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POLL: Insurance billing and session length (US clients)

mad hattermad hatterMember
This poll is for clients in the US. I am curious about how your Ts/Ps bill for your therapy, particularly since Jan.2013 when new insurance billing codes were put into place.

Therapists are currently allowed to bill insurance for individual sessions in time increments of 30 minutes, 45 minutes, or 60 minutes. Since sessions do not always end exactly at those times, therapists are instructed to apply the following ranges:

90832 Psychotherapy, 30 minutes (from 16 to 37 minutes) with patient and/or family member

90834 Psychotherapy, 45 (from 38 to 52 minutes) minutes with patient and/or family member

90837 Psychotherapy, 60 minutes (from 53 minutes or longer) with patient and/or family member

"Psychologists who conduct sessions that require more than 60 minutes may continue to do so and will bill using the new 90837 code effective Jan. 1." according to The APA Practice Organization. In other words, if your session is longer than 60 minutes you should only be billed 60 minutes unless there is some add-on code (like a suicidal crisis) that can be used to justify additional charges.

The reason this is of interest to me is because at my first session with a new female P last week, I was asked to sign a paper that agreed that my sessions would last from 45-50 minutes long, and yet when questioned about the charges, the receptionist admitted that it was billed as a 60-minute session. I challenged the P on this when she also said my sessions would be around 50 minutes, sometimes longer and sometimes shorter. I said, I don't think I should be billed for 60-minute sessions if I am only getting 45 minutes of time. She seemed surprised that I knew about the insurance codes and (in my opinion) caught off guard. She admitted that my sessions needed to be 53 minutes to qualify for a 60-minute charge and then changed her story that my sessions would probably be 55 minutes long, despite the form I had to sign that said otherwise. Is this not financial exploitation of the client for the therapists benefit totally unethical and dishonest? I do not think I can or should trust a therapist who is dishonest in business, particularly when it benefits her at the client's expense.
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yakusokuyakusokuMember
T told me that my 90808 code was going away at the first session of the year, and then I researched it and talked to him about it. I've had to do almost everything for myself this year, because our plan was changed, so I am a lot more involved in the billing than previously, though T would still explain how our contract worked to me. He was making billing decisions about when to charge and not and now we have to cooperate more on that, because they will (hopefully, if my account is ever "fixed" from a glitch we've been having for months now) reimburse me, rather than pay him directly. I have found I am actually more educated about the new codes and billing practices, law, etc. than anyone I have spoken with at the insurance company so far.

My T bills for the most insurance will allow (previously 90808, 75-80 minutes, now 90837, 60 minutes) and then provides any extra time for free. Last year, we paid 5/6 his hourly rate for me and 2/3 for H. H's sessions were generally 60-70 minutes, whereas mine were generally doubles or more. He chose to provide that for free and I'm still trying to work through the self-loathing of accepting that all the time...
B bltMember
My T has never been super rigid about time. Before the code changes, we would go anywhere from 50-60 minutes. When the codes changed, she told me that she was being restricted to using the 90834 (45 min) code for me except for special permission, and therefore she was going to try to end at 45 minutes. Then after a few weeks she told me that 45 minutes really felt short to her and she was struggling to adapt to it. So in practice we're still doing at least 50 minutes most of the time. Plus, she does not change for emails or phone calls.

I would say your insurance should not be billed for the longer code unless your sessions are actually 53 minutes or longer, right?
mad hattermad hatterMember
Yes, BLT, that is how I see it. Its understandable for a T to not want to donate time and want to be compensated fairly, but quite another to charge for services not given.

It bothers me that the new P was surprised by my knowledge of the billing codes. In this day and age, consumers are being forced to gather their own knowledge about health care costs since we are increasingly bearing the financial burden. We can no longer afford to be taken advantage of for our ignorance.

On the other hand, it encourages me when I hear about Ts who go above the call of duty. They are more likely to be in the business for reasons other than money, perhaps for the satisfaction of making a meaningful difference in people's lives.
yakusokuyakusokuMember
MH - Sorry. I had totally missed your explanation when I read the post on my phone. Yeah, that is entirely unethical. My T said he wouldn't charge the 60 minute code for anything below 60 minutes at all. He is considering it a minimum for himself. The family sessions that H will be billed under my name, but for him, because they discuss me and the stuff coming up from my struggles and how his stuff impacts that a lot, are billed as either 90846 or 90847, depending on whether I am there. So, T can't charge for the 60 minutes on those at all. Frowner
mad hattermad hatterMember
Anon, your T seems to be very generous.

Cat, do you feel like you actually get your money's worth out of your P-Doc? I will never understand how psychiatrists can live with themselves with the way they charge for the barest minimum of services, but then again I have never had a P-Doc to know whether they would truly make a difference in my treatment.
beccabeccaMember
I private pay, so I don't think it applies to me. I still get the full hour. I have wondered, if T's want to charge under the new codes, let's say the 45 min. amount, how come clients can't pay for the other 15 min. out of their own pocket. One would at least get to be there for the full hour and it wouldn't be all that much money. Just a thought.
yakusokuyakusokuMember
It depends on your type of insurance. When I was under my HMO, T had to have a contract to work with me (because he's out of network) and I was allowed only to pay my copays, nothing more, even if I wanted to.

Under my current insurance, I'm allowed to see T as out of network without a contract (but he is contracted for my case only again to save me money), and thus anything he charges above what they approve is my responsibility to pay, so we can pay T as much as we can afford over and above what is covered.
mad hattermad hatterMember
I went to my second session today with new P. I waited until after it was over to pay because I was planning to make a scene about paying for a 60 minute session if I got less than 53 minutes. But P called me back to her office early and gave me at least 58 minutes. I wonder if that was because I made a point of asking about it last time. Maybe it pays off to be a savvy health consumer, eh?
avoidantavoidantMember
quote:
gosh ,how sad that treatment and payment comes down to minutes


I have to agree with what Poppet said earlier.

My rather simplistic view is that 50+ years ago my mother gave birth to me; now my T is giving life to me and that's worth far more to me than money or clock watching. For a long time last year I voluntarily overpaid my T, and the only reason I watch the clock in sessions is to ensure I don't encroach into her private time as I'm usually her last client of the day.

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