[wheeler]

My therapist, who I've seen for a little over a year, started out by charging me $65 a session. I was paying out of pocket, at a reduced rate. Then my new insurance started paying $51/session, so I payed the difference of $14. Then my insurance switched again, this time covering $50/session, but a $10 copay. May therapist maintained that we initially agreed to $65/session, so I needed to still cover the $15 even though I had a copay at $10.

Hopefully all that made sense.

Now, my insurances covers $128/session, clearly a big jump, although not her 'normal' rate of $160. This coverage also comes with a copay of $10, which she is now billing me for.

But now in my crazy little head I was hoping she would forgo the $10 copay because she is getting compensated above and beyond the agreed upon price of $65.

I really don't want to have to talk about the dreaded money-thing again with her. I feel bad even being bothered by the $10 copay, shouldn't I just be happy that we both win?? She gets an increase and I get a decrease.

I was just starting to change my thinking towards my constant mistrust and attachment issues with her, and I get this invoice emailed to me this morning which is gnawing at me.

Thanks for reading this

I don't have any advice for you, just commiseration - i struggle mightily with the money thing - the one big rupture t and i had a few years ago was about money. i hate hate hate having to talk about finances with her, i pay out of pocket because she doesn't take my insurance and my deductible is so high even if i submit receipts i'll never meet it, and i can't afford to go as often as i do but i keep doing it anyway. argh. i really wish you the best.

[Salmon77]

I'm not good at talking about money either, best thing I can say is that it's like any uncomfortable topic, figure out what you want to say, write it out if that helps, then just say it.

On the copay--AFAIK there is a belief that the client needs to always pay something, even just a little, so that the professional aspect of the relationship stays obvious and so you have some skin in the game. If you aren't paying it starts to feel more like chatting with a friend or something.

Might be worth thinking about what it would have meant to you if she didn't ask for the copay, what was the wish really for there? I'm guessing the $10 is not the real issue.

I don't like to talk about the money either but I never regretted doing it and negotiating a solution that was mutually acceptable and I did beat up myself for not trying. The worst case is that they say no and then you can still decide if you are willing to pay that fee. I think it can also be a good exercise in negotiating skills. I never provided them extensive explanations or apologies, just said this is the amount the therapy session is worth for me and took it from there. Of course they will try to get the best deal for themselves, I won't blame anyone for that.

Personally, I'd be thrilled with a $10 copay. Be thankful for good insurance.

[wheeler]

I know it's not about the $10, and of course I am happy for such a low copay, but it's still bothering me. Maybe I'm having a hard time reconciling that I pay her to care. Maybe it's the whole money-thing, which I had with my mother? My mother was very tight with her money, she never was one to give her kids any. And if she loaned it to you there was always interest tagged on.
I suppose a conversation with my T is in order, but I really don't want to!!!

[Moment]

Wheeler, I think you know what you have to talk about with your therapist, and I encourage you to just plow into it, even if you don't want to. Sometimes the stuff that is hardest to talk about is the most productive. You seem to be thinking logically about this, but also have feelings that conflict, and that stuff is really rich to discuss in therapy.

[Pennster]

I think it's great to talk about this since it's bothering you.

But I might also look into the insurance company's regulations. It's my understanding that the provider isn't at liberty to set the amount you actually pay her. The insurance company sets the copay, and that's what you both have to abide by.

But perhaps this differs by state? I don't know! But if it were me I would want to know what the insurance agreement says before I have the discussion.

[AllHeart]

Originally Posted by wheeler

I know it's not about the $10, and of course I am happy for such a low copay, but it's still bothering me. Maybe I'm having a hard time reconciling that I pay her to care. Maybe it's the whole money-thing, which I had with my mother? My mother was very tight with her money, she never was one to give her kids any. And if she loaned it to you there was always interest tagged on.
I suppose a conversation with my T is in order, but I really don't want to!!!

I do get where you are coming from. Still, $10 is a helluva deal.

Food for thought -- Do you find value in your t's services? Is she worth the $10? Is your t worth the $138 she is now being paid? Does it help if you look at the bigger picture that you are still fortunate with having to pay less than her normal rate of $160? She could ask you to pay that extra $22 I suppose.

Caring comes in so many ways, one such as giving a client a reduced fee when they are in need. You are really only paying your t for her time and services. The caring part comes as an added bonus.

[thesnowqueen]

I have the same discomfort and so really sympathize. Unlike Xynesthesia I feel like it's 'in bad taste' to negotiate - that its like telling the service provider their services are not worth what they are asking. I also worry that if I pay less than the asking fee then their heart won't be fully in it, Because of these beliefs/feelings I can't even approach the matter

It's a problem at the moment because I'm on my last repeat of my meds and they very clearly aren't working anymore. I've been seeing the same P-doc for 9 years and a few people have said its good to change. So - now would probably be the time to do it. However, my T has suggested a P-doc who I got in touch with. She sounds really lovely - replied in reasonable time - HERSELF - to my messages (new patients are asked to message her for an appointment). Reassured me that a complicated history and memory flaws are ok, and we will work it out. Even used smilies in her messages!

HOWEVER emailed me something to read before booking. Some great things in it - like it sounds as though one can always contact her if needed. (Something I'v found impossible with P-docs in urgent situations). But, first appointment works out (in dollars) to $205. Ordinary appointments afterwards are $106. These rates are pretty much DOUBLE what I have been paying my regular P-doc...

(Please note I live in a different country to most of you, so rates are likely to be very different).

ETA: I really don't know whether its open to negotiation with a P-doc. Maybe I should ask T...