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Friday, April 12, 2013

A Clarification for Therapy Consumers

Some problems that come up for people paying for therapy with health insurance

 Surprisingly sometimes clients in therapy are confused about who the insurance company is and who their therapist is...  Somehow the fact that they are 2 different entities escapes the understanding of the client.  When you pay for therapy with insurance (usually it is the bulk of the fee paid by the insurance and the patient pays a small co-payment), the insurance comes with you, not the therapist.  You are a subscriber to that insurance; your employer has made an agreement with them to pay a certain amount per employee every year to them and, in exchange, they will pay for a certain amount of therapy for any employee who chooses to use it.

 It has nothing to do with the therapist:  The therapist doesn't make their rules nor determine how they do business.  The therapist is independent.  They have created and built their practice; it belongs to them; it is an entity on it's own with nothing to do with your particular insurance company.  (In fact, sometimes some of us feel like the insurance companies have taken advantage of us by inserting themselves in between us and our patients)

Most insurance that therapy clients present with are called HMO's. This means that the company will only pay "providers" (this is what they call therapists) who are on their list.  To be on that list, a therapist agrees to their conditions, primarily to be paid at usually about half their normal rate.  For a new therapist, just building their practice, this is helpful to them as it brings patients to their practice.  For a seasoned, established therapist, they are doing you a favor to agree to deal with your insurance.  That's because for the therapist, it is extra paperwork, tracking, and phone calls-so, they do more work for less money.
The reason I am bringing this up is the occasional odd and unpleasant interactions I have had with some patients over insurance issues.  Somehow, they think I am responsible for what their insurance company does!  And the insurance companies, for their part, do seem to set it up that way, i.e. to make it look that way.  (They leave it to us to do their dirty work as you will see in the following 2 examples).
For example, recently one of the companies a few of my patients use, decided to raise the co-payment on some of their subscribers.  They didn't inform anyone---not me, not the patients.  It wasn't until I sent in my claims that I  saw this discrepancy.  Since I usually bill for a number of sessions at a time, usually about 6, there were some debts accumulated.  In this case, they had more than doubled the co-payment.  So, I had the unhappy task of telling my patients that they owed me money.  Some of them reacted angrily to me as if it were my doing.  One patient said:  "It sounds like the old 'bait and switch' to me."
Another time, the company decided that the patient had used enough of their benefit and, basically, didn't want to pay for anymore therapy for that patient.   When I told the patient, word for word, what the insurance representative had told me (basically that a limited number of sessions could be used going forward and that they had an end date), he thought that I was throwing him out of therapy.  I was able to straighten that out with him but, then, when I suggested that he could continue, paying himself for his sessions, he immediately and unequivocally refused.

Maybe you can see that these kinds of incidences can be hard on the therapist.  From our point of view, it is unfair.  Sometimes we feel devalued.  These examples I gave are but 2 of many things like this that happen.  So, I just thought that, for the sake of all of us---patients who want to use insurance to pay for the bulk of their therapy, and all therapists who agree to accept insurance---that I would try to clarify how this works.
Insurance is just an alternative method of payment but therapists are independent entities and are not the insurance company and have zero power over them.  (Most health insurers are for-profit businesses and so, naturally they have their eye on the bottom line; they are not helping professionals; they are in business to make a profit, not to help people.)
The therapists are just as subject to the whims of the insurance companies as the clients are.

Was this explanation useful to you?


  1. Being a therapist is not an easy job. We should be aware about the satisfaction of our clients. Well, this post is useful and yet very informative. Thank you for such very well-said explanation.

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