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  #1  
Old Jun 01, 2010, 08:41 AM
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BlackCanary BlackCanary is offline
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I'm trying to determine how typical OR atypical my HMO policy is regarding appointments for mental health care.

My T gives me my next appt each time I visit - may not be the same day of the week or time, depending on his schedule. There is apparently a policy that prohibits a regular scheduled day and time. I've booked thru the online system - it lets me schedule 4 appt in a row at the same time on Wed each week. My T said I must cancel all but one.
I've always struggled with this - I want the implied contract and committment of same time next week, every week.

My son just started with a child psychologist in the community, trying to determine how to improve his school work habits. He has his own "time" - every week, same day of the week, same time.

What do you get - one at a time or same time every week?

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  #2  
Old Jun 01, 2010, 08:47 AM
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My t's office schedules as you go. I can schedule a few weeks ahead of time if I wish, but there is no such thing as a standing appointment. I've never had that with any of the t's I have seen.
  #3  
Old Jun 01, 2010, 08:54 AM
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I am a regular ... every week, same day of the week, same time. My T says, "I own that time".
Xtree
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  #4  
Old Jun 01, 2010, 08:55 AM
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Mine is a regular appointment - I know she keeps that time free if she can, even if I haven't scheduled an appointment, and we set the next appointment at the end of each session. I like having same day, same time, and as far as I'm aware there was no problem with my insurance (still don't really understand the system though!).
  #5  
Old Jun 01, 2010, 09:04 AM
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same time each week, I have a standing appointment. Unless it's a holiday or something, like yesterday.
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  #6  
Old Jun 01, 2010, 09:08 AM
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Originally Posted by zooropa View Post
same time each week, I have a standing appointment. Unless it's a holiday or something, like yesterday.
dont you hate monday holidays ive realized there is a lot of them lol
  #7  
Old Jun 01, 2010, 09:09 AM
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i have a standing apt every monday same time i like the stability of that i know she will be thare at tht time exsept for holidays.anoyed at monday holidays lol
  #8  
Old Jun 01, 2010, 09:16 AM
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dont you hate monday holidays ive realized there is a lot of them lol
YES! Sometimes I think I'd like to change my appt from Mon to a different day so I don't always get bumped by holidays, but I've had T on Monday for over a year and a half and it seems like that's how I start my week now. I don't like change much, so I'll just stick with Mondays for now.
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  #9  
Old Jun 01, 2010, 09:18 AM
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Wanted to add: The reason my t won't give a set scheduled time is that there are only 5 5:00 appointments in his week, for instance, and EVERYBODY wants the latest appointment in the day, particularly if it is for a child. Those appointment bookings are first come first serve for that reason. Equal availability to all. Scheduling a few weeks ahead usually does the trick, but not always.
  #10  
Old Jun 01, 2010, 09:35 AM
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I see T at the same time every week.

When I first started, we would just schedule as we went. I remember the day a couple of months into therapy when he asked "do you want to make every Friday at noon your appointment time?". It made me feel so secure knowing that I would be expected and welcome every week. I had a lot of fear of being referred or of being "too much" when I started therapy, and having a standing appointment quieted that fear a little bit.

My standing appointment times have moved around a bit over the years as my schedule outside of therapy has changed, but I always have a standing appointment.

I don't understand why your HMO won't let you schedule appts in advance? Even if the HMO won't let you have an appt on the book for some reason, it seems that T could keep every Monday at 1 (or whatever) open for you.

  #11  
Old Jun 01, 2010, 10:21 AM
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BlackCanary, I schedule mine one at a time as I go, but not because an insurance company tells me to do it that way. I can't see why an insurance company would care what time you meet each week. Maybe you need the same time each week because that's your only free time.

With my first T, I also only scheduled one at a time, because my schedule was so variable. With my next T, my current guy, we started the same way but shortly thereafter, he gave me a regular slot, same time each week. That made me feel so good!! I didn't realize that therapists do this a lot. It made me feel like I mattered to him, that he was willing to carve out the same time in his schedule each week, just to see me. He reserved that time for me and wouldn't let other clients have it. It was great! I was very needy then, so this helped me in some way. Now I am doing a lot better, and we just schedule one appointment at a time. This is working well for me.

Have you called your HMO to ask about their weird policy? I would be very curious to hear their rationale.
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  #12  
Old Jun 01, 2010, 10:45 AM
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My insurance has never dictated WHEN I could see my T, just how many sessions they'd be paying for. This year since that new law, I only have to pay a "specialized" doctor co-pay AND unlimited. Cheaper!

That being said, my T from day one just assumed I was coming at the same time every week.
  #13  
Old Jun 01, 2010, 10:50 AM
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If it's your insurance policy or therapist, don't think there's much you can do about it? I would just try to use the constantly shifting day/time to my advantage; life has a lot of change we can't control, I'd work with the appointment thing the same as I did my T going on vacation.

I had a T in private practice so could see her the same time every week. It was hard for me when we changed times, or days, or locations; the mind gets use to the "habit" so easily but I think that can make other things more difficult. I think you have to compare insurance/clinics with rules to each other, rather than all T's as those in private practice are free to do what they want whereas your T is not.
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  #14  
Old Jun 01, 2010, 11:30 AM
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I'm just trying to get a sense of the custom out there.

FYI - my T is an employee of the HMO -it's a traditional center-based HMO. He has never given me a reason why this rule exists, just that it is a rule. I'd have to guess that it's a first-come, first-serve situation, like FarmerGirl said. My T likely has more clients than he can fit into a single week - some of us can't be seen each week even if that's what we'd prefer, some of us will get an appt 5 or 7 days out, some will get one that is 10 days out.
I've gotten MUCH more comfortable with this method as time has passed. However, setting up the "regular" time for my son really triggered my own insecurity about not having the sense of commitment that I'd get from a regular time. Like Sunrise said "It made me feel like I mattered to him"....
With the HMO employee, there is no need for a referral and no limit on visits.

The logic that fails me with the HMO: If this policy is so strict, then why doesn't the on-line appt system enforce it? They spent 20mil+ on this highly secure system but FORGOT to have it include this rule? The system enforces multiple other rules that are specific to my membership (names of practitioners, types of appts I may schedule, do I have a referral, etc).
Velcro, like you, my co-pay has now become = to the lower medical co-pay under the new parity law.

My son's T is paid by the HMO, but is in private practice - none of the HMO-employed practitioners were available to see him. He's limited to 12 visits on the first referral.
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Old Jun 01, 2010, 11:43 AM
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BC, maybe one week you can have an appointment on Tuesday, at 2:00 pm, then the following week at 2:01 pm, then back to 2:00 pm the next week, and so on. It seems like if your T wanted you to be able to come in at a consistent time, he could find a way to make it happen. If your T doesn't want you to have a consistent time, then you probably won't get far with this, no matter the policy of the insurance company. T's have many ways of getting around senseless insurance restrictions (if they want to).

I found it really great to have the regular weekly time when my T had a really heavy schedule with too many clients. It seems like he has fewer clients now and it is not so hard to get an appointment, so I don't mind not having a regular time.
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Old Jun 01, 2010, 11:43 AM
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One of the reasons I prefer the schedule as we go method is that I am able to get in more than once in a week if I need to, and we have the flexibility to spread out my sessions when I don't really need to see him every week. If every client was scheduled each week like clockwork, wouldn't there be problems with that kind of flexibility? I know my t sees more patients than can technically be scheduled in a week, but not every client needs to see him every week or even every two weeks or so. So it works out. It is a rare occasion that I feel like I'm having to "wait" to get an appointment and I'm always able to get in in an emergency, although it may not be at the most convenient time. I've had weeks where he insisted on seeing me EVERY single day. Would that even be possible if all clients were on a set schedule? Just thinking aloud.
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Old Jun 01, 2010, 11:46 AM
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FG, just because a T scheduled some clients at a regular time weekly, it doesn't mean all clients would be scheduled in that way. Probably many Ts do a mix of each, depending on each client's needs. For example, I see my T every other week, at different times, but I know he has some clients who see him weekly.
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  #18  
Old Jun 01, 2010, 11:51 AM
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I'm sure with the HMO, they can get many more patients in than a self-employed therapist might want and so that keeps costs down. How long are your sessions? Too, for the HMO's purposes, it looks good in theory, allowing people as many sessions as they need but kind of discourages the ongoing/consistency of a long psychotherapeutic relationship.
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Old Jun 01, 2010, 12:26 PM
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@FG - I'm not trying to explore if it's a good policy or bad policy - it is what it is, and benefits some while challenging others. If I have an emergency, then no, I can't be fit in if there's no cancellation. If T has 25 clients and 20 spots, then next available is likely to be in about 7-10 days. A private practice T can work 50-60 hr in a week when there is a need; mine is limited to a 40 hr week.

@Sunrise, I think that's probably the most common - some clients are weekly, some are every other week, some are 2x, and most T's have the freedom to offer a recurring appt to some and flexible scheduling for others.
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Old Jun 01, 2010, 12:30 PM
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@FG - I'm not trying to explore if it's a good policy or bad policy - it is what it is, and benefits some while challenging others.
Oh, I wasn't either really. Just thinking aloud.
Thanks for this!
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  #21  
Old Jun 01, 2010, 12:47 PM
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BC- I am scheduled regularly every monday at 10, though there have been many weeks where that time isnt convenient for me and we make a diff appt time. My T is much more flexible in the mornings and afternoons. She has told me that she has limited evening appts (which I have not needed). When I begin to work, I may need evening appts and in that case, I can understand why a therapist might schedule on a first come first serve basis the most coveted times. It looks like my T has "regulars" in the evening which might be a problem for me.

I dont understand what the benefit might be for an insurance complany to restrict regular scheduling. It doesnt make any sense to me. Could they really be so concerned with fairness to all clients?
  #22  
Old Jun 01, 2010, 01:45 PM
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If a therapist has regular scheduling, when someone can't/doesn't come there's a blank in his schedule and an independent therapist might only want 3 clients on Monday, 8 on Tuesday, etc. The way the HMO (which is both the insurance company AND the therapist, the therapist is assigned to the company and works for the company) the therapists get a regular schedule (9-5 Monday through Friday, say :-) but, there aren't any blanks because each space is filled week-by-week and any would-be blanks are taken up by first-time/new clients.

The HMO tells the therapist how often they will work (and/or can hire more therapists and pay one who works less, less money) and gets optimal scheduling, like how stores schedule their employees (when I went to Sears Roebuck manager training that was the part I loved; you had to do word problems, "The store is open these hours, you have 5 employees, these 3 are full time/work 40 hours and the other two are part-time, PT-1 is a student with these X hours free and PT-2 is a housewife with kids that can only work 10-2 every day").

My T use to charge for cancelled appointments (less than 24 hours) but if I went on vacation, it's not like she could put someone else in my slot because it was "mine" so she lost income when I was away. Too, it was hard to adjust her individual schedule, she had to plan years ahead she said for people to terminate, or to change workplaces, locations, etc. With the HMO, the therapists can adjust their hours, it's just harder to get an appointment with them (because that person might have fewer hours than people who want to see him).
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  #23  
Old Jun 01, 2010, 01:47 PM
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My T is same every week. I do like it that way.
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  #24  
Old Jun 01, 2010, 01:48 PM
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I wish mine was the same time every week. We usually schedule 2 weeks at a time. My son goes to the same T, so we have to work out times for the both of us. It's never the same day or time.
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  #25  
Old Jun 01, 2010, 02:24 PM
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if I went on vacation, it's not like she could put someone else in my slot because it was "mine" so she lost income when I was away.
?? I don't get this. Why couldn't she see a first-time client, a client who goes on a more flexible schedule, or an emergency appointment during this time? When I'm away, I don't expect my T to sit there during my appointment, holding my spot and not getting paid. I'm sure he fills it with another client.

Based on who I've seen when I've been going in/out of my sessions, T has some people he sees at a regular time each week, and some people with more flexibility. It doesn't have to be either/or.
Thanks for this!
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