Welcome back.
IMHO if your T is happy seeing you for a lower fee then hang in there because:

1. You are so worth it
2. It's not up to you to b responsible for your T's finances. That's a need that they must care for themselves.
3. In the middle of a crisis you need help and support from someone you trust.

I agree with Outsider in that it's so easy to tell you my point of view, but it is hard to live with this sort of thing as I need to talk to my P about insurance issues also.

When I've spoken to him in the past, he assures me that everything is fine, and that payment is only 1 aspect of his job, not his main concern, so if your T says the new plan is okay, I think you should try to let go of the emotions attached to payments, which is very hard.

Maybe try to look at it from a different perspective, as if you were seeing any other sort of medical professional. It seems like insurance reimbursements are changing, or lowering, all the time, but would you worry if the same thing happened to your gp or dermatologist...or anyone else? I get statements back from my insurance and notice that a doctor has charged 4-5 times what the insurance reimburses and it doesn't bother me, but I have to admit, when any little change happens with my insurance payments regarding therapy, I start to stress out as well.

It's hard, but I think we have to trust them to let us know when changes in payments are an issue.

Thanks you guys. I know what I should do, what I probably will do, because it feels like the choices I have are accept whatever help he offers, if he does, or revert to dissociating and avoiding all triggers to function.

I ran all sorts of financial scenarios and I just can't afford to pay him anything more than a few dollars over what the insurance company will cover with our budget as it is. I don't know how to tell him. If we had rented a slightly cheaper place, we'd have been able to pay him more, but I didn't know they were going to only cover 50% of standard rate.

I really need to update him on how I'm doing right now (still not great), but I'm afraid (ridiculous) he will think it's pathetic, my being so upset and worked up and needing MORE help when he's already been seeing me three times a week and I just saw him yesterday.

I've been cleaning and unpacking to get by (distract myself and ride the good feelings that come with accomplishing stuff), but I have literally run out of things I can do. There are piles of H's electronics stuff to be cleaned up, but he's not ready to figure out what he wants done with it. I have done EVERYTHING else, even got dinner cooking. I just want to go back to bed and sleep and not have to think about anything right no, like how I've ruined my family's finances, caused us to lose our home. Last night, I went to bed early and started hyperventilating, couldn't get enough air.

It's stupid to be so overwhelmed. I'm sorry.

It's really sounding like he won't offer anything afterall and I can't complain about that. I don't know if I pushed him to that with my past terror of receiving or else he's just finally realized what I've been telling him the last two years, we're just TOO MUCH. I told him we'd come and discuss it Monday, but how do I do this? I can't even think about the decision I'll have to make for more than a couple minutes without going hospital level freaked out. I feel sick and alone.

i have a feeling your t would see you regardless if you paid or didn't pay. my intention isn't to make you feel bad about that i just mean, he seems willing to work with you very generously, a lot of ts are like that.

i recently ran in to an issue with my T (and she is still way more than I can afford but I CAN pay her so I do). Her rates went up... and, because she is a T, she left it for me to negotiate because my co-pay would have gone up by about 60% (and it's already high). she told me stuff she could/was willing to do, that she has negotiated with others, about the rather significant loss she'd incur. i think a good t will do that, though i did call her a jerk for it (for not just telling me what to do).

but she wouldn't just "tell me" what to do... so i had to ask for what i needed and she gave it to me. i think if you're being honest, saying what you can do and if your t accepts, it's okay! but i know, like me, you often feel very guilty about receiving. my t and i had to process that a little for a few sessions.

it will work out to something you can feel okay with - i have a good feeling.

Thanks, Cat. (((hugs))) So good to see you.

I think the triggered, end-of-the-world, freak out is done for now and the CPs and others who were super stirred up are all silent for the moment. T says he's confident God will help us through this like through everything else. It may be that I have to cut hours or ask him whether we can do the lower rate, but charge consistently on all the sessions he didn't want to before (the Skypes, for example), so that he'd only be losing $25 on a typical week (or maybe I could make up that difference), when I'm not in crisis or having major life changes that require three in person sessions. And then charge the new crisis procedure codes for those weeks, so at least he doesn't lose as much. One of the huge problems is they got rid of the code for our longer sessions, so the only way to put down a longer one for insurance purposes is if I am in crisis.

H and I are trying to get a conference call with his benefits advisor and the insurance company rep, because there were so many assurances that this would be a better plan for the employees. The change will cost me $5-7k this year if we keep paying a full rate and their online estimator said 38% higher than they actually listed as allowable, so maybe there's some mistake??? She offered a call last week before we saw the rates, but I was moving at the time. Once we talk to them and see if there is no way to "fix" this, then we can make decisions. Until then, I'm going to see and pay T like normal.

Anyway, thanks to everybody who has been there. After just taking a bath and sleeping and praying and practicing songs for tomorrow, I feel a lot calmed down, just from all the self-care, which I'm behind on from the move. I made lunch and dinner and spent time with my family today and despite the freaking out and feeling like T hates me, I made it through OK, which I'm proud of. Last year, things would have been worse, taken a lot more work to regulate.

Anyway, thanks everybody. I will update when I actually know more (or freak out again, lol).

(((Non))) So sorry I didn't comment on this before... I'm so sorry for all that you're having to go through right now. I'm glad you've found at least a little bit of peace. I hope you and the littles can hold on to that for a bit, if you can. Please keep us updated on how you're doing with everything. I'm sorry I don't have anything to offer at the moment...just some hugs.

((Anon))

I just now saw this thread, don't know how I missed it before. So sorry for what you are dealing with! I had a freakout over an insurance change this year myself just a couple weeks ago. It can feel so threatening and scary that something as personal as our therapy is at the mercy of the whims of insurance companies and a changing economy. But as others have said, *people* are what's important; money is just a form of energy exchange. I hope that you are able to negotiate all this in a way that will let you feel peaceful.

Have to say I loved monte's whole post and could not have put it better myself. Hope you are able to hold on to some of those thoughts; glad it's been easier than last year.

(((kashley))) (((HIC)))

Thanks for the support. I'm kind of flabbergasted now. So, one of the two claims, shows the uncounted amounts as "covered by traditional coverage," which is weird, because I'm not supposed to have any until after I meet the deductible. The other shows $0 covered by traditional coverage, but still gives the lesser amount as countable toward my deductible. Both technically list the full payments as "allowable." Both claims use the same diagnosis and CPT codes, except one day had a different code. There is no way this is getting sorted out without talking to our rep.

In the meantime, I've decided to go with T's suggestion and just trust God and the work we've been doing all along. And I trust that T is the sort of guy who will find a guy to work with us. I mean, when we discovered that I had accidentally been paying after hitting my maximum last year, he talked about counting those amounts toward my payments. So, I know he will find a way to work with me, even if it's not perfect. I'm reaching out to safe people, like my pastor, to help me stay focused on the present reality, not the past where every attachment was dangerous or threatened. I know from experience T is not like that. Just I can't keep all of me convinced there, lol.

An update:

* Have had two conversations with the insurance company. They kind of contradicted each other a bit. But, then again, every time I've been given information, something has turned out to be wrong.

* We are appealing their limit of T's rate, but the appeal will take up to 30 days.

* Contrary to previous information, if T contracts with them either fully or on my case, they MIGHT negotiate a higher rate with him. But, after the nightmare they have been, will T want to do that? H and I are having a joint session today, so we'll ask him, I guess.

* I overpaid a bunch of copays last year that our previous insurance company didn't charge us for (and never notified us we hit the maximum), but I didn't notice until too late in the year. T might credit us some of that, but he was also underpaid by a similar amount, due to both insurance company mistakes and his own billing practices. I know if we demanded it, he would probably credit us, but considering all he provides over and above, I'd really rather just call it even and ask him to be more up front, involve me on billing decisions if he has to do claims in the future (I have to do them right now), from now on. H and I agreed on that.

* I am freaked out almost all the time about money issues breaking the relationship, which I mostly realize is because of past stuff and my T has reassured me that things will be worked out one way or another. I just have this constant feeling like he's going to regret or resent all he does.

* On the positive side, despite H freaking out and getting very angry, I stayed calm and remembered everything I needed to communicate on the phone call with the insurance company. They suggested looking for new therapists in their network for me and I almost broke down in tears trying to explain how difficult, painful and possibly dangerous it would be right now to have to start over. Then, yeah, numb of course.

Anyway, that's my update. For now, it's just a waiting game on the appeal and whether T is going to try to contract with them.

This all sounds very difficult to deal with. I can only imagine how I'd be reacting...
Wanted to send good wishes and let you know I'm thinking about you. I hope it all gets worked out soon.

Iris xxx

(((Iris))) (((Poppy)))

Thank you for the support. I'm actually OK with it for now. I'm able to not worry about it until there is something to worry about. I just need to learn to deal with my T's obvious discomfort over the financial impact of what is ultimately my choice to continue to prioritize my mental health until we know the answer. I'm actually starting to make it makes him physically ill when I pay him. Not my job to take care of, and I guess it's his turn to have ME make him feel sick, as I've had enough of that over the last few years. He'll do his own work on it, I'm sure. At least all the freak outs about things falling apart and seeing him be steady through it, that even if things have to change a little, he will never abandon me, and wants to continue working with me as long as I need it...well, I guess it has been a time of further building trust. Of course, like many, I am just waiting for the bottom to fall out. The more I trust him, the more certain it is that he will go "poof."

Update: My behavioral health case manager called me tonight. She seems nice and to understand the importance of being both accurate and sensitive to how much distress the company has been causing. We scheduled a conversation for 2:00pm tomorrow. She said, because she is on the clinical side of things, she may not know all the answers to the procedural issues, but she will stay with me through the process of getting it, rather than letting me get bounced around unanswered or inaccurately answered.

Crossing my fingers that this issue will be resolved, at least temporarily, until our family's first batch of sessions are used up and we have to reapply for the exception to get the "usual, customary and reasonable" level of reimbursement, instead of their mysterious, lower out-of-network rate.

So appreciative of how steady my T has been during this, just trusting God that we won't be let down and reassuring constantly of his non-intention of going "poof."