[tealBumblebee]

Does a T get more money when they use insurance? Here's a hypothetical example of my situation not using 'real' numbers, but exact proportions.

In the beginning, T didn't take insurance and charged "$500". T used a sliding scale and I paid $192 of that. With changes/accreditation, etc. T's price went up to $658 and my price remained the same.

T no longer takes sliding scale, and i'm still paying "$192" out of pocket when her now normal fee is over $650 - which leaves about an 70% adjustment. If I switch to insurance, they pay 80% of the fee after deductible and my copay would be like 18% of the total fee (about $119 in this scenario) - I don't know where the rest of the money goes.

So, seeing as I would be paying less to T when filing insurance - would she still technically be making more money via insurance regardless because she's getting my payment and theirs; even though there is some money missing somewhere?

Edit: I'm not sure why there is an angry face there - total accident.

[Wysteria]

Okay...I'll use "real" numbers... (RANT ALERT)

My insurance company only pays T's the "market rate" of like $45-65/hour. The real rate that almost every T I know of is more like $110-$145. And SW, LC's etc think that they should be paid same rate as T's with PhD's....

So, if my T took insurance, he would have to be "processed" and fill out all kinds of paperwork for ALL the different insurance companies. He would have to deal with "filing" paperwork every time a patient came in. He would have to answer endless calls and questions about how he practices and whether there is a real "need" for me to see him. He would have to rebill and keep track of all the monies paid and not paid and the mistakes by the insurance companies and bs...

He still has other patients to deal with and his daytime hours are filled with taking care of patients and some groups at night. Thus he would have to fit in in all this paperwork on his own time or between clients or use billable time to deal with my insurance company and their "processes".

In the end...he would get like $45 from insurance and I would still have to pay the $30 copay. Thus he nets $75 and a HUGE waste of his time.

He still has to pay for the office, insurance, general admin costs...and eventually would probably have to pay for an office administrator to deal with the paperwork...and thus payroll taxes and a bunch of other crap.

ON the other hand, and as 90% of other Therapists have ended up doing...they just charge cash and deal with some special clients with a sliding scale for those that really need help. If at all.

He still has student loans to pay off, the mortgage, business expenses, transportation and all the other lovely things that take money in this world.

So if you, on a sliding scale pay him $65 dollars, he is still short the other $60 he could make dealing with cash clients. And would be short the $10 that he would have made if he had filed insurance and finally gotten paid sometime down the road and wasted hours on paperwork.

Meanwhile...you also have to meet your annual deductibles for individual or family (typically @ $1000 to $5000) and thus your first say 20 + visits you would have to pay the full $75...or until your deductible has been met.

In the past, there has been a "special" deductible just for Psych stuff...so you actually had to meet two...one medical and one psychological. (oh and by the way...you are only allowed 10 T visits a year and 2 pdoc visits by your insurance unless you have a special rider ($$$) for extre psych care...!!! )

Or you can pay cash all year and take a big deduction on your income taxes at the end of the year...if you file long form. It has actually helped me quite a bit, but cannot make up for the amount I spend on psych visits, T visits and medication copays.

If you were a Therapist....which would you choose to do?
There are NO easy answers, but most T's have given up on the system and only work with paying clients...and my T also answers emails, phone calls and talks with my other psych providers to help me get good care. All that time also comes out of his "billable hours" or budget and his personal time with family or friends....and should be considered when looking at the $125 he charges me per hour "in the chair"...

I hate this system!!!!! But I have had to go into debt to try and make ends meet and get the help I need. Hopefully the Obamacare mental health parity rules will help all of us get the care we really need....not just 10 visits a year even if you are sui and have major psych illnesses...

Wysteria Blue

[HazelGirl]

The extra time and hassle of dealing with insurance companies more than balances out the "extra" they might be making. A lot of the time, they don't even make as much through insurance, and still have to do extra paperwork. They only do it for the clients who want to use insurance.

[JustShakey]

I used to do some medical billing. Insurance companies are horrid. They always seem to pay less than what even a reduced cash pay patient would pay and will wiggle out of anything they can. I can only imagine what a PITA it is to get them to pay for therapy of any duration at all.

[tealBumblebee]

Well the whole reason I asked was because T suggested it to be something to look into. I am paying out of pocket only 29 percent of the price that everyone else pays - she doesn't have a sliding scale anymore. I imagine that insurance would at least cover more than the 30% that i'm paying.

She gave me the same conversation about limited sessions BEFORE she took insurance and said that was one reason why she didn't take it. Now she takes it and I just want her to make the most money she can that I can provide; thats my ultimate goal.

I know about the deductible and called and they said that there is no limit to the number of sessions. That it is equivalent to the same as any doctors visit and they cover 80%.

I'm just trying to do the right thing and have no idea which route to go.

My T's secretary says our insurance pays really well (and promptly) which sounds a bit like an unusual things for the insurance companies they deal with. They've never limited any of our sessions and have never not paid.

[Freewilled]

Could you ask your T? You could prob use your insurance and then if they were to cut you off at some point - then go back to self pay, right?

[tealBumblebee]

Originally Posted by 1914sierra

My T's secretary says our insurance pays really well (and promptly) which sounds a bit like an unusual things for the insurance companies they deal with. They've never limited any of our sessions and have never not paid.

The way the secretary seemed, it hasn't been a prob. She even offered to do some back pay for previous sessions since i've been had it.

Originally Posted by Freewilled

Could you ask your T? You could prob use your insurance and then if they were to cut you off at some point - then go back to self pay, right?

She knows i have a big thing about not paying her what she deserves (i've literally asked her to raise my price) but now that they are going up again I feel like i have to do something. Because i'm not paying nearly enough. Also she never has suggested it before so now that she has i'm like ok maybe it isn't so hard for her. However, i doubt i can go back to self pay at the same rate if i change so i'm gonna start saving up now to be able to afford the out of pocket bill at the beginning of the year. Now I'm anxious about getting fired and losing insurance and losing T.

[stopdog]

I don't believe a therapist deserves any specific hourly rate. They, like others in business, charge what the market will bear and what they think they are worth. What they think they are worth and what they can get sometimes match up and sometimes don't. I think the only real question is whether you can pay the amount the therapist seeks from you, and let them worry about the rest. If you cannot, then one may ask the therapist to charge something less. The therapist is free to make changes or not-but it is not the buyers problem to worry about what the seller charges. In my opinion.

[growlycat]

I am confused by it all. Now that insurance has dropped main T, I paying a little bit more, but frankly, he made lots more with the insurance.

[nottrustin]

It really depends on your insurance company and what your T charges. I receive a statement from my insurance company about all bills. T bills $140 per session my insurance company pays $41 and I pay $20....dd's T charged $100 a session. I have never seen T without having insurance but I know she would work something out with me. Because she has a private practice she pays somebody to do her billing where as if I just paid a flat out price then she wouldn't have to do with that added expense.

One thing which doesn't really have to do with your question but just something. T can write off the difference between what is paid by me and insurance and what is billed on her business taxes. So in my T's case she can write off the $79...in your sliding scale scenario T can write off the difference as well.

[ScarletPimpernel]

Originally Posted by Wysteria

I hate this system!!!!! But I have had to go into debt to try and make ends meet and get the help I need. Hopefully the Obamacare mental health parity rules will help all of us get the care we really need....not just 10 visits a year even if you are sui and have major psych illnesses

I don't know what type of insurance you all have and how far your T and you are willing to go.

I have full Medi-Cal (Medicaid) and a managed care insurance. My managed care insurance pays for my Pdoc (can see her every other week if needed). My managed care insurance also pays for a T once a week. But, of course, there are no T's currently with my managed care.

So I sought out a private T who accepts Medi-Cal. For some reason an insurance company called Optum oversees Medi-Cal therapy claims. Optum typically only allows 8-16 sessions a year for adults. If you need more, you're supposed to find other resources (i.e. county services, groups, clubhouses, etc.)

In my situation, I have no community resources available to me. So I went fighting. I wrote/called EVERYONE I could think of who might help me. In fact, I just found out that I went way overboard The head of Optum and the head of Medi-Cal are going to have a meeting...solely about my case. We're hoping they're just going to bypass the 8 session renewal, and let us have long-term therapy.

My total sessions approved are now 48. It takes a lot of time, effort, and energy to fight the insurance/government for what you need. But it is doable. The main thing is to do a ton of research, get a variety of people on your side (i.e. politicians, mental health professionals and organizations, advocate, obudsman, etc.), and be able to prove "medical necessity".

No one believed me when I said I could get more sessions. My T never knew and the Access and Crisis Line didn't even know. But now they know. So just because insurance gives you a limit, doesn't mean you can't push that limit.

If you're having financial difficulties, I hope you give this a try

There are also ways to get your insuramce to reimburse you for out of pocket charges. Don't know enough about that yet.l personally.