my own growth and the relationship that keeps me going. Plus you have your co-pay. The financial committment does not have to be astronomical for it to be effective. It can be nominal or even symbolic (as in my tuition).
Yea Laurie for bringing this up and turning it into something productive!
gg
Posted by alexandra_k on March 21, 2005, at 0:41:28
In reply to Re: We talked and talked and talked, posted by All Done on March 20, 2005, at 12:38:17
> I told him what the insurance company was telling me. His first instinct was to say that the insurance company can't tell him what to charge. I told him I thought maybe they could because of his contract. He also kept mentioning the fact that we (him and I) had/have an arrangement we already agreed upon. Well, I told him I agreed to that not even knowing he was a provider with my insurance company. He's been a provider since before I met him. Our agreement was made without him telling me he was a provider.
Well done :-)
> Oh. And I paid him $90 when I left.
Unbelievable. Really.
He f*cks you over and you pay him for the priveledgeI can't help thinking that money is important to them for the same reason it is important to everyone. And there really isn't any more to it than that. Don't we show committment by turning up? Don't we show committment by taking what they have to say seriously? Don't we show committment by thinking about them during the week? Don't we show committment by doing homework tasks or whatever?
Where else in life are you fairly much solely expected to show your committment by paying a fee? Are you supposed to give your kids pocket money to show them you are committed to them? How about your spouse? How about your friends?
Would they ditch you if you couldn't express your committment with $$$?
I know they gotta live eat have money for stuff just like the rest of us. But I have to say IMO the rationale for such exhorbatant fees is just so much sh*t.
It makes me so mad.
I'm sorry
Posted by alexandra_k on March 21, 2005, at 0:42:43
In reply to Re: We talked and talked and talked » All Done, posted by alexandra_k on March 21, 2005, at 0:41:28
I'm sorry. I shouldn't have posted anything. It isn't about your t so much as my poverty and thus lack thereof. I really am very sorry.
Posted by gardenergirl on March 21, 2005, at 0:50:55
In reply to Re: We talked and talked and talked, posted by alexandra_k on March 21, 2005, at 0:42:43
Posted by Dinah on March 21, 2005, at 10:26:02
In reply to Re: We talked and talked and talked, posted by All Done on March 20, 2005, at 12:38:17
Oh my. When I talked with my therapist about this topic (I thought he was on my plan but he wasn't) he seemed to feel quite injured that he'd be getting $40 less per session than he was currently getting for those sessions that were covered. He said "You do realize I'm not allowed to charge the difference between what the insurance company paid and what I now get from you." in the most injured tone of voice. I felt injured that he felt compelled to charge me $40 more than the majority of his clients. That still stings, yet conversely gives me some power that I enjoy.
But in the end he shrugged and said that's the way it was. He also made some statements about treatment plans and diagnosis codes that I took as being threatening, though he tells me I'm mistaken. I don't think I am. :(
I was reinforced with my desire not to go through an insurance company.
Posted by All Done on March 27, 2005, at 3:01:01
In reply to Re: We talked and talked and talked, posted by All Done on March 20, 2005, at 12:38:17
I'm very sorry, everyone. I wanted to respond to you individually earlier but there were a few things.
First, I started feeling like I wanted to defend my T and I didn't think that would end up being very productive.
Also, I wondered if I was upsetting myself about the situation somewhat unnecessarily. The ball is in his court and I can think about the result after he tells me what information he comes up with. I worry a lot and I guess this week wasn't a good week for me to spend too much time worrying where I didn't have to. My son was still sick and my aunt had a massive heart attack and was put on a ventilator. She was just taken off tonight and they don't think she'll live much longer. My cousin (her daughter) is a bit of a mess and so is my mom (her sister). Understandably so, but they are needing a lot of support from me. The whole situation is reminding me of when I lost my dad, though, and I don't know how much more I can do for them before I get way too sad. I'm already missing him a ton.
But I digress. I saw my T today and I don't think he's talked to the insurance company. We didn't talk any specifics about the issue. If he doesn't bring it up at the beginning of the next session, I will ask what he thinks his time frame is for looking into this.
It wasn't a great session. I didn't really realize until I left, but I feel like my connection to him has been sort of damaged. Hopefully, it's temporary and we can work things out. But until then, I'm left feeling uncomfortable and really, really anxious. It has to do with some other things too, not just the insurance issue, but that's definitely part of it. I don't like feeling so uncomfortable especially when I was just starting to feel more attached to him. It all has me so uptight and nervous I almost called him tonight and I never call. I feel like I'm losing him and that feeling always makes me panicky.
I'm sorry guys. I'm feeling pretty lousy, but I wanted to let you know I *do* appreciate your responses and I don't mean to be ignoring you.
You've been so sweet to me.
Thanks,
Laurie
Posted by fallsfall on March 27, 2005, at 10:04:21
In reply to Re: I'm a bit of a mess :(, posted by All Done on March 27, 2005, at 3:01:01
Yes. I understand. I understand the impatience. I understand wanting to defend your therapist while at the same time you are angry at what he is doing (or not doing). I understand the divide (for me, it really did get lots better - the fee/insurance issue helped us get closer).
Do bring it up when you are ready. Don't feel like it is a taboo subject.
Sounds like a rough time with your aunt. And you need to be support for your mother and cousin. I hope you have some IRL support yourself - but remember that we will be here to support you, too. Let us know what you need.
(((AllDone)))
Posted by gardenergirl on March 27, 2005, at 10:16:18
In reply to Re: I'm a bit of a mess :(, posted by All Done on March 27, 2005, at 3:01:01
Oh sweetie,
We're here for you. And of course you would feel conflicted about this. I bet you want to feel good about him, but the insurance thing is tricky.And I'm so sorry about your aunt. How awful. I'm glad you are there for your cousin, but do also take care of yourself. Let me know if you need any late night IM's, okay? I'll let you know if I can sleep in the next day or at least nap. No worries there.
We're here for you. You can share this with us.
(((((Laurie))))
gg
Posted by shrinking violet on March 27, 2005, at 11:34:05
In reply to Re: I'm a bit of a mess :( » All Done, posted by gardenergirl on March 27, 2005, at 10:16:18
Posted by Dinah on March 27, 2005, at 13:38:30
In reply to Re: I'm a bit of a mess :(, posted by All Done on March 27, 2005, at 3:01:01
I'm so sorry about your family. The situation itself and the feelings it's reawakening in you about your father. My thoughts are with you and yours.
There's no need to defend your therapist to me. I think his response, while justifiably annoying, is not at all unexpected for a therapist. They aren't generally business whizzes or they'd have gone to business school. And we like them that way. He's just trying to feel his way along a new territory for him.
Money is always a tricky subject in therapy. :(
Posted by All Done on March 28, 2005, at 0:05:04
In reply to Re: I'm a bit of a mess :( » All Done, posted by fallsfall on March 27, 2005, at 10:04:21
> Yes. I understand. I understand the impatience. I understand wanting to defend your therapist while at the same time you are angry at what he is doing (or not doing). I understand the divide (for me, it really did get lots better - the fee/insurance issue helped us get closer).
Thanks, falls. It really helps me to hear that things got better for you and your T and that it even helped you get closer. I just feel so out there on my own right now and it's kind of lonely :(.
> Do bring it up when you are ready. Don't feel like it is a taboo subject.
I will. We even talked about it yesterday. Just not much I think, in part, because he hadn't talked to them, yet. I'll bug him next week if he doesn't bring it up. I don't think it would be a very wise idea to have a white elephant in the room with us. It's kinda small in there ;).
> Sounds like a rough time with your aunt. And you need to be support for your mother and cousin. I hope you have some IRL support yourself - but remember that we will be here to support you, too. Let us know what you need.
>
> (((AllDone)))A lot of my IRL support comes from my husband. He knows about my aunt, of course, but he has a hard time understanding some of the therapy stuff. (Especially when I don't tell him about all of it. Sigh.) So, it's nice to know I have you guys, too.
Thank you so much, falls.
Laurie
Posted by All Done on March 28, 2005, at 0:11:20
In reply to Re: I'm a bit of a mess :( » All Done, posted by gardenergirl on March 27, 2005, at 10:16:18
> Oh sweetie,
> We're here for you. And of course you would feel conflicted about this. I bet you want to feel good about him, but the insurance thing is tricky.I do want to feel good about him. He said he thinks this is a new "phase" of my therapy (I think he used the word phase.) Maybe less idealization of him or something. At kind of the same time, he was talking about the beginning, middle, and end of therapy. I guess my head is just assuming a new "phase" means I'm closer to the end. I don't like thinking about that :(.
> And I'm so sorry about your aunt. How awful. I'm glad you are there for your cousin, but do also take care of yourself. Let me know if you need any late night IM's, okay? I'll let you know if I can sleep in the next day or at least nap. No worries there.
>
> We're here for you. You can share this with us.
>
> (((((Laurie))))
>
> ggThanks, gg. I feel like I have a lot of stuff I want to talk about, I just don't know how to get it out in an organized manner. So, if we do IM, consider yourself warned - much rambling will ensue ;).
Posted by All Done on March 28, 2005, at 0:13:01
In reply to {{{{{{{{{{{{All Done}}}}}}}}}}}} (nm), posted by shrinking violet on March 27, 2005, at 11:34:05
Posted by All Done on March 28, 2005, at 0:23:40
In reply to ((((All Done)))), posted by Dinah on March 27, 2005, at 13:38:30
> I'm so sorry about your family. The situation itself and the feelings it's reawakening in you about your father. My thoughts are with you and yours.
Thanks, Dinah.
> There's no need to defend your therapist to me. I think his response, while justifiably annoying, is not at all unexpected for a therapist. They aren't generally business whizzes or they'd have gone to business school. And we like them that way. He's just trying to feel his way along a new territory for him.
>
> Money is always a tricky subject in therapy. :(Justifiably annoying - I like that :). Somehow, it feels better to me to be annoyed than angry. (I think I tend to use the terms interchangeably, though.)
And what do you mean he's not a business whiz? I like to believe he knows everything about everything (um, just like I thought my dad did). Maybe that's why I'm so darn disappointed :(.
Posted by Dinah on March 28, 2005, at 0:28:29
In reply to Re: ((((All Done)))) » Dinah, posted by All Done on March 28, 2005, at 0:23:40
Ok, clearly he's not perfect. Otherwise he would have showed his various and sundry failings very early in therapy. Perhaps my therapist could give a course in *that*. :)
"How to Ensure You Are Not Idealized (or Making Errors a Therapeutic Opportunity)"
Posted by All Done on March 28, 2005, at 1:02:01
In reply to lol » All Done, posted by Dinah on March 28, 2005, at 0:28:29
(((Dinah's T)))
;)
Posted by mair on March 28, 2005, at 5:07:16
In reply to Re: too funny, Dinah :), posted by All Done on March 28, 2005, at 1:02:01
I know I'm jumping in late here, and I haven't read all of the posts on this thread, but I dealt with exactly the same issue with my T after i first started seeing her. She was a provider for my insurance company although she worked in a different state from the one I lived in so she had to submit claims to her state and they then passed them along to my state. The allowed amount she was permitted under her contract was less than a T would have been allowed in my state. She submitted the claims and generally didn't bill me until after she got paid, but she'd bill me for the full difference between what she got from the insurer, and her normal hourly rate. More than that, the insurer in her state was so awful about processing claims that it took months for her to get reimbursed, and I started paying her on a monthly basis what she thought I would owe. She only had a couple of patients with my company and I think she maybe thought she could bill me differently since I lived in a different state.
I figured out that what she was doing was wrong but I hadn't been seeing her that long. I have a real aversion to dealing with money matters and in particular money disputes and I really didn't want to say anything to her. I found out that it just bothered me too much, however, - not so much the money as the fact that she was just not correct in the way she was billing me. I pretty much thought that raising it with her would fracture the relationship we were just starting to build and that I'd end up losing her, but I couldn't let it go.
After I raised it, I realized that she was amazingly naive and uninformed about the way these things were supposed to work and that her billing practices were a little sloppy. She certainly wasn't gypping me deliberately. I also discovered that she was really upset to discover that she had been doing things wrong, but also that she'd be getting paid so little if she could only bill me my copay. We worked out a compromise where we split the difference. I know I was still paying more that I was supposed to, but it wasn't that much different and could certainly live with it. And I was so grateful that she handled it in a way that made me feel ok for bringing it up.
Ultimately she dropped my insurer which meant I started having to submit my own claims. That hasn't been too bad because my state's allowed amount was higher than her's anyway.
What I learned was 1) you have to bring this stuff up if it bothers you; 2) the T should be able to deal with it in a constructive way; and 3) you can't assume that the T understands his or her provider contract, or for that matter, has a clue how the financial world really operates.
Mair
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