Charged extra for session - should I ask why?

Possible trigger for content about being suicidal

A few weeks ago I had a session with my therapist and felt extremely suicidal. I was the last client of the day and he told me I had to go to the hospital. He said he wanted to be sure I brought myself there so he followed me in his car. He ended up staying with me at the hospital for a while, and didn't leave until about an hour and a half past the time when our appointment should have ended normally. I really appreciated him staying, but felt bad because I was wasting his time, so I told him a couple times he didn't have to stay if he didn't want to.

The company he works for has my card on file so I get charged automatically after each session. I got an email saying I was charged my normal coinsurance rate for that session, but then I just got another email (a few weeks later) saying I was charged an additional amount for that same session for "crisis" services.

Obviously I appreciate my therapist and want him to get paid for his time, but I feel a little blindsided by the extra charge. It's not an outrageous amount or anything and I'm not going to try to get my money back, but is it bad of me to feel upset about the charge? If I'd known I'd be charged more I would have gotten myself to the hospital sooner and just told him to not stay. Should I bring it up to my therapist or the receptionist or just forget about it?
Thanks for any opinions!

I would absolutely bring it up to your therapist. It's totally fine to approach it as "this is not about wanting the money back," but I think it warrants discussion. You should've been told about the charge ahead of time.

Thank you. I just don't want to sound unappreciative or anything. It sort of just made me feel like only a paycheck (which I guess technically I am), but I thought he stayed just because he wanted to. I just don't feel like telling him when I'm suicidal anymore. I don't know how I could word it though without sounding rude.

I was going to say this too, but I didn't want to assume any feelings on your side or imply something that you didn't already feel.

I would really really be upset, because I, too, would think that he was staying because he wanted to... but then, devil's advocate here: he probably WAS staying because he wanted to, but he also has to be ethical. Which means reporting that he stayed longer and provided support. Know what I mean? He wanted to but also has to be ethical. If he didn't want to, he wouldn't have done it.

I don't think that you are going to sound rude bringing this up. I think your reaction is entirely normal and expected.

It's possible your T doesn't know that you were billed an extra crisis charge. It could be that however he wrote up his notes, the company he works for added the extra amount to the bill. So I'd definitely mention it.

I would bring it up too. If it bothers you, it will probably get in the way of your progress in therapy unless you discuss it. I think it's particularly important that he know that the way it was handled this time will make you less likely to tell him that you're feeling suicidal in the future. Then you can talk about how to fix that because I'm certain that's not the outcome he wants.

I agree.

It's good to know I'm not the only one who would feel this way, thanks. It's true that he probably does care. Thank you for reminding me of that

Good point. I hadn't even thought of that possibility. Thank you LT!

I'm sure he wouldn't want that either. I was thinking the same thing, that I'd probably have to address it at some point whether I want to or not, otherwise I'd have a hard time being open with him again. It's making not want to tell him stuff, regret telling him personal things, and want to cancel my future appointments. So I guess I better bring it up! I feel like I'm overreacting though

I really, really don't think you're overreacting. It seems perfectly natural to be a bit confused and annoyed by the charge. Even if it weren't for something emotionally laden like therapy, it would still be frustrating to not know that you were going to be charged for something that somebody offered you, especially if you said at the time that it would be okay if they didn't do that extra thing. Plus I imagine there are feelings lurking around this issue (or at least there would be for me).

You might even pre-emptively acknowledge that it's awkward to talk about as you're bringing it up. Sometimes that makes it easier to bring things out in the open.

You are definitely not overreacting and your feelings are totally understandable. As one poster said he may not know you have been charged....On the other hand, maybe he does...If he did/does know he should have spoken to you about it first and told you he was going to put it through to the system. Surely he would know (should know at least) that it would cause some negative feelings? You will need to speak about it in order to get back some of the trust it feels like you have lost.

Although a very different scenario it reminds the time my friend once had a chimney fire. She was worried it might get out of control but felt it would be okay. A neighbor offered to call the fire brigade for her to which she accepted just to be on the safe side. They came out and in the end actually didn't have to do much at all and the fire died out on its own.... My friend ended up getting a bill for $500 afterward though...She understands the need to charge and the fee but the financial side of it didn't factor into things at the time of the fire so somehow she feels like she was the one that got burnt...She now swears she will never ring the fire brigade again unless the house is full blown burning down.

First of all, I am sorry you were feeling so bad and I hope you are feeling better.

I *definitely* think you need to talk about this openly with your therapist—all of your feelings about him, not wanting to tell him things, wanting to cancel appointments. I think this event has stirred up a lot in you. In my experience in therapy, it has been talking through the “ruptures” that occur between me and my therapist that has been the most helpful, more helpful than anythign else we talk about.

It is a conundrum that many of us struggle with, that our therapists care for us, but we also pay them. I read once somewhere once that we pay them for their time, but their caring is free. I know I personally have fantasies of wanting to be taken care of by my therapist, to merge with him, to somehow have him fill a great abyss of need I feel inside of me....For me, the money I pay him is a useful reminder that he can’t do that for me—that no one can—or perhaps only I can—even though at this point I believe he truly enjoys being with me and truly cares for me, maybe even loves me.

Your therapist did spend significant extra time with you. He did provide crisis services. If you’d known he was going to charge for them, would you have not wanted him to come? If not, why not, if the amount of money was not really the issue? I hope questions like that will get explored in your therapy.

This is a good question for me to think on, thanks. I think it comes down to feeling pathetic, like I'm so unworthy that I have to PAY for someone to be there for me when I'm suicidal and my life is on the line. I know my thinking is probably off on that, but that's just how it feels

I really appreciate all the responses! Smileygal, that analogy makes perfect sense and relates to how I feel right now.. and ElectricManatee, that's a good idea to start by saying something like "this is awkward but...." That usually helps me work up to it.

So I kind of just cancelled my appointment this week because I started panicking about going. I know that wasn't too smart or mature

I had a crisis appointment charge once but they billed it to the insurance company and I just had my normal copay. I only noticed it when I looked at my EOB.

Can you call back and uncancel your appointment?

I think most of us realize our T is doing a job, but since they are human, they don't necessarily get paid for every minute or episode of work (except lawyers). My T once mentioned that he doesn't get paid for emails. I don't email him often, but told him that the rest of us don't get paid for having to email outside of work hours either. He got real quiet...

I've never been in that situation but imagine I'd feel he only went with me because he was obligated, not that he wanted to. So I would talk about it. From what you say, it seems like you would have a hard time being able to hold back. Maybe you should uncancel?

Really sorry about your struggles. I hope you are doing better.

I hope you are feeling better. I understand the feelings you are having.

Not entirely the same situation, but about a month ago, I had an ER physician disregard the reason I had come in (related to self injury that I believed was becoming infected) and proceeded to lecture me about wasting resources that could go to people who are actually sick. I had been to the ER for the injury the day it happened, and they always say, at discharge, if it starts to blah blah blah, come back. And I did. And then he lectured me instead of actually listening to thed problem.

I left feeling discouraged, crying as I walked out of the ER and sat in my car, crying and suicidal for a while. I didn't see the point of asking for help or caring for myself at all if that is what "they" think. Turns out, it was infected, btw, and the situation still makes me upset thinking about it.

I was in the ER again, yesterday, for self injury, and the PA/FNP who treated me wanted me to speak with the social worker. I brought it up with him, because I still have the belief of "why should I care if the doctors don't even care?" I could tell the SW was a little shocked that one of the doctors would do that, and totally disregard the actual complaint.

I think my point is, if I didn't say something, which I hadn't until yesterday except on here, the ER staff would be completely unaware of the situation and it would just fester inside me until that belief was so big that it actually did physical damage.

Your T may or may not be awaare of the charge, but I think it would be best for you and him to talk about the feelings it's bringing up in you. Not wanting to be honest and not wanting to go to T appts is only going to hurt you, in the end. Getting into why and how to manage those feelings would help both of you.

Thank you all for helping me with this. I know it wasn't best to cancel but now something's actually come up and I can't go. I still feel like running away though. When I do see my T, I feel like asking him if he went to the hospital with me because he wanted to or because he felt he had to. Would that be rude to say it like that?

Gosh. I certainly understand why this would be difficult for you!

I don't think it would rude at all, and I think this is an important topic to bring up.

I don't think that's a rude way of asking, if that's what's on your mind. I have often found that some of the best therapy discussions start with a question or statement that is blunt in a way that would be impolite in a different context. True, honest feelings and thoughts can be a little unwieldy sometimes.