when i started seeing him we negotiated a rate such that... my contribution is fairly minimal. he took pity on me 'cause i'm a poor students (trying to live off scholarship with no other funds), basically.

i was to see whether my health insurance would cough up. i guess... i tried to sound optimistic about that in our first meeting... but after he seemed similarly optimistic, i told him that i really... didn't think they would cough up. he seemed truely fine about that. said 'oh well, its okay, we can work together anyway'.

i've been paying my contribution. i guess i thought he knew that no other contribution (from health insurance) had come in. i mean, i deal with his secretary with respect to payments, but i guess i thought he would have had a little look in the system at some point and seen that they hadn't come in. and... just kind of thought to himself 'i guess they didn't cough up after all'.

last session we were talking about keeping in touch when i leave the country for a while. he said something about how he didn't know if health insurance would cover phone sessions and i said 'but they aren't covering anyway' and... he looked shocked. very shocked. and maybe even a bit pale.

i launched into an apologetic rant... i thought he knew... and he said 'oh i'm not blaming you but i don't know why the secretary didn't tell me'... and i said that maybe she thought the payment was still coming... i don't know. hang my head. shame. he tried to repair but he continued to look shocked.

i sent him an email. explained some more. said that maybe i'd misrepresented myself. breeched teh contract. would be understandable if he didn't want to see me again etc. that he should take some time to think about what he wanted to do. he could cancel the session by txt or email if he wanted. that maybe i owe him some (a hell of a lot) of money...

he... replied. said he was shocked, yeah. but that he doesn't do it for the money. that he certainly does still want to work with me.

i love my t. was so scared i was gonna lose him :-( so scared. i've never told him that i love him. do you think it would freak him out???

[Rapunzel]

I think you should express your feelings. Why is it harder to tell him that you love him than that you hate his guts? Both can be real feelings, and are often connected. Did you know that love and hate are not opposites? The opposite of love is indifference. That's one thing you aren't, isn't it?

Aw, I don't tell him that I hate his guts.

I've only expressed anger to him once or twice. I expressed anger to him recently (before our last session) actually. The start of the session was filled with him telling me how happy he was that I trusted him enough to express that I was angry with him. I think he might be partly doing to to reassure himself... But I guess I have expressed anger / frustration to him at times, and that is a risk, yes. And he responds well to that, yes.

It is hard for me to express dependency because I worry that I'll repulse him. I figure he probably gets a lot of dependency already with his kids and stuff. I worry that he will want to get away from me if I'm clingy or if I express needy / dependent feelings. That being said, I have expressed them a little. Indirectly, though, I guess...

Indifference... Thats what I'm trying to foster towards Bob :-) Stuck in hate at the moment. I remember saying to him at some point that the trouble with idealisation is that it tends to lead to disillusionment and rage. I'm stuck in the rage now. Trying to emotionally remove myself. It is working, but it is a slow process...

I'm not indifferent to my t, yeah.

I just have trouble expressing my feelings. Cause they are little kid feelings. Sometimes... I think my emotional age is around 2 years old. I mean, I'm fairly good at putting on a good front. But those old buried feelings... Little kid... Throwing tantrums and wanting to be held and wanting to curl around his leg and never let go and throw my arms round his neck and make him carry me everywhere. And older feelings, too, of course. Sigh. I wish I didn't have these feelings.

[Rapunzel]

It's hard to express feelings. Hey, I hope you are okay with what I wrote, above. It seems like there has been a lot of people around here hating their therapists lately, and I know that you have been very angry with yours at times, right? I don't know what you have actually said to him, but I do know that therapists expect you to have feelings about them, and it's fine to express them, even love and hate and anger, etc. In fact, it can be vitally important to say what you feel. I guess it builds trust when you are honest about that.

Yeah, it really can be hard to express feelings. I'm fine with what you wrote - I appreciate your response :-)

I guess... I take little risks with my therapist. Sometimes he responds well (and that is healing) and sometimes he doesn't (and that hurts me immensely). I think we are still getting to know each other and he really doesn't know what is needed at times... We fix things up (because I know he is basically trying, and basically well intentioned, and basically non-judgmental etc). But it is slow, yeah. And sometimes I withdraw cause that is what I need to do... And sometimes I take a little risk, yeah.

:-)

If you really want to express that you love him, maybe just do it in the method that is most comfortable for you. Perhaps you can do it through writing. I don't know. I am a bit depressed now because I just realized that I could never tell my T "I love you" but I have no problem saying "I want to have sex with you." What the hell???? Anyway, I think it is absolutely wonderful what your T said to you and a teeny, tiny bit funny to picture him sitting there all pale for the rest of the session. I mean, now that everything worked out we have to smile a little bit about tha t :-) It must have been awfully shocking for both of you. I'm really glad that it worked out for you.

[sunrise]

alex, I hope you can sort out the finances with your T. It sounds like he was being forgetful about what your prior arrangement was. I hate that kind of stuff!

</font><blockquote><div id="quote"><font class="small">Quote:</font>
he... replied. said he was shocked, yeah. but that he doesn't do it for the money. that he certainly does still want to work with me.

</div></font></blockquote><font class="post">That sounds reassuring.

</font><blockquote><div id="quote"><font class="small">Quote:</font>
i've never told him that i love him. do you think it would freak him out???

</div></font></blockquote><font class="post">Are you wanting to tell him this now because you feel like you almost lost him? No, I don't think it would freak him out at all. I am sure he knows you love him. And I bet he has had other clients tell him that. T's expect that. It's OK. He will accept your love and not make you feel shame for feeling that way.

Hey. Yeah, I don't think I'm gonna tell him I love him lol. I guess I was just really very relieved that he is still going to keep working with me!

Er... There is more to this story...

See... When I first saw him I said that I'd send in the claim to the health insurance company and see whether they would reimburse or not. I was optimistic because I really really really really wanted him to agree to see me. But then he seemed optimistic about it as well and I worried that I'd misled him rather... So I said that I didn't think they would do it.

You see... I'm on a basic health insurance plan. No provision for therapy but 80% of specialist doctors visits are covered. The more expensive plan has an up to $500 per year therapy provision. So fairly clearly, my plan is NOT intended to cover therapy. But... I was going to send off a claim anyway - since he is a specialist psychiatrist.

Then I had some trouble with his secretary. She put the amount I was contributing for each visit (less then 20%) alongside the objective amount for each visit. I asked her if she could print me off the dates for each visit with the objective amount and not list the amount that I had contributed. She seemed puzzled. I said 'because I'm concerned that the insurance company will calculate their contribution on the assumption that the amount I've paid is 20% of the amount they should contibute'. She said... 'Well... Is it fair to ask the insurance company to contribute 80% of the objective cost when you are only contributing that much?????'

Shame. I muttered something about 'well, p-doc is offering me the sliding scale and not the insurance company'. But I wasn't really convinced (especially since I know they don't intend to reimburse therapy). I just walked away at that point. I wasn't sure what to do... So in the end I asked my p-doc if he could ask his secretary if it would be possible to print off the dates I saw him together with the objective amount leaving off my contribution. He didn't have any idea why I asked him to do that (I really didn't want to try and explain because I thought it would look like I was 'telling tales' or trying to make trouble for his secretary. He said we should go out and talk to her together.

He said 'can we talk to you for a minute?' then kind of handed things over to me. I asked her if she could list the objective contribution leaving off the amount I'd paid and she said 'no'. I asked her (very measured but I guess I looked upset) 'is that because you have an ethical problem with doing that, or is that because it is a limitation with the computer software?' He flinched a little at that point and wandered off into the other room (probably because he was worried I was trying to see whether he would take my 'side' or something). She said that it was a limitation of the computer software because of the way that things were set up. I accepted that.

I never sent off the forms. Because... I worried that it was unethical of me to ask the insurance company to reimburse when firstly, they never intended to reimburse therapy on my policy (and the most expensive policy maxes out at $500 for therapy each year and I'd be claiming a LOT more than that). And secondly because I'm not contributing anywhere close to 20% of the objective amount.

So... I promised (in our first session when he agreed to work with me) that I'd send off the claim. And... I didn't send off the claim. So... I broke the therapy contract. So... He would be well within his rights (it would be understandable if) he chose not to work with me anymore and if he charged me the amount that the insurance company might have contributed if I had have sent in the claim. I was terrified that he was going to terminate me. I would have figured out the money... Would have taken years to pay him... But I would have figured that out...

But he said that there never was any question of his terminating me and that he certainly still wants to keep working with me. Phew. But... He seemed mega-pissed with his secretary (I told him the whole story just like I've put things here). I tried to defuse things there. Said that the time I talked to her about this she seemed really quite flustered. Had just arrived and there were other people waiting and stuff. That I understood that she didn't mean any harm and stuff... None of that seemed to help him be any the less pissed with her, though :-(

Sorry that was so long, but that is the whole situation.

I guess I thought... That he would have checked and seen that the insurance money hadn't come in and that he would have figured the claim had been declined. I guess I did intentionally mean for him to be misled :-( I'm glad this is all out in the open now, and he knows I never sent in the claim :-( I feel really aweful about this whole situation :-( I worry that I screwed him over, too :-(

I guess... I'm just so relieved. Though I still feel dirty and ashamed... Lots of issues around being poor and other people making concessions for me :-( I guess that what she said really hit a nerve for me :-( But... I worried that she was right. It was something I was worried about before she said anything, but her saying it made me realise that YES there was a worry there about how ethical it was to ask them to do that. But of course it wasn't very ethical of me to not send off the forms when I'd promised him that I would :-( I have trouble with ethics a lot... My mother did some things with money that I struggle a little with ethically... I want to be a good person :-( I just didn't have the courage to tell him upfront that I thought it was wrong to ask the insurance company for reimbursement :-( And... That was wrong :-( :-( :-(

and... i worry some that this might be about me being mad with what his secretary said to me. i mean... i guess it is fairly inevitable that he is going to be pissed with her for having said that to me. he might feel like SHE screwed him out of all that money...

and i was really upset that she said that to me :-( but... i don't think i want to punish her. i don't think that not sending off the forms was about that.

maybe not sending off the forms was about my usual procrastination. i often don't claim for prescriptions because i can't be bothered.

i don't know. i don't know what happened. maybe i should just send off the frigging forms already. i'm just really scared. how much money will i be claiming? thousands. i don't expect 20% of specialist visits is going to be about once or even twice a week therapy... once or twice a year, sure, but once or twice a week for a year? i don't think so :-(

i'm scared that they will phone me up and start hassling me. i'm scared that they will launch an inquiry into what the frig we have been doing all this time. i'm scared that they will try and discredit the therapy that we have been having saying that it is a crock and that isn't what he was trained to do so it isn't covered by his speciality :-( (he does of course charge more than clinical psychologists and the up to $500 for therapy reimbursement on the more expensive plan is (explicitly) for REGISTERED CLINICAL PSYCHOLOGISTS).

[sunrise]

Alex, can you send a claim off for just one visit to your insurance? This is what I did with my T as a test case. If they would reimburse for one visit, then I would send them more claims. But I didn't want to freak them out by sending in a claim for 10 visits at a time. In my case, my insurance would not even reimburse for one visit, so I proceeded no further. But if they had reimbursed for one visit, then I would have established a precedent for reimbursement, and I would have submitted more claims. And if they denied those, I would have used as evidence that the service was reimbursable, the fact that they had reimbursed for the first visit. Anyway, that was my strategy. Didn't work, but I thought it had potential!

So can you just submit a claim for one visit and see how that goes?

It seems like the secretary would have established a standard protocol for how to bill insurance when the client is on sliding scale. She could just stick to that for you, and if your T objects that isn't what he wants in your case, he can take it up with his secretary and have her change her standard operating procedure. You shouldn't have to be involved in office protocol. Your T and his secretary need to work out their policies.

Best of luck. I hate insurance stuff (especially since they won't reimburse for my T -- grrrrr).

(((alex)))

i'm sorry. Reading this made me feel sick inside. Money issues are death to me. i can't even work up the nerve to ask my T about any kind of sliding scale... even though i'm pretty poor.. even the slightest miscalculation and i won't be able to see him.

your T is a good guy. i am so glad he's going to keep seeing you.

try to do your best to let go of the stress of it... i think sunrise has a killer idea. Send in one.

> can you send a claim off for just one visit to your insurance?

What a brilliant idea!
Yes. I should do that. I need to claim a GP visit and a couple prescriptions anyway (since that cost me over $100 and I should get about half of that back). I should just send that off when I send off the rest. Thanks for the great suggestion!

> It seems like the secretary would have established a standard protocol for how to bill insurance when the client is on sliding scale.

P-doc tells me he has done sliding scale before but... I don't think he has. I think he just told me that he has so I don't feel too special. I say this because firstly, he didn't even call it 'sliding scale' and seemed to kind of go 'aha!' when I did. Secondly, because he had to talk to his secretary about how to bill me - she really didn't seem to have any idea what the hell he was trying to do.

The main issue is that the majority (probably all) of the people he sees in his private practice are Australian Citizens. That means that they are entitled to Medicare. I don't think that he sees many others for therapy (though of course he tells me he does so I'm reassured that he is competent and so I don't feel too special). So... Their getting the fee back from medicare for a standard psychiatrists visit (to get a prescription) is no problem at all. I'm with a private insurance company, however, so things work a little differently with me especially with respect to the kinds of things that are covered by my insurance.

Thank you.

Thank you Gerber. Yeah, money is a significant issue for me. Living of student scholarship is pretty hard going... Especially when we are expected to do various things to be positively contributing to the department and those things cost money. I should say that the proffs and visitors here are really very terrific with subsidising students out of their own pockets (with respect to conference dinners and the like which are networking opportunities mainly) but it really can be hard going...

I think I'm in the financial %#@&#! as it is with only one pay before I'm off to conference in NZ and I've still got accomodation and conference registration to pay for eep!!! (And yes I've used up all my departmental budget just with flights).

I simply couldn't afford to see him without the sliding scale. I could pay him more during the first semester of the year but the second semester is always really very tight with conferences and stuff where we need to contribute significantly even though it is subsidised significantly.

When I had just arrived here I phoned a couple of clinical psychologists and asked about whether they had sliding scale student rates to offer to students living off scholarship with no other source of funds. The best they could do was $100 per session which is basically one third of my weekly income. There was simply no way I could afford to do that. I literally couldn't have afforded to eat even if I ceased with departmental activities altogether (hence cutting off my chances of ever getting a proper job) :-(

So... He really has been wonderful to me. I told him that I really didn't mean to take advantage of his generosity or anything like that. But I do feel bad, rather. Questioning my motivation etc. That really is a great idea about sending off one claim. I could do them one at a time and see how many they do before kicking up a stink lol. Sending one would be manageable. Sending 60 or so... Just fills me with terror.

[smiley1984]

Why are you worried about sending a claim to an insurance company? you are a paying customer. The worst they can do is say no.

I may be wrong but I think that if you see a psychiatrist doctor, they are covered as specialists, I see a psychiatrist for therapy because medicare doesn't subsidise psychologists - it ends up costing the government more but that is not my fault, it is just the policy. It shouldn't matter what you are seeing the doctor for - if your insurance covers doctor visits, it should pay. This is probably why he assumed the insurance would be ok. In australia it doesn't matter why you are seeing the doctor, if you see a doctor it is reimbursed.
From my personal experince with insurance companies here, they are much better than the US ones. They don't ask you to try and justify why you need treatment and decide what you need, that is up to the doctors and they pay what your policy covers you for - that is a reason I would never move to the US, too many complicated insurance issues.

Hey. I don't get medicare because I'm an international student. I have OSHC Worldcare https://www.oshcworldcare.com.au/Default.aspx

I'm worried because there must be... Around... 60 sessions or so that I should have claimed for...

[sunrise]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
alexandra_k said:
I'm worried because there must be... Around... 60 sessions or so that I should have claimed for...

</div></font></blockquote><font class="post">Can you check your insurance to see how long you are allowed to wait to file a claim? For my insurance, you must submit the claim within one year from the date of service. If yours is similar, submit for the visits that are due to expire soon.

[ECHOES]

Alex, he is angry with the secretary because she didn't to her job. He hires her to take care of the financial end of his work so he could be free of that concern. What you told him means she wasn't doing her job in your situation so I imagine he wondered about her performance overall and how it was affecting him financially overall also.

Insurance covers or doesn't and (in the US) the decision has to be made based on the contractual provisions of the plan, and not the dollar amount involved. We have Insurance Commissioners in each state who oversee and take complaints against insurance companies. Magic words here when you have an issue with an insurance company is that you are going to send an appeal to the Insurance Commissioner; these are tracked in detail and used as part of the rating the insurance company receives. The appeal has to be handled within specific guidelines and timelines.

I'm so glad he reassured you that all was well and will continue right along! That must have really be an unnerving time!

thanks guys. see him tomorrow so i guess i'll see what he says. i downloaded the form about how i claim. it asks whether i've paid already (in which case to attach receipts and they put the money in my account) or whether i haven't - in which case he needs to contact them about recovering the money and i need to simply attach the bill.

if he mentions it... i'll say about maybe trying to claim for one session and seeing how we go.

thanks guys