[rainbow8]

I know people were talking about insurance changes. I have BCBS and my copay went up about $11.00. What bothers me is that my T used to charge $150 for 90 minutes, and my copay was about $26. Now, for the same time period, it's billed as $150, and then $125 which I assume is for the extra 30 minutes. So she is getting $125 for 30 minutes? Is this the new law about times, so they have to do it this way? I will call insurance and ask, but I never understand their answers. My T has a billing person but I don't understand her either.

Between this $37/week new fee, my DBT which may be going up too, I'm not sure, and the pdoc, this is going to be difficult. I know it doesn't sound like a lot, but my H is retired and we can't keep spending so much. Maybe I will have to cut down to an hour but I don't want to do that. I'll ask my T if there is another way to bill it, but I doubt there is. I don't think she raised her fee, so why shouldn't she get $75 for another half session and not $125? Does this make sense?

There were some changes made recently that seem to be hitting all of us stateside. There was a thread all about it , Ill see if I can find it for you.

http://forums.psychcentral.com/showt...highlight=hour

[rainbow8]

Thanks, lola. If insurance can only bill for 45 mins. or 60, then does that mean I'm paying for 60 plus 45 but only getting 90? Then my T owes me another 15 minutes since she's getting paid for it, and I'm paying for it in my copay? I'm serious. Does that make sense or not, to anyone?

Your gonna half to talk to her Rain.

[sunrise]

Rainbow, this is my understanding of the new billing codes:

OLD / NEW
20-30 min / 30 min (16-37 min range)
45-50 min / 45 min (38-52 min range)
75-80 min / 60 min (53 or longer min range)

Even though the appointments are listed as either 30, 45, or 60, the CPT manual does provide guidance for billing and gives ranges, which I put in parentheses above. The APA says, "In general, you should select the code that most closely matches the actual time spent" with the client. So if a therapist spends 50 minutes with the client, they should select the 45 minute appointment code, since this covers appointments 38-52 minutes in length.

Rainbow, since there is no code that is a close match to a 90 minute appointment, it sounds like you are now being billed for 1 60 minute appointment and 1 30 minute appointment. Probably in the past,with the old codes, your T was fudging a little and billing you for 1 75-80 minute appointment when you were actually getting 90. I think an alternative to how she is billing you now might be to charge for 2 45 minute appointments instead of 1 60 and 1 30. So you could check to see which of those alternatives is cheaper. But it also could be possible that there is some prohibition on charging for the same service twice in one day.

One thing I notice is that the allowable ranges provide for appointments up to 7 minutes longer than the stated time. So the 30 minute code allows the appointment to last up to 37 minutes, and the 45 minute code allows the appointment to last up to 52 minutes. By extrapolation, a provider would use the 60 minute code for up to 67 minutes before needing to add a second service. So technically, I think your T could provide you with a 67 minute appointment at something close to your old rate. So this might be the way for you to go in striking a balance between maximizing time and minimizing cost.

Originally Posted by rainbow8

I don't think she raised her fee, so why shouldn't she get $75 for another half session and not $125?

Because your time with her is not billed by the minute, it's billed by the session.

[SallyBrown]

I can't quite tell if your question is about how much she gets paid, or how much your copay is. The two things are not related to each other. The copay is set by BCBS, and so you'll just have to talk with her about how to minimize that. If all you're paying is a copay, what does it matter what BCBS reimburses her for?

I'm not an insurance expert, but I strongly doubt she gets reimbursed for $150. She probably gets $75 or $90 or something like that. It probably says on your BCBS statement. For instance, my T charges $200 per appointment, which is what you would pay if you're uninsured. If you are insured, he gets about $90 instead, plus the copay. As far as I'm concerned he can ask BCBS for as much as he wants; my copay isn't going to change, unless the number of sessions or billing code changes (or BCBS decides to change it).

I'm sure she'll be happy to talk to you about how to organize your billing so that the burden on you is minimal. But I wouldn't start trying to be punitive about how much she charges for a half hour ($125 vs. $75) -- you're not the one paying for that, and she may well have a perfectly good reason to have adjusted her fees in that way.

I know they do not get reimbursed the whole fee from the insurance company...they get paid the "agreed upon fee" (I think it's called) from the insurance company...and in some cases it's AMAZINGLY low.
I had a T who said he was only keeping my plan for me and a few others and that they were difficult to deal with and not really worth his time...I could see online what he was getting, and frankly, he was right (assuming he had billing issues with them as well like he said...I know I have had LOTS of issues with my plan).
Regardless, make sure you get all the time you should be getting while in there!

[anilam]

Originally Posted by rainbow8

Thanks, lola. If insurance can only bill for 45 mins. or 60, then does that mean I'm paying for 60 plus 45 but only getting 90? Then my T owes me another 15 minutes since she's getting paid for it, and I'm paying for it in my copay? I'm serious. Does that make sense or not, to anyone?

I don't know much about insurance. However, billing for 105 mins and giving 90 mins session is a fraud and I don't believe your T is doing that.
Try to talk to her about that- she surely can explain that to you.

[Littlemeinside]

Based on another thread, you expect her to respond and read your emails between sessions for free? Would you prefer she charged you for that too? Give and take a little here.

[sunrise]

Rainbow, I've been reading some more on this issue, and I don't think what I wrote earlier was correct with regard to your bill possibly being for 1 60 minute appointment and 1 30 minute appointment. (I think this was your assumption too.) I do not think it is permissible to bill for 2 separate appointments when it was truly just 1 long appointment. The 60 minute code for psychotherapy is to be used for all therapy appointments 53 minutes and longer. So if your therapist chooses to give you 90 minutes, she still has to use the 60 minute billing code.

Beyond talking with your therapist about what the second charge is for, you could ask the insurance about your bill and request the CPT code for each of the charges. The new CPT codes for psychotherapy are 90832 (30 min), 90834 (45 min), and 90837 (60 min). If you have a different code than these, you can look up online what that is for.

[elliemay]

You still pay 1/10 what I pay and you get a longer session.

My new pdoc charges twice what my therapist does.

I would let this sleeping dog lie if I were you and count my blessings. If she's willing to handle insurance for you and accept a co-pay, you are very very lucky.

[sunrise]

Originally Posted by elliemay

I would let this sleeping dog lie if I were you and count my blessings. If she's willing to handle insurance for you and accept a co-pay, you are very very lucky.

I must admit, there's a lot of wisdom there, as you pay only $37 for 90 minutes. (I pay over 5X that amount!) I think if you do need to know, you could just not bring it up with your T at first (or maybe ever) and just ask your insurance company what the CPT codes are for the 2 charges you are seeing on your bill. That will tell you a lot.

[Fixated]

I don't know if you should worry with comparing what you pay to what others pay. I guess it is always good for us to know we are blessed to receive quality care, but this is a change to your system of knowing. I think it is okay to have some reaction and questions, especially if it was not discussed with you at all.

[SallyBrown]

Rainbow, I've been thinking about this further and I think that I may have slightly misunderstood your angle on this, although I still stand by what I said earlier.

I totally get your being confused about this charge. Insurance baffles me. It truly is strange that she managed to charge you twice on the same day. Could even be some kind of odd mistake. Who knows, it's all a mess all over the place right now with insurance. I think you ought to talk to T about it -- I have brought in statements to both T and pdoc before because they are really, really confusing sometimes. The last thing you want is some kind of error to linger there. And, even if it's small, you shouldn't have to pay more of a copay than you've actually incurred. So, it's a worthwhile question.

But what I'm wondering is, do you think maybe you're looking for other ways in which T has "cheated" you out of something? Like the e-mail? I realized later that maybe when you were talking about $125 vs. $75 it might not be so much about how much she got paid as trying to figure out exactly what the charge was. It seems the focus is on your feeling she might "owe" you more time. In which case, this may just be your hurt feelings playing out in a different way.

[rainbow8]

I agree it might be best not to bring it up with my T, but here's the way it looks on my Explanation of Benefits forms:

In one form Sept., 2012, amount charged is $150. The allowable charge was $129.50 and my coinsurance (copay) was $25.90. They paid her $103.60. It's been that way for 3 years. The one charge per visit.

Now, in 2013, they have 2 amounts for the same date.
Amount charged; $150.00, allowable charge $128.10, coinsurance $25.62, amount paid to her, $102.48.

Amount charged: $125.00, allowable charge $58.10, coinsurance $11.62, amount paid to her, $46.48.

Then it's added up to a total of $275.00, allowable charge of 186.20, copay 37.24 and amount paid $148.96.

I THINK my T charges $150 for 90 minutes. So, now she's getting $186.20 instead. I think I can ask to pay my former copay unless she raised her fee to $186.00. Does that make sense or not? She wouldn't charge a weird number like that! Her website says $125 for an hour, I think, but that's old. So I will ask her tomorrow if I get to it. I hate spending time on her fee!! My H wants me to pay her $2.00 since that would add up to $150. He's very logical, but of no help whatsoever. He also said to go back to one hour, that 90 minutes just means I can tell her "I love you" more. He, my H, can be so hurtful!!! He's mean and when I tell him that he doesn't understand. I make use of that extra 30 minutes and it would be hard to cut back to 60 minutes now.

[rainbow8]

Originally Posted by elliemay

You still pay 1/10 what I pay and you get a longer session.

My new pdoc charges twice what my therapist does.

I would let this sleeping dog lie if I were you and count my blessings. If she's willing to handle insurance for you and accept a co-pay, you are very very lucky.

I paid my former T $100/session for more than 5 years. My H lost his job during that time and is now officially retired. I couldn't afford that fee anymore.

[rainbow8]

Originally Posted by SallyBrown

Rainbow, I've been thinking about this further and I think that I may have slightly misunderstood your angle on this, although I still stand by what I said earlier.

I totally get your being confused about this charge. Insurance baffles me. It truly is strange that she managed to charge you twice on the same day. Could even be some kind of odd mistake. Who knows, it's all a mess all over the place right now with insurance. I think you ought to talk to T about it -- I have brought in statements to both T and pdoc before because they are really, really confusing sometimes. The last thing you want is some kind of error to linger there. And, even if it's small, you shouldn't have to pay more of a copay than you've actually incurred. So, it's a worthwhile question.

But what I'm wondering is, do you think maybe you're looking for other ways in which T has "cheated" you out of something? Like the e-mail? I realized later that maybe when you were talking about $125 vs. $75 it might not be so much about how much she got paid as trying to figure out exactly what the charge was. It seems the focus is on your feeling she might "owe" you more time. In which case, this may just be your hurt feelings playing out in a different way.

No, it's not my hurt feelings this time. I admit I'm jealous of her making a lot of money since I've never earned more than peanuts at any job I've had, professional or not, but...this is strictly a case of: what are they doing? Did her fee go up? Why did my copay go up and they're paying her MORE than $150? It's the change from the years before when she didn't tell me her fee went up. In fact, I did ask her about this already but she didn't have an answer. We didn't discuss it at all. I said we'd figure it out when I got back home. So, here I am. Maybe she was getting too little before. I won't pursue it if that's the case, but I really think my copay should be the same as it always was.

[Perna]

You have to talk to your insurance people; it's not a "law" of any sort, it's just what they have decided to do/a new "standard" and some insurances/doctors are doing it and some not.

90 minutes sounds like 2, 45-minute sessions, back-to-back, to me, I use to pay, out-of-pocket $190 for 100 minutes I remember. I'd go once a week instead of twice a week.

[SallyBrown]

Originally Posted by rainbow8

No, it's not my hurt feelings this time. I admit I'm jealous of her making a lot of money since I've never earned more than peanuts at any job I've had, professional or not, but...this is strictly a case of: what are they doing? Did her fee go up? Why did my copay go up and they're paying her MORE than $150? It's the change from the years before when she didn't tell me her fee went up. In fact, I did ask her about this already but she didn't have an answer. We didn't discuss it at all. I said we'd figure it out when I got back home. So, here I am. Maybe she was getting too little before. I won't pursue it if that's the case, but I really think my copay should be the same as it always was.

Again, the copay isn't your T's decision. It's Blue Cross's decision. And that decision is independent of your T's fee. This has absolutely nothing to do with her fee, and her fee doesn't really matter because you don't pay it. You pay the copay.

It seems like you really, really resent her making more money, even though your contribution to it would be the same regardless of how much she makes. Why should her fee NOT go up? She does have a right to make more money if she can, you know, just like we all do. And I can see her not telling you her fee went up because you don't pay the fee. You pay the copay. The amount of which is not her decision or under her control.

You should make sure you are not being double-charged for your copay through some kind of glitch. Your T may even be able to accept less than your actual copay if you really can't afford it, and that is a discussion you will have to have. But your resentment of how much your T makes *even though it has nothing to do with how much you pay her* is rather mean-spirited, and goes pretty hard against how much you claim to value her.

[adel34]

Hi Rainbow,
Insurance is so confusing! Half the really good therapists aren't on it because there are so many weird things going on. Blue cross is a good plan though, I mean there's a lot of choice in who you can see.
I would talk to her about this tomorrow. Hopefully she'll have an answer or maybe she can talk to the insurance company for you.
II think your husband is really mean sometimes. What you say in therapy isn't any of his business! Hope things work out tomorrow.

[likelife]

If you pay coinsurance, and not a copay (depends on your plan), it would make sense that your portion would increase as your T's fee increases. It would be nice if the whole insurance thing were a lot more transparent (on their end). Seems like a pretty ridiculous system sometimes.

[blur]

Originally Posted by rainbow8

I agree it might be best not to bring it up with my T, but here's the way it looks on my Explanation of Benefits forms:

In one form Sept., 2012, amount charged is $150. The allowable charge was $129.50 and my coinsurance (copay) was $25.90. They paid her $103.60. It's been that way for 3 years. The one charge per visit.

Now, in 2013, they have 2 amounts for the same date.
Amount charged; $150.00, allowable charge $128.10, coinsurance $25.62, amount paid to her, $102.48.

Amount charged: $125.00, allowable charge $58.10, coinsurance $11.62, amount paid to her, $46.48.

Then it's added up to a total of $275.00, allowable charge of 186.20, copay 37.24 and amount paid $148.96.

I THINK my T charges $150 for 90 minutes. So, now she's getting $186.20 instead. I think I can ask to pay my former copay unless she raised her fee to $186.00. Does that make sense or not? She wouldn't charge a weird number like that! Her website says $125 for an hour, I think, but that's old. So I will ask her tomorrow if I get to it. I hate spending time on her fee!! My H wants me to pay her $2.00 since that would add up to $150. He's very logical, but of no help whatsoever. He also said to go back to one hour, that 90 minutes just means I can tell her "I love you" more. He, my H, can be so hurtful!!! He's mean and when I tell him that he doesn't understand. I make use of that extra 30 minutes and it would be hard to cut back to 60 minutes now.

rain, it sounds like your T may be submitting the charges so the allowable charges add up to ~$187.5 which is what 90 minutes would cost if she just billed it without insurance and going by her website hourly rate of $125 ($125 (hour) + $62.5 (half hour) = $187.5 (90 minutes)). her allowable charges 128.10 + 58.10 = $186.2. that is probably as close as she could get it to $187.5 without making the figures she put down for the amount charged sound weird and illogical like charging figures with cents. she probably started from the allowable charges and worked backwards to the amount charged to be able to get properly compensated according to her website hourly rate of $125.

[rainbow8]

Thanks, blur. That makes the most sense of all. So all this time I was getting a bargain price for 90 minutes, I guess. I still want to ask her if I can pay the same copay as before or my H will make me go to 60 minutes per session. She has someone do her billing and I think she's the one who figured it out. My T is not so great with fees and numbers, just like I'm not.

[rainbow8]

I talked to my T about it today and I'm still confused! I forgot what she said her fee is. I think it's $275 for 90 minutes, $150 for 60 though that doesn't make sense. I asked her and she told me, then she went on to talk about the insurance and how it's billed, and I lost her! I was tired and sort of spacy. She said it's billed as two parts or something. I guess before she could only charge $150 for 90 minutes? She also said, what we posted about in the other thread, that many Ts are reducing their time because of the change in the coding or whatever it is.

However, the bottom line is that she said to pay what my H and I feel comfortable with! She's a nice T! My H thinks I should quit so he's still angry about how much she charges. You'd think he'd be happy, but no! So I can pay what I was paying her before.

She says her fees are on the low end.
I commented to her that her website hasn't been updated for a long time.

[SallyBrown]

Originally Posted by rainbow8

I talked to my T about it today and I'm still confused! I forgot what she said her fee is. I think it's $275 for 90 minutes, $150 for 60 though that doesn't make sense. I asked her and she told me, then she went on to talk about the insurance and how it's billed, and I lost her! I was tired and sort of spacy. She said it's billed as two parts or something. I guess before she could only charge $150 for 90 minutes? She also said, what we posted about in the other thread, that many Ts are reducing their time because of the change in the coding or whatever it is.

However, the bottom line is that she said to pay what my H and I feel comfortable with! She's a nice T! My H thinks I should quit so he's still angry about how much she charges. You'd think he'd be happy, but no! So I can pay what I was paying her before.

She says her fees are on the low end.
I commented to her that her website hasn't been updated for a long time.

Fantastic! I'm glad you get to pay what you did before. Really wouldn't have been fair for her to change it to two payments without telling you first, and it's a testament to how much she cares that she wants to make this doable for you.