T charging for "extra services"?

Does your T charge extra for things like consultation with another practitioner, reading your emails, writing recommendation letter, typing invoices for insurance reimbursement etc?

This came up rather awkwardly with my T. I'm hoping to meet with a psychiatrist but one whose treatment philosophy is similar to mine. My T said she has one psychiatrist she works with. I mentioned my concern that her approach may be different and we talked about what I'm looking for. Finally I asked if she could maybe talk to her on my behalf, how she may go about treating my condition given my T's impression of me. She said she would....but that she also charges her usual rate but "it shouldn't take any more than 15 minutes".

I quickly responded "oh oh yeah of course" but honestly, I hate to admit I was kinda shocked. I mean, I get it.... But I thought the session rate included minimal "extras" like maintaining a client file, cracking open the DSM from time to time, and yes, maybe one random consultation.

I *get* that I can't go psychiatrist shopping through her. And I would certainly expect an hourly rate if I was dragging her into a lawsuit asking her to testify for me...but for this one time 15min thing it makes me sad money has to come into it. We've been working together for nearly two years and I've never sent emails or asked for anything.

She truly does deserve compensation for extra work. But I guess that's how you define "extra". Given the context I've shared already, this makes me especially hesitant to ask for any other favor or send a one sentence update email like its painstakingly out of her way. Since I'm feeling extreme rigidity in her time/money/compassion boundary it makes me retract into myself and lose trust. I'm really surprised by my reaction and I'm sure I'm the one being unreasonable.

STILL I'm curious...is this the norm? Even for a one time occasion? By the way, I pay totally out of pocket.

I'm not sure... T doesn't charge for maintaining a client file etc. He did for consultation he had with another T though (uh, concering me). I think that also has something to do with insurance - It'd be weird if one practicioner (e.g. pdoc) would charge for this and the other practicioner (e.g. T) would not.

my "T" is court appointed so all fees are billed to my probation officer

Stipulations like that have been in place in the contract of every therapist I've worked with.

All of them talked to another practitioner at least once about me, and at one point or another all read an email from me and responded and a few talked to me on the phone (No. 3 once for almost an hour) or gave me invoices. None of them charged me for any of it. Even Smaug the evil psychiatrist only started charging me for calls towards the end, when she was trying to gouge money out of me.

However, most of these people were private pay. Possibly they thought getting $150-200 for an hour of their time per week covered extras, even though their contracts said otherwise. A therapist who takes insurance might be more likely to charge for those extras, since they can't bill insurance for them and they're already getting paid a lower rate by insurance.

My psychiatrist, therapist, and medical doctors do not charge for any of this with 1 exception-2 of my specialists now charge $20 and $30 for disability papers. This seems to be a trend where I live (and perhaps other areas) as I havent seen this elsewhere.

I can see one charging for a true consultation with another, but the phone call you referred to does not seem to be an actual consultation, and I don't think she should be charging clients for making calls like that. My last primary care doctor used to call or email specialists all the time on my behalf, and I was never charged as it's just part of patient care.

Also, they should not be passing off the cost of business to you (eg typing invoices). I also think it's wrong to charge for emails, which are just part of patient communication that goes with patient care, although i know some do.

Some of these charges are built into the insurance reimbursement with the time spent face to face. The cost of doing business is one. The fee they get technically includes that, as well as writing up session notes, etc. I would put patient communication in that same category. I know you pay cash, but the concepts are the same.

I'm sure others might not mind, but I would not want to use a psychiatrist who nickles and dimes me like that. I know charging for disability papers is becoming pretty standard, but I don't agree with that either. I think that is all part of the job, not extra work.

This is something i feel strongly about for political and economic reasons (I belong to an active healthcare reform group who has many who work from the inside and we discuss these topics all the time).

If you are happy with her overall, maybe it would be good to talk with her about this and e press your discomfort. If you have a good working relationship ans she is helping you, perhaps that is what counts.

My T and marriage counselor don't charge for any additional services, including e-mails, texts, occasional phone calls (even ones 15 minutes or longer), consulting with another T, etc. I think they just consider it a part of the services they provide, along with the weekly appointment. I know my p-doc doesn't charge for e-mails, but I'm not sure about other stuff because I've only been seeing her about 6 months, so some issues haven't come up yet.

No, my T does not charge for the time he spends talking with my Group T about me even though they don't work in the same practice.

My T does not charge extra for these services. I would understand if she choose to since it is a business, but it would make me sad and uncomfortable because the business is in human connection and that can certainly impact that connection.

At least your T was up front about the charge.

And I don't agree with you that you can't "shop" for other mental health providers through your T. You said it yourself, you've been working with her for 2 years. She knows you very well probably and she probably has a least a few more connections in the mental health world that you do. Continuity of care is incredible important, so having a working relationship already is a huge plus.

This sounds really hard, and I'm sorry that it's distressing for you. ::

The only "extra" things my T charges for is if she has to go to court, and if phone calls go over 15mins. She has talked to my Pdoc many times and even talked to ex-T a couple of times. I never got charged.

I don't blame you for being surprised.
My therapist has on occasion talked to, say, a marriage therapist about me. I was not billed for that.

I would be surprised as well. I would probably choose not to have him talk to anyone rather than pay a fee for such a thing.

Charging clients for consultations with colleagues is not a common practice. I was not charged once for this when I was in therapy. That doesn't mean it's illegitimate. Every practitioner can have whatever business policy they want, but everything that has to do with payments has to be clearly spilled out in the contract called "informed consent" BEFORE the therapy starts. If your therapist didn't inform you that she charged for extra services before she began to work with you it's a problem. Therapists are legally required to make their fees and all the charges transparent so people would know what they are signing up for.

For me it is the opposite way around, Electric. I mean that my T has done these kinds of things for me, and I was expecting him to charge me, and then he did not.

It seems to be the general consensus from these replies that most Ts would not charge. I do see as well why it would make you feel sad - like T is making it so clear that she would not go the extra mile. I wonder if it is worth raising this again with T and trying to say how you feel about it? I know if it was me I would feel awkward about doing that. But on the other hand if you are upset but you don't say anything. do you think it might fester and affect your therapy?

Thank you for all your replies!

I could bring it up, especially if she enforces it. It was said like it was common practice so I felt like I was overreacting. Nice to hear others would feel similar

I've never had to pay for such "extras," and I've had a bunch of therapists over the years.

I do not know the norm but T has never charged me for the extras. At this point she has never needed to do a consult. But has helped with short term disability ability, phone calls and LOTS of emails. There have been a few times over the years that I have needed a second appointment in a week. She will not charge me becauae she won't bill my insurance. She doesn't want my insurance company to know that I am really struggling

My Ts consult with each other about my case on a semi-regular basis. I've never gotten charged any fee for it.

With both of them, the only thing I have ever been charged for is a face-to-face session. I don't do outside contact with M, but for L, we have exchanged emails multiple times per day, had 45 minute talks on the phone several days in a row, and I am not charged for any of it. Her normal session fee is quite high so I'm sure she's planned it to cover extra time commitment. Perhaps it would be different if she were operating under an insurance carrier and getting paid less.

[QUOTE=satsuma;5754429]For me it is the opposite way around, Electric. I mean that my T has done these kinds of things for me, and I was expecting him to charge me, and then he did not.

A few times I mentioned she should charge me when we have had lengthy phone calls or emails. She always refused saying the are part of her service

My T has in his contract or whatever it is called that he bills for things like this. I have only required it once though, and he did not bill for it (we had been seeing each other for several years at that point).

It may be this T's professional practice but it would sting if it happened to me, too.