billing issue

My T said I would be getting an accidental bill in the mail, and just to throw it away, she changed to a new billing company. I got that bill in the mail today, and it was actually for one session in February. I was puzzled, why February?

It said date of service February 12, and what insurance paid for that session. Any other time I wouldn't remember off the top of my head, but this was the month where T canceled four sessions, and one of those sessions was desperately needed (although I did not tell her that). That date was February 12th. My mom's birthday. I always struggle over what to do on her birthday, and this was the first one with a therapist, so I planned to talk to her about it that day, but then she canceled (daughter problems).

I am quite sure this wasn't an intentional charge, but she got paid from my insurance that day. If it were you, would you let it go or say something? Since it happened to be my mom's birthday as the date in question, I remembered right away that she canceled on me that day.

I did Email her to let her know this, haven't heard back yet, but after I sent the Email I thought it could be taken as not as innocent as it was intended. I hope she doesn't take my Email as accusatory.

I am kind of confused about the facts but if you think she charged you in error - I would check it out.

If she said it was accidental then it's accidental. I am not sure why it needs to be addressed as she already said it is accidental bill. I am slightly unclear on the whole thing

Sent from my iPhone using Tapatalk

The bill is accidental, not the date.
She waived my copay, and this was a bill for a copay. I don't pay a copay. But this still says a date was charged to my insurance that I did not have a session.

Charging me for the copay was an error. Charging my insurance for that date is also...but don't think she knows this.

Check with your insurance company to make sure they did actually pay for that date. If the billing company got your copy wrong, maybe they had other issues.

I wouldn't worry about how she takes your email. You can clear it up if she gets defensive.

Something about this makes me think you mentioned another time you got a messed up billing that showed overcharging or something and it was around the same time she waived your copay. Sorry if I've got that wrong. Anyway, she's either a mess at billing or a genius.

Hope you're faring well during this break.

Oh I see. Check with your insurance and she should check her billing.

Sent from my iPhone using Tapatalk

Yes....that's why she fired that billing company previously, too many problems. She was too big and they were no longer able to keep up with her needs. So now she has a new one. Good memory, ruh roh! You remember exactly right!

I'm doing ok. A lot of soul searching. My next session is Tuesday. Thanks for your thoughts!

Unless you are limited to s certain number of seasons or if it affects you financially, I would just wait and see what she says about it. I personally wouldn't say anything to the insurance company unless I felt it was really necessary. I'm biased though and have never felt much sympathy for insurance companies, so what people do is their own business unless it affects me in a direct way. I had a T a long time ago that billed my insurance company when I didn't show for a couple of appointments. I knew he shouldn't have but since the alternative was probably charging me a hefty no show fee (often the full price of the session), I never acknowledged it.

Aw, this sounds confusing and upsetting. I know that anything that occurs on or around my mom's birthday is highly sensitive for me. I'm sorry this got brought up for you at a time when you are already struggling with your t relationship.

I see frequently here that people's t's waive their copay. I deal with insurance every day, and I want to mention that waiving a copay is considered fraud under federal and state laws. It is also expressly forbidden by most insurances unless you discuss each instance with them directly. The AMA (the organization I am associated with) considers it unethical. I believe the APA has similar conditions.

Personally, I don't have a problem with it and I occasionally waive copays in circumstances when I feel I can justify it but I am prepared to have to explain it and I cannot make it a regular practice.

I wonder if your t is having to justify her waiver policy with your insurance company and that is why these old bills are coming up. If she charged for a session that didn't happen and waived your copay she may be trying to explain that to them.

I hope his isn't the case. I think what you need right now is some stability with your t and the chance to work on your relationship. Money and insurance issues are a stressful enough without everything else you're going through.

Sending you positive thoughts and strength.

I hear what you're saying about insurance companies. I would have a problem with a therapist that billed for a no show or non-existent session, though. It's an integrity thing for me.

I didn't know waiving the copay was so common...I guess I haven't really seen anyone talk about it. I'm VERY grateful for it, wrong or not I guess. And really, my T has spent so much time Emailing and reading Emails that I should have just left it be like I didn't notice it. I pay a LOT for insurance so may as well use it as much as I can, I say. Make 'em pay! LOL

It did, however, bring up that date in my mind again, and how awful February was for me, emotionally and in therapy. February is when she shifted her boundaries. But I didn't question it till the first week in March. I don't even want to think about that month anymore...

In most other cases this is an issue for me too. When I first saw the statement I was confused at first but then realized what he was doing. I was stressed to the max and very poor at the time, so frankly I was grateful that he opted not to bill me, even if it meant he was doing something shady.

No one likes insurance companies. I promise you they are as much a headache for the provider as for the patient (I am both, obviously, and I know this is true)! However, when a provider decides to work with an insurance company they agree to abide by the rules. No one forces me (or your t) to take insurance. If she hates insurance companies then she would work in cash and just waive your fee. Plenty of t's do that.

I agree with the above- insurance companies are slimy and gross, but a provider with personal integrity stands by what they agreed to do.

Again, so sorry you are caught up in this.

I had this happen recently when my insurance EOB stated they paid a claim when at was on vacation and out of the county. I checked my insurance company website and that claim was no longer on the site. I assumed T realized the problem and had her billing person correct it.

You should have access - either by mail or online - to an EOB from the insurance company that will outline the date of service, what service was provided, and how much they paid for it.

If the insurance company shows that they paid for a date that you did not see your therapist, then it is fraudulent billing. If she has had a third-party outfit that handles her billing, then she should follow up with the insurance company to make sure they are reimbursed for the claim submitted in error. If she actually submitted that billing, then I'd keep an eye on her.

I can understand you feeling uncomfortable about this, we need our Ts to show integrity at all times.

She Emailed me back, thanking me, telling me she'd look into this.

I'm probably not going to be very popular for saying this but I'll go ahead and say it because I do feel strongly about it. It is an integrity issue regarding the billing for sessions when the client isn't there. A therapist who bills insurance when a client isn't there, whether by mistake or for fraudulent reasons, needs to be called on it and things need to get straightened out. But it also really isn't okay for a therapist to offer to allow the client to not pay the co-pay as a way of giving them a break. A therapist makes a contract for payment with the insurance company by saying, I charge $120.00 a session but I'm willing to settle for the insurance company payment of $50.00 and the client's co-pay of $20.00. It's a business agreement that is contractual.

It a therapist wants to give a client a "break", why not say, I'll give you a free session every four sessions or something along that line? Here in the U.S. we are really struggling with the whole issue of medical insurance and when therapists/doctors fool around with the payment of services, by stepping outside the contractual lines, it just throws another problem into the situation. I totally think it's fantastic that a therapist wants to help her client who is struggling financially, but it is an ethical issue for both the therapist and the client. Wouldn't we all be up in arms if we heard that a therapist was over-charging a client on the co-pay to make up for her stated service--ie. accepts the insurance payment of $50.00 but charges a co-payment of $70 instead of the agreed upon co-pay of $20.00?
How is not charging the correct co-pay okay but the overcharge isn't?

I do understand wanting a break on the cost. Therapy is expensive and at times it nearly broke me . . . literally, but it is an issue that needs to be played fairly on both sides of the fence. . . at least, that's how I see it.

I understand your point and you are right, especially if over the long run it results in higher premiums and co pays. I've only experienced a T waiving a fee once, when I lost my debit card. I offered to pay her at the next session but she said no and told the secretary to waive it. I wouldnt let this go on, but I do believe that taking a higher co pay is more problematic than waiving one, since it's the T who ultimately takes the hit, not the insurance company and not the client. So while I wouls point it out to my provider if they were under charging me and would probably insist on paying, I don't think I'd take it any further than their office if only because it's a kind gesture on their part.

If a billing agency is doing her billing, most likely what happened is they billed off her schedule assuming she saw you and somehow didn't get the information that you didn't meet. The T probably didn't even know this happened until you brought it to her attention. I'm sure she'll get it taken care of. I doubt this is a case of a T trying to get away with anything. Billing errors happen, and all that needs to be done is to bring it to the attention of the therapist so she knows there's a specific issue in the first place remembering it will probably take a few months to get the paperwork straightened out with the insurance company. Insurance companies are notoriously slow with paperwork usually.

I'm afraid to know how my therapist bills or what she waives for other people. I pay her full fee in cash, and while it does bother me that I know she takes less from those who have insurance, it would piss me off if she waived co-pays on top of that. The fact that other people may be paying a lot for their health insurance premiums means nothing to me because I pay close to $600 month in premiums, and this therapist isn't a covered provider, so I get socked coming and going. The whole system sucks, but that doesn't make it okay to play footsies with fees.

I get in a twist over fairness and integrity issues like this. Whether we see them or not, people (like me) are harmed with side deals. Those kind of therapists will try to make up their lost money one way or another.

Thanks Lola, nope, I didn't think at all that this was an intentional charge. It was my worry that, by bringing it up to her, she would think I was accusing her. Not the case though, as it turned out.

I apologize for opening up an unintended can of worms regarding copays.

I pay cash for both = more because I don't want insurance companies dictating anything. I pay for health insurance through the university - but rarely use if for anything. I have it mostly in case I am hit by a bus and taken to a hospital without my consent (I would never consent to going so for me without consent is a given). I don't really care what other people pay or don't pay. I have never looked at my insurance statement even when I have gone to urgent care for bone setting situations. It never occurred to me to bother.

I can wholly understand resisting medical treatment and all. . But if you were hit by a bus and were conscious but severely injured.. would you really not consent to standard medical treatment?