[InRealLife45]

Are T's OBLIGATED to continue seeing a client who files a coverage GRIEVANCE************* (not agreement).

?My T's contract was terminated and I filed a grievance against my insurance company to keep paying for sessions.

So I've been seeing her for the past 19 sessions under the assumption that they agreed to pay her/have paid her.

But tonight she told me they haven't paid her a dime since this whole thing started, they just keep SAYING they will.

So I asked her why she is still seeing me if she hasn't been paid, and she responded with, "Because... I have to." So I said no she didn't have to do anything, she could say no, and she said, "I do have to keep seeing you. I really CAN'T say no. You went to the BOARD and very specifically said "I want her to keep being my therapist," so now I have to keep being your therapist. I'm a part of the grievance process you started. I can't say no. Do you want me to say no, is that what this is about?"

Is this a rule for therapists paid by insurance? They can't stop seeing a client who files a grievance like mine?

[GingerbreadWoman]

If those were her exact words, then your therapist sounds like a real jerk. :/

I have never heard of anyone being obligated to treat any patient. Perhaps she doesn't understand how the law works with regard to this issue.

[HazelGirl]

No T is forced to treat a client. They must go through the proper channels to let one go or refer them to someone else, but they are never required to see a client they don't want to see.

[InRealLife45]

Originally Posted by HazelGirl

No T is forced to treat a client. They must go through the proper channels to let one go or refer them to someone else, but they are never required to see a client they don't want to see.

then why did she say that and why is she still seeing me? i am confused.

[JaneC]

She just sounds so unprofessional, and not at all like any therapist worth their salt.

Please for the sake of all that matters, your mental good health....get away from this woman!

[sailorboy]

I think what you're not asking is the more important question - are you obligated to pay her if your insurance company decides it won't? Review your contract obviously but my guess is yes.

[feralkittymom]

I'm not so sure. There may be something in the governance of grievance procedure in your state that mandates that the client's preference be honored until the grievance is adjudicated. Since they haven't paid her, I'm assuming despite what they've said, the grievance has not been formally settled.

I can see where this would make sense in a medical situation--say a patient was undergoing a specialist treatment at the time of the grievance being filed. It would work against the patient to have treatment interrupted, and probably require a new medical assessment for malpractice purposes, if for no other reason. So it is to protect the patient's continuing care.

You can check your state's Dept of Insurance, rather than the individual company, to find out how the grievance procedure works. There's also usually a time frame for the adjudication; I would have thought @ 6 months in most states.

[InRealLife45]

Originally Posted by sailorboy

I think what you're not asking is the more important question - are you obligated to pay her if your insurance company decides it won't? Review your contract obviously but my guess is yes.

I didn't ask that question, because it is not my question. I have no intention of seeing her for any further sessions that I cannot afford to pay for in cash.

I only want to know if there is some legal reason in the grievance process that she would HAVE to continue to treat me against her will, b/c that is how she made it sound.

[HazelGirl]

Originally Posted by feralkittymom

I'm not so sure. There may be something in the governance of grievance procedure in your state that mandates that the client's preference be honored until the grievance is adjudicated. Since they haven't paid her, I'm assuming despite what they've said, the grievance has not been formally settled.

I can see where this would make sense in a medical situation--say a patient was undergoing a specialist treatment at the time of the grievance being filed. It would work against the patient to have treatment interrupted, and probably require a new medical assessment for malpractice purposes, if for no other reason. So it is to protect the patient's continuing care.

You can check your state's Dept of Insurance, rather than the individual company, to find out how the grievance procedure works. There's also usually a time frame for the adjudication; I would have thought @ 6 months in most states.

It is possible that this is the case. Although I haven't ever heard of something like this applying to therapy.

[feralkittymom]

I think sailorboy was referring to the sessions you've already had since your T's contract was dropped. At least that's how I read it.

[feralkittymom]

It's possible since ACA went into effect, that provisions beyond coverage must be treated equally. Or it might be an insurance regulation that pre-dates ACA. I haven't looked into it as I'm still overseas and it won't effect me until I move back to the States.

[InRealLife45]

What is ACA? I'm not sure what question to ask to find out the legalities surrounding this.

[sailorboy]

Originally Posted by InRealLife45

What is ACA? I'm not sure what question to ask to find out the legalities surrounding this.

The ACA refers to the Affordable Care Act.

Listen, I get why you're asking the question. You want to know if she's only seeing you because she has to. I'm guessing probably not. But ethically therapists are bound to do no harm. If she feels you need treatment during the grievance process it would be unethical to stop treating you.

But a much bigger wrench I see in this process is that most insurance companies include a provision saying the patient is liable for any treatment outside the scope of coverage. They put you on notice of this a long time ago and u can't imagine 19 sessions out of pocket will be cheap.

My advice is to call your insurance company and ask what is going on with the grievance.

[InRealLife45]

They agreed to pay for six months worth of twice a week sessions a month ago. They just haven't actually DONE that. They keep promising but so far no payments .

[sailorboy]

Originally Posted by InRealLife45

What is ACA? I'm not sure what question to ask to find out the legalities surrounding this.

Originally Posted by InRealLife45

They agreed to pay for six months worth of twice a week sessions a month ago. They just haven't actually DONE that. They keep promising but so far no payments .

When is the last time you spoke to them? I would follow up.

[InRealLife45]

Monday. I was very politely Informed that they were simply authorizing sessions as the requests came in, and if there was a question of payment it was a conversation my T could have with their billing department, and was there anything else they could do for me. So that's a dead end, I'm not a provider and don't have access to billing department.

And my t says they just pass her from person to person when she calls, no one knows anything, they haven't figured out yet how to pay her.

[JaneTennison1]

My question is, if this therapy is not helping why fight to keep her as your therapist?

Sounds like it is doing more harm than good.

[Perna]

If you are truly in D.C., you have a weird insurance setup: disb | Department of Insurance, Securities and Banking

I lived in the District for 13 years and it would not surprise me if what your therapist says is true. If you know/have a lawyer, I'd ask them to give the Department a call, they'll suddenly solve the problem (I had an insurance problem with Georgetown Hospital back in the day and just writing their legal department a particular letter dictated to me by my lawyer friend did wonders).

[InRealLife45]

Originally Posted by Perna

If you are truly in D.C., you have a weird insurance setup: disb | Department of Insurance, Securities and Banking

I lived in the District for 13 years and it would not surprise me if what your therapist says is true. If you know/have a lawyer, I'd ask them to give the Department a call, they'll suddenly solve the problem (I had an insurance problem with Georgetown Hospital back in the day and just writing their legal department a particular letter dictated to me by my lawyer friend did wonders).

Perna our situation is complicated bc she opted out of Medicare and my insurance is Medicare. Bc I filed a grievance they agreed to keep paying, but they haven't figured out how to do that and remain in compliance with federal Medicare laws. So maybe they're trying to figure out what fund to pull from? I have no clue.

And no I am not in dc. I just wrote that there.

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