[jennamurph]

Has anyone else been asked to pay "administrative fees" by their therapists? Today my therapist told me she was charging me $250 in administrative fees because she said she has spent over 5 hours on the phone with my insurance company, trying to straighten out a claim that she filed with them. She runs her own practice so I know she handles all the billing herself, but I was still a bit shocked and angry about this. This was not an error on my part; it was actually partly the insurance company's fault (they billed my former employer) and partly (I think, at least) my therapist's for putting the wrong year and ID number on the claim.

If this is the norm, I have no problem paying it, but it just seemed unreasonable to me. Any insights?

Thanks in advance.

[mightaswelllive]

Usually before starting with a therapist they will have on their paperwork that you may be charged for administrative fees/off clock work. Though I've personally never been asked to, I don't think it's out of the norm. Sorry you feel frustrated. It does suck.

My T doesn't do that, that I know of. In fact, at my last session, we were talking about the fact that if he is not actually working with a client, he's not getting paid...

$250 seems terribly excessive to me. I think if I were in the same situation, I would try to negotiate a more reasonable number....and I would also ask to see anything I had signed that stated I would pay "administrative fees". It doesn't seem fair that she would drop this on you from out of the blue unless there was some sort of agreement ahead of time...

Good luck!

[peaches100]

My t never charges me for the time she has to spend communicating with the insurance company. However, I'm sure she has never had to spent 5 hours!

On one hand, it seems unfair that you should have to pay for something that wasn't your fault. On the other hand, it's also not fair for your t to have to spend 5 unpaid hours trying to resolve things.

Since your insurance company and your t made the errors, it seems that the insurance company should reinburse your t for 2-1/2 hours of the 5 hours she spent ironing things out. But it's doubtful your insurance company will do it.

Assuming your t charges the typical $100 per hour, that would amount to $500 lost. It sounds like your t is willing to eat $250 and wants you to pay the other $250. My suggestion is to either pay the $250 or talk to a high level manager in your insurance company and try to get them to pay it.

[sunrise]

My T tries to do all administrative tasks during our session together. So occasionally he will compose an email when I am present or make a phone call on my behalf (e.g. for a referral). This seemsfair to me. If he also does stuff outside our session he has not charged, but I don't think he does a lot. He doesn't talk on the phone to me outside of session so there has never been a question of my paying him for his phone time. (My insurance doesn't compensate him so they are out of the loop.)

For insurance, I deal with the insurance companies myself. It's my buck I'm trying to save so I need to do it. I would not expect my T to spend 5 hours on the phone for me with insurance. I think your T should have asked you to do as much of this as you could and then said she would need to charge such and such a fee for any you couldn't do yourself. You would have the option to accept or decline. Can you ask her to let you know next time so you have the option of doing the phone grunt work yourself? Make sure you get an official bill for the $250 if you decide to pay it. You can probably deduct it if you itemize on your tax return.

My T also serves another role for me--coach in my legal precedings. For this role, his fee is $50 more per hour so that he can be partially compensated for the extra paperwork and travel time. This seems fair.

Assuming your t charges the typical $100 per hour

Wow, $100 is a good rate. I don't think it is typical around where I live.

Originally Posted by sunrise

My T tries to do all administrative tasks during our session together.

LOL- during one of my "concussion sessions" I told T he could work on his paperwork and I would just hang out in his office. I was totally serious! I was really just going to "connect", because I couldn't do any work with my headache and my thinking all messed up. He refused. I was like "this is your BIG CHANCE to get paid for your paperwork time!!".

I guess the cost of T depends on where you live...my T charges $90/session when my insurance is paying, and then charges $60/session when my insurance runs out. Maybe I'm just super lucky!

[imapatient]

Never heard of this.

I have heard of ins. companies having a policy that they don't reimburse T's for non-session things like phone calls, emails to patients or stuff like that.

A T's charges are supposed to incorporate their overhead--like dealing with ins. companies--in their fee structure. That's their source of income. In that way they can get reimbursed for all of their activity via session charges. It sounds like your T hasn't done a good job of integrating admin costs into their fee structure. They just should charge more per session.

Unless you signed something about those costs as separate from session charges, your T is way out of line. If you did sign something to that effect, you have an incompetent T who hasn't taken the time to structure sessions charges to cover their overhead.

Is it a new, inexperienced T? Newly independent as sole practitioner?

I can’t imagine why a T would do hits but maybe to keep session costs low to attract more business and then charge the high maintenance clients (with high overhead) for those extra admin costs as separate charges. I think it's b.s.

What if the high admin time for a given client is partly due to the T's errors/inefficiency/lack of knowledge? The ins. company's errors/inefficiency. Your errors? Just the way of your ins. company? Just because some ins. company clerk messed up? What about letting you clear some of it up yourself so you don’t get charged by her?

It's not the norm. As I say, the norm is to structure the income source, session charges, high enough to cover overhead. IF a T isn’t doping that, I see that as a problem and outside the norm. If that T wants to operate by a diff. financial model, that's her prerogative. But with the potential multiple responsibilities for extra time and that all/some of it is beyond your control, it's not o.k. with me.

I don't think I'd put up with it. Who knows what financial landmines you might hit because of some odd, out-of-the-ordinary situation? Then your cost is uncertain and somewhat arbitrary. Doesn't seem right to me.

A patient should know up front what their costs will be.

Does your pharmacy do this sort of thing? Your pdoc? Your regular primary care Doc? Your dentist? Your hospital? Clinic? Physical therapist? Chiropractor? They all deal with health insurance/system bureaucracy. Will your T charge you for a locksmith and key replacement when she breaks her key in the door when coming to have a session with you? Breaks it in her file cabinet when she gets your file while talking on the phone with your ins. company? What about charging you when doing other non-session things like consulting with other professionals?

It makes some sense to charge a given patient their actual costs of doing business with them rather than spreading it around to all patients via higher session fees, but it's not the norm, and it involves the uncertainty, etc. problems.

1. You should've been told up front. 2. The T needs to take responsibility for her own errors resulting in extra time spent. 3. A detailed policy needs to be set if this is going to be her usual way. And it will need to be very complicated given the many variables.

Your T has the tools at hand not to have to do this.

Way outside the norm, and I speak not just as a T patient, but as a professional health system analyst. This is a new business model (in the great part, anecdotes aside).

[Sad In TX]

That's ridiculous! I think you should file a complaint! Your therapist should have been up front about this crap. It's not your responsibility to deal with the insurance people when it comes to payment - you already take of that for paying for it.
I think this is way off, and I would look into what you could do to get out paying it. It's not your fault your T doesn't have administrative back-up to handle phone calls and such, but that's technically not YOUR problem.

How long were they on the phone with the insurance people? How do you know you aren't getting overcharged for something that may not have happened in the timeframe quoted?

Seriously, I would seek help with the state or something to see about getting this taken care of, and call the insurance company and see if this is even legal for them to do that. While I understand therapists get paid by the people they see, but if they don't have the tools to run their office that is something you shouldn't have to pay for. You're paying the premium, you're going to your sessions.

This person sounds rather callous for a therapist. I would ask to see where her policies are that stipulate she can make such fees, as they are supposed to be up front with that kind of thing.

[Rapunzel]

The money side of things can often seem cold and impersonal and even unfair. It's also very frustrating for therapists. Whether or not they can charge you administrative fees for unexpected lengthy time dealing with insurance really does come down to what they told you and agreed with you that you would be responsible. It's more a business issue than a therapeutic issue, but things like that do have an impact on therapy too. If you're not comfortable with it, you should talk to the T about it and negotiate something that both of you are okay with.

Spending time on billing and insurance and paperwork requirements is part of the job, and all therapists either have to count on that time, pay someone else to do it, or work for someone who handles that end of the business and pays the therapist less because the business bears those costs (among others).

My therapist has told me about spending a lot of time playing phone tag or jumping through hoops with my insurance company, but has never suggested that I pay for that time. I sympathize when that happens, and express appreciation that she did that for me. It's nobody's favorite way to spend their time.

At my job, where I work at a therapist, even though I am working for someone else, I only get paid for providing direct services. Not for doing paperwork or attending meetings or the other things that are necessary parts of the job. I don't have to work with insurance companies directly, and I appreciate that I don't have to.

But there is room for people to work out their own ways of doing things, so any way that you and your therapist work it out that you are both comfortable with is fine.

[jennamurph]

Thank you for all your feedback and honesty. To answer a few questions that have been asked, my therapist is not new to the field, and she has had a private practice for at least 8-9 years. I have been seeing her for just over 4 years. Her fee is $150 for 45 minutes.

I am still going back and forth over what I am going to do. I went back to her policy list that she gave me when I started, but it makes no mention of administrative fees. It states that she will "be happy to help you process your insurance claim form or to provide you with a statement suitable for insurance reimbursement." It then goes on to say "I must emphasize that as your therapist, my relationship is with you, not with your insurance company. Any processing of insurance claims or statements is provided as a courtesy to you, however all charges are your responsibility." It goes on to list a $25 charge for returned checks, and how overdue accounts are handled.

I have no problem with that. I pay for my sessions, and the few times I knew I would be late, I have discussed it beforehand with my therapist and she has agreed upon the time I would pay her. When she told me about these administraitive fees, I did tell her up front that I was upset about it, and I questioned why I was being made to pay for the insurance company's and/or her mistakes. She told me that she had spent 5 hours on the phone with them, way over the norm. I too have spent time on the phone with the insurance company over this claim, and I did as much work as possible on my end. This whole discussion happened at the beginning of the session, and after she said her piece, I said I was still really upset, She said well, that is the billing part of this, it doesn't have anything to do with the therapy, and I questioned how it couldn't have anything to do with it when I was still feeling such anger. Our last 2 or 3 sessions have actually been very tense, and I can't help feeling this fee is all part of it. I'm still trying to put everything in to perspective.

Thanks again for the input, everyone. This is a great community to read!

[ECHOES]

If she is contracted with the insurance company, she may not charge you for this.

That said, the fee seems to me to be a punitive act toward you because she was frustrated about the dealing with the insurance company.
I would not be happy about it and I would say so.

[deliquesce]

i think the first thing to do would be to double check anything you might have signed that states you will bear the burden of out of session costs e.g., emails, phone calls, administrative issues.

if you have signed something to this effect, then i think you should bear the cost. make sure you get a fully itemised receipt and also tell your T you would appreciate her letting you know in advance in the future, because you can't afford to throw money around like that either.

if you haven't signed anything, then you don't need to pay. it's her problem to deal with, not yours. the going rate in australia is ~$130, with the assumption that it includes 50mins therapy, and then 1hour administration/out of session contact etc.