session update and insurance rant

Okay so many of you know that my insurance company is on my last nerve.

At today's session, I learned that they demanded a graduation date for my therapy. T and I have not discussed a graduation date definitively and quite frankly, I am beyond mad that they demanded this. This should be up to me and my T...

So, he gave them one and I'm not mad about it. He had to do what he had to do. They haven't called him back since.

Luckily, we are changing insurances from an HMO to a PPO and this policy has unlimited outpatient sessions. It will cost us more with the deductibles etc. but it is so worth it. It will be effective by July 1st.

Overall my session went well. I told my T that I have been thinking about his past comments about my needing to learn to be assertive rather than aggressive. I said that I was starting to do that last session and how uncomfortable it was.

He commented that he can see that it was helpful for me and he seemed glad that I said what I said about how I've been worrying about him trying to get rid of me and the insurance issue seemed to confirm it in my mind.

I also told him that my husband commented today 'oh you must be seeing Dr. T today you are wearing a skirt'. I told him that he was joking around with me and I know he didn't mean anything by it.

All my T said was 'oh gosh tell him it would be a crime for me to sleep with you'...it isn't necessary though. That isn't what my husband meant. He was referring to my dressing up to see my T. Things are going much better with my husband and we are talking about a lot more.

T asked me why I think things have improved recently? I'm pondering this. I said because I've been sharing more with him about the sessions and he likes hearing about it. I am also focusing on being more assertive with my husband and not critical or aggressive so maybe he's responding better to me. He is just trying more overall.

Well, have a good day everyone. My goal for the rest of this week is to not look for some hidden negative meaning in anything that my T said today. I can't wait to see him again on Tuesday! I'm hoping I can say more about how I feel about him.

We'll see....

I just wrote out a response to this and lost it. Grrrr. I hate that. I'll try to post again later.

almeda, I guess it's not unusual for an HMO to request a graduation date. It's so good your T has shared this with you so you can quit wondering. Now you have all the information about what has been going on. Did he tell you what date he gave them? He must hate this stuff as much as you do. (((hugs))) That's great you will soon be switching to a PPO that pays for unlimited sessions. That is very good indeed! I have insurance through 2 different PPOs and neither pays for unlimited sessions. One pays for 12/year and the other 20/year (but neither will reimburse for my T).

Wow, can't believe your T said "oh gosh tell him it would be a crime for me to sleep with you." Guess he is very direct!

Overall, it sounds like you had a good session. The assertive/aggressive distinction is always difficult. Sounds like you are making great progress!

Hey Sunrise, he said he gave them a Dec 07 date. I was like 'we aren't doing that are we?'...it doesn't make any sense. Some clients go to therapists for years and years and I can barely get over a year...

Maybe they pay out of pocket though. Which I would do, he's worth it to me. Yes, he is direct. Honestly, my husband wasn't insinuating that at all. I'm kind of sorry I told my T that now...it was just a joke but his response to it makes me think he took it seriously...

Ah, another week before I can clear that up...great...

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almeda24fan said:
Hey Sunrise, he said he gave them a Dec 07 date. I was like 'we aren't doing that are we?'...

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And what did he say when you asked that? Was he just giving the insurance that date to pacify them but doesn't mean to stick to it?

My therapist has told me he really just does short term therapy, which he considers to be less than 3 years. I think I will fit into that category.

Well, let's see if I can remember exact words. It was to pacify themand then I think he said something like 'I didn't ask them what if you aren't ready by then'...

I did wonder, because that is what I do, if he does want me to graduate by then but I doubt he would go to all of this trouble to tell me that. Also, I told him that we will be on a PPO last session and he was happy and ran out to ask his assistant which was better a POS or PPO.

I told him the sessions should be unlimited so we'll see. My plan is to sometime soon go every other week instead of weekly. I'm nervous about it though...

almeda24fan,

LOL at your T. His giving them a Dec 07 date keeps them off his and your back for the rest of the year!! Kudos to him!!!

Stupid insurance companies.... grrrrr..

I'm so glad it went well and the nagging insurance issue has been brought out into the open. It feels so much better to know rather than to wonder and worry!

ECHOES

hey. yeah, insurance companies can get a bit tetchy if therapist says that they think they need to see you for a significant amount of time. if they get too many of those they might take him off their 'reccomended' or 'approved' provider list because he will be costing them too much! better to give them a fairly short time just to make sure the funds keep on rolling in for the time you need them from that company. i'm sure he isn't taking it seriously :-)

I just hope that when I get on to this new PPO even though it is still the same insurance company, that they will leave us alone.

This has really been impacting my mood and progress. I didn't want to tell T that yesterday because I want him to keep me informed. Although, I was the one who brought it up yesterday. I don't think he wants to focus on it but I still need to know.

As I read some of these posts, I can't believe insurance only covers a few sessions or none at all. Mental health is just as important as other medical conditions and can be just as delibilitating It is unfair what they put therapists and clients through...how is this helping any of us???

Hey. When I was working with psychologists at community mental health they were under considerable pressure to keep therapy within the 6-12 weeks timeframe. So initially... We would do this little assessment listing the symptoms I wanted help with (as targets for treatment) and then we would assess progress every 6 weeks. The therapists told me not to worry about termination - they could keep extending it for one, two, three years... They just needed to say that yes there had been some benefit and that I would profit from more time. I'm just telling you this to convey the notion that bookkeeping for third parties (community mental health, insurance companies) is one thing and what happens in therapy can be quite another. Do talk to him about this if you think he might feel pressured into terminating you, though. I'm fairly sure he isn't going to (he was happy about your changing insurance plans). But still, would be nice to check what he envisages...

Regarding the 'mental health is as important as physical health' thing I guess a couple of factors come into play... Is therapy for depression more like treatment for heart failure or treatment for a funny nose that one finds distressing or treatment for fertility... I just mean to say that it is jolly hard to find the comparisons and it is jolly hard to place therapy on the 'necessesary for survival' vs 'elective' continuum... Part of what comes into play (I'm fairly sure) is how objectively affective therapy has been shown to be. Then you weigh the cost of that effective therapy with the cost of effective treatments for conditions that are more clearly on the 'necessary' end of the spectrum and... Well... It is sad :-( But when you have a limited amount of resources and you have to decide how to allocate them across conditions... I can see why it is that health insurance companies are more keen on a quick visit to p-doc and some medication than they are keen on open ended therapy visits. It is hard... But... I can see it from both sides is all.

Alex, I did kind of get the impression that he felt pressured to give them a term date. He said they demanded it. I'm glad he made it far in the future but part of me was sad about it.

It's also confusing to me because he does have long-term patients and I kind of felt like he doesn't want me to be one of them. He was very excited about me changing insurances two sessions ago. This recent session he didn't say too much but he did confirm that a PPO is much better. I asked him if he thinks they'll leave us alone and he said probably.

I like that your therapist was like 'don't worry we'll handle it'. I really didn't get that feeling from mine. He did say 'we'll fight for you' two sessions ago but also said in the same session that he thinks it is appropriate to talk about reducing sessions. I was so close to crying at that point.

I hate that we are focusing on this. It's having an impact on me. How can I trust him more when I feel like I'm not supposed to be there? I think after Tuesday's session, I'll tell him I'll go to every other week. I feel awkward going weekly now and don't want him to initiate it or the insurance company.

So hard as it will be, I'm guessing I should do that...

My ins. co. through my husband's work authorized my meds provider & therapist to continue working with me last year. I also got a new authorization # for them this year. But when the bills came through they paid nothing. I spent a week on the phone trying to straighten it out, & you're right, the stress & aggravation are causing my mental health to deteriorate.

My husband has now taken over & will talk to the HR guy at work. This is supposed to be the mental health division of the ins. co. & from my experiences they are far from promoting good mental health.--Suzy

Hey Almeda!!

I'm so glad that things are getting better between you and your husband.

I can't imagine how stressful it is to have that insurance thing loomimg over in therapy. I can totally see how that would effect your mood with T.

Sounds like you are making progress by really trying to improve things outside of therapy. That's always the most difficult part, I think. You can talk about things with T, have a great understanding of it, but then it's like-- what do you do with it once you leave that room?

How have you been feeling since your session?

Hey Pink, I just saw your awesome session post!

As for how I'm doing? It's been up and down as usual.

I just remember how happy I was a few sessions ago when he said come 2x per week and now I'm contemplating every other week. It just hurts too much waiting for him to show signs of caring again. It took a long time for us to just get to that point where I was starting to feel closer to him and safer.

So, if I move the sessions myself maybe I'll feel more in control of my emotions? I just feel lonely like the one person who knew me and accepted me is pushing me away...he doesn't want to foster an 'unhealthy dependence' whatever that means. I can't help but feel like he's caving to insurance pressure but who knows.

It is going well with my husband. I'm happy about that.

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It just hurts too much waiting for him to show signs of caring again.

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almedafan, what are signs of caring that you are missing from your T? Is it just that he has suggested that your sessions not be so frequent? Or is he not listening to you anymore? Or maybe he is not empathetic anymore? Is he judgmental? Negative? Discouraging? Lacking in warmth? What is missing now that was there before? I think this is a serious topic to take up with your T, that you think he doesn't care anymore.

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he doesn't want to foster an 'unhealthy dependence' whatever that means.

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I think you should ask him what he means. Does he think that seeing him more than once every other week will create this unhealthy dependence? What do you think? Can you ask him what has been his experience before in therapy with clients that develop a strong attachment to him? How does that usually play out? I am sure he is very experienced at dealing with this, as all T's must go through this time and time again. What can he do to move your attachment in a healthy direction (as he sees it)? I think this is a huge topic and you need to clearly understand what he means. And since he is the expert, he should have ideas for how to guide the relationship in a healthy direction (in his opinion).

Please don't just guess at what he means and reduce your sessions because of a vague statement from him. You need to understand this so you can do the best thing for yourself.

Hey Sunrise,

I guess what I mean is when he suggested 2x per week, it felt like he cared and saw me and the pain I am in. Then, as we know, it changed the next week. We did talk about it and he said 'you don't think I care about you?'...and I said 'I don't think anybody does'...

I did ask about the unhealthy/healthy dependence and I'm not sure he finished that thought. I can't remember if he did anyway. I also said that I need to feel like my 'attachment' is okay and that I don't always think it is because of perceived hesitation on his part...he said it was okay but again I need to feel that it is...what will that take? Maybe a similar exchange like Pinksoil and her T just had...in her recent post...

Actually, I am feeling from him what I see in my dad and my husband...I'm wondering if I created this somehow...or expect to feel this so I look for it in every word, unspoken word, etc. I'm left wondering all the time by my dad and husband. Do they care? Do they love me? Accept me as I am?

I agree this needs to be resolved but I am growing tired. I feel like I try to cover this and sometimes come out with more questions than answers...again is it me or him or the process? I don't trust my feelings anymore on this subject.

But no he isn't being negative or anything like that. I'm just avoiding the topic with him right now and think if I reduce sessions then I'll get some of my control back of my emotions. Then maybe I won't feel so empty...

Okay Sunrise, I'm going to try and be assertive tomorrow. I'm going to use your questions, with my own spin of course and see where we land.

I'm terrified though. Here is where I'd like to go tomorrow:

(1) I plan to say how all of this insurance stuff and talk of reducing sessions and setting graduation dates is affecting my progress. This is what I am focusing on now when I have other issues to talk about.

(2) I need to say that I'm hurt because he seemed to agree with the reduction of sessions. He also gave them a graduation date and didn't think to ask what if I am not ready by then. why not? Am I their client or his?

(3) I need to bring up that I feel weird now going weekly and that any day he or the insurance will make the decision for me. And that will have a bad affect on me. Just when I thought that I was getting closer to him and trusting more, it was ripped out from under me.

(4) I was planning to come in tomorrow and reduce sessions on my own because of all of this. Not because I'm done but because of this situation.

I'm scared to say any of this because I don't know what his response will be. I want to say this in a way that doesn't insult him as a therapist but he needs to know it. How can we move forward unless I do this?

My inspiration to do this will be because of all of you and the courageous sessions you have had. What is the worst thing that could happen? He could say fine I can't help you anymore apparently. He's never said this to me but he might tomorrow.

I need to prepare for this response...eeek!

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almeda24fan said:
Okay Sunrise, I'm going to try and be assertive tomorrow. I'm going to use your questions, with my own spin of course and see where we land.

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Almedafan, your questions sound great, but they weren't my questions at all! (My questions weren't about the insurance/reduction in sessions, whereas yours seem to focus on that.) I am really glad, though, that you are going to discuss the insurance issue and all the uncertainty and stress it is causing you. It will be so helpful to you to resolve that. Plus, since you are asking your own questions, you don't get to throw tomatoes at me if things don't work out! LOL, just kidding. You will do great. (((hugs)))

Excuse me if I am not remembering this right but isn't your insurance going to change somewhere in all of this?

Sunrise, I should've clarified I am using your questions to me that made me think of the questions above...ah, I probably didn't even need to type any of that. sorry!

Secret, well yes the insurance will change in July. But I need to say some of this because what if the new insurance gives him trouble and this all happens again? Besides it's only April and if I feel uncomfortable now shouldn't I address it?

I am glad that you asked this question of me. Maybe I need to re-think this latest obsession...

Thanks gals!

I do think it is important that you address this with your T and it is curious as to his behaviour particularly if he also knows your insurance is changing.

I have to say that I have gone through times that my insurance had decided not to cover...(over the years) for reasons that currently escape me. My T was willing to let me keep going...as I REALLY needed to and racked up a thousand or so in charges. I did pay those off in time. I think there is sometimes a fine line of what a person can afford but that should be something to discuss and not assumed. And... from what you told me.. you will have coverage.

That being said, you apparently have concern and you might as well address it point blank.

I hate the idea of a graduation date. Who came up with that term... (hope not you... :-) ) I just think that I would feel clipped with that happening... and it has happened to me before so that helplessness feeling and anger, frustration, etc.. is one I can relate to.

I even had a time that my pdoc told my insurance company that all of this hubbub was indeed affecting MY progress. I understand.

I would guess that he is as frustrated as you are...I think...at least as your advocate he is probably feeling a little ticked and emasculated by this crapola.

Work with your T, advocate for yourself and express how you are feeling. Try to go in assertively rather than aggressively ... though you can express your aggressive, etc... myriad of emotions over this.

You have reason justly to feel all that you are feeling.

I think you also have a right to ask questions of your future insurance though benefits can change... what are the limitations, is your T par, are auths needed, are the visits and monies limited and howso?

Hang in there. Keep talking to us.

Thanks Secret, I needed to think about all of this again. I was planning on going in there tomorrow and shutting down to protect myself.

I know with the future benefits, it's a PPO and outpatient or even inpatient sessions are unlimited coverage. So maybe what is the point of me talking about this anymore...

As for the graduation date, that is his term. I don't think he likes to use the word terminate. I don't even want to think about graduating...this is part of what is taking a toll on me.

I'm just wondering, at what point will someone want me around and not try to get me to leave? The list is endless of people throughout my life that have rejected me. does it really have to be my therapist too? My ex-husband recently contacted me and I can't even type out what he told me after years of not hearing from him. The short version...he is sorry that he never loved me and just didn't want to be the one to end it.

That is seven years total wasted of dating him and being married to him. I stayed way longer than I should have to work on that marriage because I thought he wanted it too. So you see, this just keeps happening over and over...

I totally know that I am whining at this point.

Okay so tomorrow I'll re-focus. I need to determine what the real cause of all of this is. Maybe that is the opening line...

Thanks Secret!!!!

Yes.... it is all relavent... The emotions and the associations. Do not feel that this does not need to be talked of. It is all important and part of the journey you are taking.