This has been the topic dujour for both my personal and martial therapy for the last week and a half. Our situation is tight. Very tight. It has been this way since we got married 11 1/2 years ago. It is depressing and I hate thinking about it but since my husband is horrible at paying bills and keeping track of finances I have to do it. I guess I never thought that at 37 I would still be in my "salad years."

So in my last session I had to talk to my T about her fee. I dread this. Really, really dread doing this. I've already had to negotiate around my financial situation with her once but now I just had to know that if anything gets any worse for us, would she and I be able to work something out.

Over the last year therapy has become much more of a necessity than a luxury and I don't know how I would hold up if I had to quit now. Struggling with this has been making it hard for me to depend on her because I may not be able to afford her. I don't like it when the business part of our relationship intrudes in on everything else. Something about that just feels weird. I image it feels a little like having to sign a pre-nup after a romantic proposal.

So of course she said we could work something out if it came to that and to let her know if anything changes as soon as it does. I have gotten so much from her and I can give so little in return that the least I feel I can do is make sure she gets her full fee. She is worth more but thankfully she doesn't charge what she is worth.

hate these discussions but they are a necessary part of life aren't they? (eyh?)
robin

hey river:

i totally hate it! my t has a sliding scale, and my hubby was recently laid off at work. i hate talking about it so much that i haven't even asked him if my payment can be lowered until he finds another job. and we don't have any insurance either!!! i know i really should just suck it up and ask, but it's hard, isn't it?

We have two family members in therapy and even with the insurance I have to pay half and so it gets very expensive. I have often thought about asking for a reduced rate...lol...like a family plan but I am too cowardly to even bring up the subject and so I pay because I do value our therapy very very much...but it does get hard sometimes to cut back on other things so we can continue with therapy. AJB...in your case there is a very real need for a fee reduction... as least temporarily unless your husband finds new employment. It wouldn't hurt to ask. I wish your husband every success in finding another job very soon. It's a real tough economy these days.

River I applaud you for bringing this up. I guess it's part of what we need to learn... to ask for what we need. I'm glad your T is willing to work something out for you. In this tough economy even T's are feeling the pinch. I'm sure she does not want to lose you either. But I totally understand the panicky feeling of having to leave your T for financial reasons.

thanks, true north. i know it would be fine to ask, i mean that's what the sliding scale is for. i will get around to it eventually. i just hate for him to get even less from me. i know it will get better with a new job and insurance. i'm not VERY worried--yet.

river, i certainly hope things work out for you soon too!

Hi All,
Well, I've been thinking about it too. It was all fine untill now that I can't imagine that for whatever (financial) reason I would have to quit. It is really great that I came across this low cost therapy. Otherwise I can't imagine I could ever afford it. Even though it is a 'low cost therapy' I began to worry that if I loose my job (which can happen around 2 months time when my contract may or may not be extended) even the low cost could be too high. But then I also think if I succeeded in getting a job that I just applied for I'd love to pay more for my sessions.
Anyway I just got this fright recently that if I will loose my job and won't be able to afford therapy sessions any more? Or will have to move somewhere else to get a job?
I know I am worrying ahead and maybe everything will be fine. But if... I imagine that would be most humiliating moment to me to talk to him about it, but I would have to.

Hi everyone. Thanks for bringing this topic up.

I'm looking for a new T at the moment and what with the ridiculous prices I'm paying for anti-depressants and other costs I was really worried I would be able to afford a T at all. Thankfully I've secured a job for the next six months but with everything else I'm not sure if I can afford the full rate.

Can anyone explain the sliding scale thing to me? I'm terrible when it comes to asking people for anything ( an example: if I need to pee on the train and there's someone sitting on the outside seat, I'll just sit there as I don't have the nerve to ask to get out, sad I know!) so the idea of negotiating a fee with someone who is helping me seems horrifying.

Thanks

I see that someone already started a thread on this subject so I’ll just tack my angst onto the end of it. This is about some bad news I just received from my insurance company and my worries about how it will affect my therapy.

Today I got a letter saying that upon further review, my T is ineligible for reimbursement. They’re going to “reprocess” all my claims, meaning I’ll have to pay them back. And oh yeah, they included a complaint form to fill out if I so desire. Grrr.

The reason they’re denying reimbursement is exactly what I thought in the beginning: Because she has only a “training” license. When they denied the first claims, and I called to ask why, they said it was because she didn’t have a Federal tax ID. I asked a few times, are you sure it isn’t because she just has a training license? They said oh, no, it’s because of the tax ID thing. Since she is sole proprietor, her tax ID number is her SSN, which understandably she doesn’t want to give out to all her patients. So then the insurance told me if she just gets an NPI (National Provider Identification) number, everything will be fine. So she did, and up until today I was submitting my own claims and receiving out-of-network reimbursement. Now, three months later, they’re going back on everything they said.

So I’m royally ticked off at them because it’s taken them three months to figure out what I guessed correctly at the very beginning, and now they’re going to make me pay for it. Nothing I can do about that, I know. It’s the usual for insurance companies and I’ve just got to live with it. I’ll get over it. Although I might appeal any decision to make me pay anything back, based on our conversations (which they always say are recorded for quality purposes) where I specifically asked about her training license being the reason and they told me it wasn't a problem.

The more important issue is how this will affect my therapy. First of all, I’m feeling discouraged because I just want to do therapy already! Here is another obstacle. So it is tempting to indulge in some self-pity. Trying to resist that.

Then there is the fact that even though she doesn’t charge much compared to “licensed” T’s, there’s no way we can afford weekly sessions without some reimbursement. We could afford once or maybe twice a month. But that doesn’t seem like enough when I already feel so “behind” from a year and a half of therapy attempts that haven't worked out. I would prefer weekly.

In the letter, the insurance company said they might be able to reimburse, if my T can bill her charges through a supervising T who is eligible under my plan. I know she has a supervisor and he is probably eligible under my plan.

Here’s the thing: This feels like such a touchy boundary issue. I've been careful to say as little as possible about the insurance stuff because I don't want it to affect our relationship. Last week, she asked how the insurance stuff had turned out, and when I told her I was getting reimbursed, she said she was happy to hear it because none of her other patients had tried it and been successful. So now if I ask for this special billing procedure, I’m worried that it will finally affect how she feels about me.

But there’s no way to avoid bringing this up. At the very least, I’ll have to come less frequently. She’ll ask why, which will require me to explain. Maybe I’ll just leave it at reducing the number of sessions and not even bring up the part about billing through her supervisor. I don’t think she could do it anyway and I’m worried that even asking would affect our relationship in a weird way.

I’m just feeling really frustrated right now. Thanks for letting me vent.

SG

Strummergirl,

This sucks! How infuriating for you to have been told one thing and to find the opposite is the case. And so frustrating and discouraging to have this "intrude" on the therapy when you just want to get on with the work.

I want to say, though, that I have been through this whole money thing in different ways in my previous country with both a couples and individual therapist there. I would STRONGLY encourage you to bring it ALL to your T, and to think about it as *part* of the therapy. You are now in a situation where, through no fault of your own, you feel like you are going to be materially and emotionally deprived by someone else's error. How you respond in this situation is really rich ground for therapy.

I hope you don't mind if I make a couple of observations. One is that you note some possibilities here for you to act so that you might not have to just lump it quite so badly - if you take a risk. One is by complaining and asking the insurers to carry the cost of their own error, and to stick by what they told you. Another is to share the situation with your T and ask her to go through what *might* be a simple administrative procedure to allow you to continue as normal. Her use of this procedure might also benefit her other clients.

What I notice is that you want to carry all the worry and work of this yourself, to take the fall so that no one else is bothered - so that no one else can think less of you? so that you don't feel needy or dependent maybe? I don't know, but I do know that if you minimise or hide the situation no one else can help you.

What I learnt through dealing with this kind of situation is that money issues and the communication around them are actually part of the T's job, just as they are part of the insurer's job. Think of it this way - you are the only one who is NOT getting paid to sort out this difficulty!!

Sending you lots of strength and courage to help you bring it to the people who can help you.

SG I am so sorry this has happened to you. I think Jones gave you an awesome response and I agree with her 100%. I could fill pages with all the aggravation I've endured with my insurance company for mental health claims. They lose them, they ignore them, they pay at different rates (they also told me they could not ask for the money back) they charge different co-pays at times and there is NO written brochure or document that I could locate that spells out my benefits. It all seems so arbitrary. The insurance company sent me to my husband's employer, who sent me to the benefit administrator who knew zilch and sent me back to the insurance company who sent me to the employer. So I really have no idea what I'm entitled to specifically. My claims would get lost in some black hole and no one could ever find them so now I fax them all to someone with a name who manages to take 6 weeks to send me a check. I have to call her all the time to nudge her to process the claims. I have 8 claims a month between me and my son and the paperwork gets overwhelming. Another issue to deal with along with all the others.

And like you I hate discussing this with my T but I have recently begun a dialog about this because he was not sending in my treatment plans in a timely way, so I could be allocated further sessions and I'm always running behind. By the time he sends them in (they only allot me 12 at a time) I'm up to the 12th claim and have to start all over again asking him to re-submit. He is awful about paperwork.

Sorry to go on...but I don't think it's wrong to ask her to submit under her supervisor at all. My son goes to group therapy and it's led by an intern and another LCSW in his office. They sign the receipt and he signs as the supervisory person and it gets reimbursed with no problem (other than what I described above LOL).

And I agree the whole topic of money/insurance is fertile ground for therapy and you should not bear the brunt of this alone. It's a hard topic that no one likes to discuss but you will see that your T only wants to help you. It's actually in both of your interests to get this all settled.

Let us know what happens. And BTW, I would not give back ANY money to the insurance co... I would fight them on it. You are in the right.

Good luck,
TN (grrrr to insurance companies)

Thank you for all your responses. I suddenly feel like a foot soldier who has been complaining of a little skirmish in the company of combat veterans. I’m so sorry to hear of what YOU have all been through! The insurance went surprisingly well as long as I went to in-network providers. It’s only now, that I’m seeing someone out-of-network, and pre-licensed to boot, that I’ve run into problems.

The letter didn’t specifically say I’d have to pay them back. It just said they were going to “reprocess” the incorrectly processed claims. I assumed that meant they were going to ask for the money back. I’m happy to hear that they probably can’t do this. I will fight them if they try.

More irony: The total for the five sessions they paid for with her doesn’t add up to what they happily forked over for just ONE session with the former T. Even if they paid 100% reimbursement with her, they’re saving a ton of money since I transferred. But I know that’s not the way they look at it. Makes too much sense, maybe?

Jones, you asked why I am I afraid to talk to my T about this? Because I’m afraid she’ll see me as a burden and want to terminate. You are right, I should give her a chance, but it also opens up the possibility of counter-transference. And I’m sorry to keep harping on this but I endured a lot of that from my former T without even knowing how I was causing it and I’m so extremely scared of causing it again with her. I know we just talked about this and had a great session but this stupid fear is back again strong as ever. In fact if you want to know the whole gory truth, I just finished writing her a letter telling her I’m quitting therapy because I’ve just run into another insurance-related obstacle, which makes me realize how long I’ve been attempting therapy and how little progress I’ve made, and that therapy’s probably not going to work anyway because as soon as I get someone to help me, I turn around and unconsciously try to manipulate them into leaving me, and that’s probably what happened with my former T, and by the way that’s what happened with my spirit mom so it must be a pattern, and I need to leave before I repeat it with her, blah blah blah...Obviously I’m not just talking about insurance anymore, now this has kicked off all my abandonment fears again so I just want to run away before she can leave me.

But you are right, if I don't take the risk she can't help me, and it is something she "should" help me with, and I "should" be able to ask. So I probably will even though I'm really afraid.

*sigh* Am I done with therapy yet?

Thank you
SG

Oh, SG... it sounds like you are hard up against your abandonment fears with this situation and I'm sorry. They run so deep in us. You talked this fear through with your T, but now you have a pressing real life situation that offers to test the old beliefs (if I let myself be needy I'll be left) against the new beliefs (it's possible to share and be safe). That is very scary. If your T is worth her salt (and some are), she will be able to stay with you through difficulty, not just when it's easy. I soooo hope you get that.

"I turn around and unconsciously try to manipulate them into leaving me"
Um, I may be off-track here, but is that a fancy way of saying "I deserved to be left"? Maybe it is or maybe it isn't - but it could be worth checking in with yourself. You don't, by the way.

((((((((SG)))))))))

J

Hi there SG. I'd just like to say that I think this sounds like an amazing opportunity to get a need met that hasn't really been met before. You're right... you aren't just talking about insurance anymore... I hope you give her the chance to help before you run. If this is highlighting a pattern of yours, running pretty much ensures that you're just prolonging this confrontation to a later date.... that's how things work in my experience.

Plus, I flat out LOATHE insurance companies and I'd hate for them to bully you out of care that you need and deserve. Another thing I thought of when reading your post... I know this is hairy b/c of your old T, but countertransference is NOT your concern. It shouldn't even have to be on your radar. I mean obviously it IS because of your experiences, but it's your t's job to manage it. Trying to avoid "causing" countertrasference is practically impossible IMO... I mean, you could sit on the couch and say.... 'frog' or 'hopscotch' and conjure up some sort of internal reaction from your t... but HOPEFULLY, you will never know it. i guess I'm saying... what CAN you talk about if you're trying to avoid countertransference and you don't know your t's sensitivities????? Any and everything has the potential for countertransference.

quote:

makes me realize how long I’ve been attempting therapy and how little progress I’ve made, and that therapy’s probably not going to work anyway because as soon as I get someone to help me, I turn around and unconsciously try to manipulate them into leaving me, and that’s probably what happened with my former T, and by the way that’s what happened with my spirit mom so it must be a pattern, and I need to leave before I repeat it with her

I hate to break it to you, but it sounds like therapy IS working because you are now aware of something that used to be an unconscious pattern... that's part of the goal right?

Lastly... you say you "manuipulate ppl into leaving you." When i've felt this way before, it's usually because it's easier to blame ME than it is to feel the pain that might come from realizing being left had very little to do with me at all. Feeling small and powerless is often worse than being liable for me, and i wonder if it might be the same or similar for you...?

I guess that's it. Keep writing and talking through this. Don't give up now.

-CT

Hi SG
I hope that despite the letter you wrote you are not going to leave therapy. I can't imagine your T would not want to help out if there is an alternative billing procedure that would make the bloody insurance company happy. That must be horrible to come across this kind of administrative sh..t when you are trying to deal with your real problems, and there is another obstacle coming up.

I kind of understand you fear of not wanting to bother your T with this kind of stuff too much. I'm just thinking of asking my T if we could have our appointment time 15 minutes later, cause every Monday I'm sick of fear that I will be late and loose some of my precious session time. But that means I'm asking him to have his working day 15 minutes longer while he probably would like to go home after a long day and just chill out.