Home
Log in / Sign Up
    Private Messages   Advanced Search   Rules   New User Guide   FAQ   Advertise   Contact Us  
Forum -> Relationships -> Manners & Etiquette
Who is right?
Previous  1  2  3



Post new topic   Reply to topic View latest: 24h 48h 72h

Scrabble123




 
 
    
 

Post Thu, Jun 04 2015, 2:39 pm
I have a totally different opinion. I think that the therapist should charge the amount that she usually charges... $60 let's say and insurance would probably cover a percentage of that and leave the mother paying a co-pay of $21.00 or such (I just a 36% since $40 is $36 percent of $110). She does not have to charge the insurance $110 if her rate is $60 and the parent's co-pay should be from the actual price that the therapist charges and not a different price because the therapist got lucky that the insurance let's her charge more than usual.
Back to top

imaima




 
 
    
 

Post Thu, Jun 04 2015, 3:05 pm
Scrabble123 wrote:
I have a totally different opinion. I think that the therapist should charge the amount that she usually charges... $60 let's say and insurance would probably cover a percentage of that and leave the mother paying a co-pay of $21.00 or such (I just a 36% since $40 is $36 percent of $110). She does not have to charge the insurance $110 if her rate is $60 and the parent's co-pay should be from the actual price that the therapist charges and not a different price because the therapist got lucky that the insurance let's her charge more than usual.


Her rate is not 60. She lowered her rate to 40-60 to do chesed for the client, and now the client wants to fight with her over it.
Back to top

Scrabble123




 
 
    
 

Post Thu, Jun 04 2015, 3:08 pm
imaima wrote:
Her rate is not 60. She lowered her rate to 40-60 to do chesed for the client, and now the client wants to fight with her over it.


Didn't someone say that the therapist's going rate is $60/session?
Back to top

studying_torah




 
 
    
 

Post Thu, Jun 04 2015, 3:19 pm
Don't forget the time the therapist is spending to write up and submit paperwork to the insurance that she's not getting paid for!
Pay the $40
Back to top

JAWSCIENCE




 
 
    
 

Post Thu, Jun 04 2015, 5:26 pm
Scrabble123 wrote:
I have a totally different opinion. I think that the therapist should charge the amount that she usually charges... $60 let's say and insurance would probably cover a percentage of that and leave the mother paying a co-pay of $21.00 or such (I just a 36% since $40 is $36 percent of $110). She does not have to charge the insurance $110 if her rate is $60 and the parent's co-pay should be from the actual price that the therapist charges and not a different price because the therapist got lucky that the insurance let's her charge more than usual.


This is an inaccurate reflection of medical billing. Usually the way medical billing works is the provider sends a bill with a billing code to the provider and they charge a certain amount. The insurance NEVER pays the full amount. They have a "negotiated rate" and it varies by the service. OP mentions this is a specialized therapy which usually has a higher rate. Even if the amount is being billed as a deductible the client only pays the negotiated rate. That is why she probably said it is usually 40-60$. Most insurance companies usually have that negotiated rate. OPs insurance has a different negotiated rate of $110 for this particular service. The therapist bill is actually not who determines the rate, her bill will ALWAYS BE HIGHER THAN WHAT INSURANCE ACTUALLY DEEMS IS THE CORRECT PRICE, the insurance company always knocks it down to what they deem the appropriate price. The insurance company also has a set co pay or co insurance for each service that is specified in this plan when you sign up. The therapist cannot change that without committing fraud.

It is my understanding that the therapist agreed to settle for $60 if the insurance doesn't pay anything and simply denies the service. In those cases when a service is "not covered" the insurance has no negotiated rate and tells the therapist to bill the client whatever they want. Her best guess for what the insurance would charge if this was deemed a service that is covered but must be paid by the client until the deductible is met was 40-60$ but she is not in control of it and could not guarantee that. That doesn't mean she gets paid less because the insurance company decided to contribute. What you are asking her to do - get the insurance payment and then forgive the co pay is not legal.
Back to top

Lady Bug




 
 
    
 

Post Thu, Jun 04 2015, 7:56 pm
I doubt anyone is doing therapy for $40. OP, you misunderstood, intentionally or not. Pay up your share and thank the therapist for billing your insurance for her rightfully earned payment.
Back to top

Scrabble123




 
 
    
 

Post Thu, Jun 04 2015, 8:52 pm
JAWSCIENCE wrote:
This is an inaccurate reflection of medical billing. Usually the way medical billing works is the provider sends a bill with a billing code to the provider and they charge a certain amount. The insurance NEVER pays the full amount. They have a "negotiated rate" and it varies by the service. OP mentions this is a specialized therapy which usually has a higher rate. Even if the amount is being billed as a deductible the client only pays the negotiated rate. That is why she probably said it is usually 40-60$. Most insurance companies usually have that negotiated rate. OPs insurance has a different negotiated rate of $110 for this particular service. The therapist bill is actually not who determines the rate, her bill will ALWAYS BE HIGHER THAN WHAT INSURANCE ACTUALLY DEEMS IS THE CORRECT PRICE, the insurance company always knocks it down to what they deem the appropriate price. The insurance company also has a set co pay or co insurance for each service that is specified in this plan when you sign up. The therapist cannot change that without committing fraud.

It is my understanding that the therapist agreed to settle for $60 if the insurance doesn't pay anything and simply denies the service. In those cases when a service is "not covered" the insurance has no negotiated rate and tells the therapist to bill the client whatever they want. Her best guess for what the insurance would charge if this was deemed a service that is covered but must be paid by the client until the deductible is met was 40-60$ but she is not in control of it and could not guarantee that. That doesn't mean she gets paid less because the insurance company decided to contribute. What you are asking her to do - get the insurance payment and then forgive the co pay is not legal.


A provider submits a bill with a code and the amount they charge for the code. The insurance company will have a negotiated rate. So someone could bill $200 and another person $75 for the same service and the insurance company will have a negotiated rate of which the insured is responsible for a percentage or portion. What I said is not an inaccurate representation at all.

If the therapist's personal rate is $60/session and the insurance will probably allow the entire $60 to be billed and not need a negotiated rate and just have the insured pay the agreed-upon-in-the-plan portion. Not every provider charges more than the negotiated rate. For example, some dentists will charge $125.00 for a full cleaning when most insurance will not make an issue with the same code for billings up to $275, but that is just the lower rate that that dentist charges. I agree that the dentist to actually bill higher, but for some reason he decided not to (with the same codes as the $275 dentist).
Back to top

Fox




 
 
    
 

Post Thu, Jun 04 2015, 10:40 pm
Obviously, this is definitely a case for the LOR.

However, I can't help but feel that the therapist didn't do a very good job of clarifying how any insurance money would be applied. My guess is that she didn't really expect an out-of-network insurer to pay much, if anything, so she kind of glossed over that possibility.

It makes complete sense to say, "My rate is $110. Because of your circumstances, I will take $40 from you plus anything that the insurance company pays up to a maximum of $110."

A lot hinges on whether she was explicit about her fee. If she didn't articulate that she charges $110, then the OP is correct to be, at best, confused. If she did, then the the OP owes $40 *unless* the therapist receives more than $70 per session.

In other words, the total payment by insurance *and* the OP should not equal more than the standard fee.

On a side topic, I'm a little confused by why Lemon Amother was offended by a patient who paid an agreed-upon set fee rather than the full insurance reimbursement. The practitioner in this case gambled on the fact that the set fee he/she negotiated would be *more* than the likely insurance reimbursement. That turned out not to be the case.

Either you agree to take the insurance reimbursement, whatever it might be *or* you set a fee and agree that any insurance reimbursement will be applied toward the set fee -- but not in excess of 100 percent -- and that that the patient will pay the remainder.

Lemon Amother's situation sounds more like the practitioner regretted being bamboozled into offering a highly discounted set price, but only became unhappy *after* the insurance company paid more than was expected.

I can understand the aggravation, but when you set a price for a service, you can't get mad simply because people *could* pay you more but don't.
Back to top

JAWSCIENCE




 
 
    
 

Post Thu, Jun 04 2015, 10:53 pm
Scrabble123 wrote:
A provider submits a bill with a code and the amount they charge for the code. The insurance company will have a negotiated rate. So someone could bill $200 and another person $75 for the same service and the insurance company will have a negotiated rate of which the insured is responsible for a percentage or portion. What I said is not an inaccurate representation at all.

If the therapist's personal rate is $60/session and the insurance will probably allow the entire $60 to be billed and not need a negotiated rate and just have the insured pay the agreed-upon-in-the-plan portion. Not every provider charges more than the negotiated rate. For example, some dentists will charge $125.00 for a full cleaning when most insurance will not make an issue with the same code for billings up to $275, but that is just the lower rate that that dentist charges. I agree that the dentist to actually bill higher, but for some reason he decided not to (with the same codes as the $275 dentist).


You said it yourself, "the insured is responsible for a percentage or portion". The therapist cannot just let her out of that. It's part of OP's contract with the insurance company. They do not lower the percentage or the flat copay if the service is billed at the negotiated rate. It would help to know if what OP is paying is a copay or coinsurance, but it would still not change my mind about who is in the wrong.

If the patients insurance has a set co pay of $60 and the provider bills $60 they will put the entire $60 on the patient. Billing more so that the insurance will cover the $60 you want and then just forgiving the balance since you never intended to collect it is insurance fraud. It gets people in serious trouble. This provider might have been hoping for $60 (I doubt it, that's not enough for this service) but if the insurance company decided the patient responsibility is $40 on top of the $ they are paying she cannot just forgive it. The very fact that she did not bill only $60 and she says "most insurance companies allow $60 per session" indicates that these sessions are billed higher and are worth more than that. The therapist would be acting unethically and likely illegally to forgive the patient portion and take all the insurance money without filing some sort of demonstration of hardship with the insurance company.

My understanding of OP's post was that the therapist thought it would cost $60 to the patient, not that she has a flat fee of $60 for any and all services. The therapist agreed as a chessed to take only $60 from the patient even if the insurance company completely denies the claim. She took this client on as a chessed in the first place as she normally doesn't agree to take clients with this particular insurance. Now OP wants to hold her to that $60 even though it exposes the therapist to unethical and illegal activity. American health insurance is confusing and leads to many misunderstandings like this. I agree the situation sucks. I simply don't agree the therapist is in the wrong and frankly OP bickering over this is going to leave this therapist feeling burned and like she never should do anyone a favor. The therapist does not usually use this company and has no control over them and their payment schemes. If OP wanted an exact quote on what this would cost out of pocket she had two options 1)call her insurance company and try to get an answer out of them 2)agree to not use insurance at all and settle a rate with the therapist beforehand. The therapist can guess what the insurance company might want but she could be waaaay off and you can't hold her responsible for that. If you want her to give you a binding quote you need to pay out of pocket and ignore your insurance company altogether, not ask people to commit insurance fraud for you.

Let's say this therapist typically does not take insurance and charges a flat $60 per session. She agrees out of the kindness of her heart to do the extra work she hates and submit a claim for this lady since she wants to help and it seems likely the copay will be less than $60. The therapist does not know the details of this insurance plan - remember she does not typically use them. Miracle of miracles the insurance company pays $60 but alas they determine that according to the insurance contract they have with the patient the co pay should be an additional $40. The therapist has all ready received the amount of money she wanted but she cannot legally or ethically accept the money from the insurance without also accepting the money from the patient as the two are contingent upon each other. The insurance company counts that money towards deductibles and max out of pocket expenses for the year etc. To simply forget it would be fraud. The moment OP asked the therapist to fill out insurance paperwork she negated her right to ask for the flat fee of $60 since doing so gives over the power of pricing the service from the therapist to the insurance company. She should have instead found out the details of her insurance plan instead of assuming this would be cheaper (yes I know it is impossible tog et a straight answer out of an insurance company. Which is why you can't expect the therapist to accurately predict their pricing either). If one truly has documented financial hardship there are ways that hospitals have to get around this - usually involving donated funds to pay these amounts and/or a large staff that documents the hardship with the insurance company etc. to ensure no fraud takes place. It is unfair to ask the therapist to extend the chessed to this - she's not a one woman legal and billing department. She doesn't even usually take this insurance - maybe for this reason! There's no free lunch. You have an insurance policy that charges co pays and this situation stinks. deal with it. don't begrudge another woman who did you a chessed for her unwillingness to commit insurance fraud or to take less payment than she deserves. The therapist is not the problem here - the insurance company is.
Back to top

amother
Bisque


 

Post Thu, Jun 04 2015, 11:00 pm
OP here. Boy, did I open a can of worms! I think the problem is that the therapist never told me how much her actual expected reimbursement is. She told me most insurances allow somewhere between $40-$60. (Copay and insurance combined). Because we thought it would be applied to the deductible, I assumed I would pay the $40-$60. I believe the $110 she billed insurance is an inflated number that she never expects to get. (ever been to a lab like quest diagnostics-they will bill insurance for like $200 and the allowable is $17?) Because she is not contracted with insurance, they alowed her full amount with no discount.
So I still agree that she is legally and halachically allowed to bill me my portion; I still maintain it would be a mentshlish thing to do to lower my copay since she is making way more than she typically does. And because she is not contracted, I dont think she has any legal requirement to bill me the full coinsurance.
Regardless of the above, I spoke to my husband and he feels we should pay the full amount.
We are hoping we won't need services much longer.
I have learned the hard way to either 1) not go out of network in the future or 2) be much more clear about the payment prior to starting services.
Back to top

Scrabble123




 
 
    
 

Post Thu, Jun 04 2015, 11:02 pm
JAWSCIENCE wrote:
You said it yourself, "the insured is responsible for a percentage or portion". The therapist cannot just let her out of that. It's part of OP's contract with the insurance company. They do not lower the percentage or the flat copay if the service is billed at the negotiated rate. It would help to know if what OP is paying is a copay or coinsurance, but it would still not change my mind about who is in the wrong.

If the patients insurance has a set co pay of $60 and the provider bills $60 they will put the entire $60 on the patient. Billing more so that the insurance will cover the $60 you want and then just forgiving the balance since you never intended to collect it is insurance fraud. It gets people in serious trouble. This provider might have been hoping for $60 (I doubt it, that's not enough for this service) but if the insurance company decided the patient responsibility is $40 on top of the $ they are paying she cannot just forgive it. The very fact that she did not bill only $60 and she says "most insurance companies allow $60 per session" indicates that these sessions are billed higher and are worth more than that. The therapist would be acting unethically and likely illegally to forgive the patient portion and take all the insurance money without filing some sort of demonstration of hardship with the insurance company.

My understanding of OP's post was that the therapist thought it would cost $60 to the patient, not that she has a flat fee of $60 for any and all services. The therapist agreed as a chessed to take only $60 from the patient even if the insurance company completely denies the claim. She took this client on as a chessed in the first place as she normally doesn't agree to take clients with this particular insurance. Now OP wants to hold her to that $60 even though it exposes the therapist to unethical and illegal activity. American health insurance is confusing and leads to many misunderstandings like this. I agree the situation sucks. I simply don't agree the therapist is in the wrong and frankly OP bickering over this is going to leave this therapist feeling burned and like she never should do anyone a favor. The therapist does not usually use this company and has no control over them and their payment schemes. If OP wanted an exact quote on what this would cost out of pocket she had two options 1)call her insurance company and try to get an answer out of them 2)agree to not use insurance at all and settle a rate with the therapist beforehand. The therapist can guess what the insurance company might want but she could be waaaay off and you can't hold her responsible for that. If you want her to give you a binding quote you need to pay out of pocket and ignore your insurance company altogether, not ask people to commit insurance fraud for you.

Let's say this therapist typically does not take insurance and charges a flat $60 per session. She agrees out of the kindness of her heart to do the extra work she hates and submit a claim for this lady since she wants to help and it seems likely the copay will be less than $60. The therapist does not know the details of this insurance plan - remember she does not typically use them. Miracle of miracles the insurance company pays $60 but alas they determine that according to the insurance contract they have with the patient the co pay should be an additional $40. The therapist has all ready received the amount of money she wanted but she cannot legally or ethically accept the money from the insurance without also accepting the money from the patient as the two are contingent upon each other. The insurance company counts that money towards deductibles and max out of pocket expenses for the year etc. To simply forget it would be fraud. The moment OP asked the therapist to fill out insurance paperwork she negated her right to ask for the flat fee of $60 since doing so gives over the power of pricing the service from the therapist to the insurance company. She should have instead found out the details of her insurance plan instead of assuming this would be cheaper (yes I know it is impossible tog et a straight answer out of an insurance company. Which is why you can't expect the therapist to accurately predict their pricing either). If one truly has documented financial hardship there are ways that hospitals have to get around this - usually involving donated funds to pay these amounts and/or a large staff that documents the hardship with the insurance company etc. to ensure no fraud takes place. It is unfair to ask the therapist to extend the chessed to this - she's not a one woman legal and billing department. She doesn't even usually take this insurance - maybe for this reason! There's no free lunch. You have an insurance policy that charges co pays and this situation stinks. deal with it. don't begrudge another woman who did you a chessed for her unwillingness to commit insurance fraud or to take less payment than she deserves. The therapist is not the problem here - the insurance company is.


I think that you must have misunderstood my first post.
I thought that the therapist's charge is $60/session. I thought that that is what she bills to the insurance, but somehow found out that she could get away with more so she billed for more and was told that the insurance allowed $110 (and that the insured was responsible for $40).
I was saying that if her actual price is $60/session, it's unethical to change it because she heard she can get more (you are allowed to change prices, but not after you told someone that you charge $60/session as your standard fee). So I said that she should charge the insurance what she actually bills which is $60/session and that the insured should pay whatever portion the insurance deems will be appropriate (which should be around $21 dollars because that's the same percentage as $40/$110)
I'm not sure what you think I'm saying. Obviously the therapist is not allowed to forget to charge the insured her portion and I would never suggest anything so ridiculous. I just thought that the therapist said that she charged $60/session and that since she thought that insurance would not cover it she told the insured to expect to pay around that amount (and possibly a discount). I thought that the actual rate was $60/session in which case the insured should only be paying the portion of the actual rate and not an inflated one just because.

Here's my original post:

Scrabble123 wrote:
I have a totally different opinion. I think that the therapist should charge the amount that she usually charges... $60 let's say and insurance would probably cover a percentage of that and leave the mother paying a co-pay of $21.00 or such (I just a 36% since $40 is $36 percent of $110). She does not have to charge the insurance $110 if her rate is $60 and the parent's co-pay should be from the actual price that the therapist charges and not a different price because the therapist got lucky that the insurance let's her charge more than usual.


Where did I say that the insured should not have to pay her portion? SHE SHOULD
Where did I say that the therapist should not charge her actual charge? SHE SHOULD

I obviously misunderstood what the therapist's rate was, and you too grossly misunderstood what I was saying, but I don't know where you were taking that form.


Last edited by Scrabble123 on Thu, Jun 04 2015, 11:05 pm; edited 1 time in total
Back to top

JAWSCIENCE




 
 
    
 

Post Thu, Jun 04 2015, 11:05 pm
Fox wrote:
Obviously, this is definitely a case for the LOR.

However, I can't help but feel that the therapist didn't do a very good job of clarifying how any insurance money would be applied. My guess is that she didn't really expect an out-of-network insurer to pay much, if anything, so she kind of glossed over that possibility.

It makes complete sense to say, "My rate is $110. Because of your circumstances, I will take $40 from you plus anything that the insurance company pays up to a maximum of $110."

A lot hinges on whether she was explicit about her fee. If she didn't articulate that she charges $110, then the OP is correct to be, at best, confused. If she did, then the the OP owes $40 *unless* the therapist receives more than $70 per session.

In other words, the total payment by insurance *and* the OP should not equal more than the standard fee.



This I agree with. Billing and payments can be very confusing and not every provider is good at explaining them. Especially if they don't usually use insurance. That's why this is so sad - it seems like a giant misunderstanding that is going to result in a therapist at best getting jaded about doing people favors/dumping this client and at worst the therapist getting bad mouthed around town as a money grubber for trying to do a chessed (OP I doubt you would do that, but there are people out there who would).

By asking the therapist to submit the insurance claim, rather than paying the therapist a set fee and submitting a claim for reimbursement herself OP made a gamble that the insurance copay would be less than the flat fee. It wasn't. Seems to me they were exactly the same, which is pretty much a wash. Could have been avoided by understanding ones insurance plan, but even people who own healthcare companies often don't understand their insurance plans...

But to be so upset at the therapist who did her a favor that she feels the need to post about it on imamother when she ultimately paying her what the therapist suggested she would likely have to pay anyway strikes me as off.
Back to top

Scrabble123




 
 
    
 

Post Thu, Jun 04 2015, 11:06 pm
Another option would be for the insured to just pay the therapist upfront and then submit the claim herself.
Back to top

JAWSCIENCE




 
 
    
 

Post Thu, Jun 04 2015, 11:13 pm
Scrabble123 wrote:
I thought that the therapist's charge is $60/session. I thought that that is what she bills to the insurance, but somehow found out that she could get away with more so she billed for more and was told that the insurance allowed $110 (and that the insured was responsible for $40).


Ah, yes. We both thought OP was saying different things. I did not think this therapist has a flat rate of $60. I understood it to mean the therapist estimated, based on her experience with other insurance companies, that the insurance company would determine the service is worth $60 and then they would pay some of it. This is where the misunderstanding originated. I thought you were saying the therapist should be happy with a flat $60 and forget the OP portion, not that she originally quoted $60.

It still sounds to me like from OPs new post the therapist never said she has a flat $60 fee. SIMply that this is what insurance usually awards her. She sent out her usual bill and insurance awarded her more. She had no way to know that would happen.

If the therapist promised she was going to bill $60 and then billed more, she is indeed in the worng, although OP would likely still have the same $60 bill.
Back to top

Scrabble123




 
 
    
 

Post Thu, Jun 04 2015, 11:16 pm
JAWSCIENCE wrote:

It still sounds to me like from OPs new post the therapist never said she has a flat $60 fee. SIMply that this is what insurance usually awards her. She sent out her usual bill and insurance awarded her more. She had no way to know that would happen.


I think that you are right. I just misunderstood the op.
Back to top

JAWSCIENCE




 
 
    
 

Post Thu, Jun 04 2015, 11:23 pm
Scrabble123 wrote:
I think that you are right. I just misunderstood the op.


well, I completely misunderstood you and it seems likely OP misunderstood her therapist. So there's a lot of that going around Wink

In brighter news we both suggested the same solution - with an an out of network therapist pay a flat fee upfront and then submit a claim to the insurance company on your own. At least that way you control your max expense.
Back to top

JAWSCIENCE




 
 
    
 

Post Thu, Jun 04 2015, 11:33 pm
amother wrote:
OP here. Boy, did I open a can of worms! I think the problem is that the therapist never told me how much her actual expected reimbursement is. She told me most insurances allow somewhere between $40-$60. (Copay and insurance combined). Because we thought it would be applied to the deductible, I assumed I would pay the $40-$60. I believe the $110 she billed insurance is an inflated number that she never expects to get. (ever been to a lab like quest diagnostics-they will bill insurance for like $200 and the allowable is $17?) Because she is not contracted with insurance, they alowed her full amount with no discount.
So I still agree that she is legally and halachically allowed to bill me my portion; I still maintain it would be a mentshlish thing to do to lower my copay since she is making way more than she typically does. And because she is not contracted, I dont think she has any legal requirement to bill me the full coinsurance.
Regardless of the above, I spoke to my husband and he feels we should pay the full amount.
We are hoping we won't need services much longer.
I have learned the hard way to either 1) not go out of network in the future or 2) be much more clear about the payment prior to starting services.


Unfortunately she couldn't tell you what her expected reimbursement was since she never uses your insurance and has no idea what they will do with her standard bill. She can only tell you what most companies do with that same bill and hope your is the same. Just like quest sends the same $200 bill to each company and gets a different amount from each of them. What could have been more clear, if you had asked, is how much hse actually bills the company. She told you how much they usually pay but I bet she always bills $110, so it's not inflated for you. It's the standard bill for all insurance companies. Your company just handled it differently than most. She had no way to know - try and let the bad feeling from that go.

It is not mentschlicht to act illegally which is what forgiving your copay might be, even without her being in network. She cannot lower your copay as it is determined by your insurance company. If you elect not to pay she can elect not to sue you or send you to collections. But that's very ugly on both sides. Instead try and ask if for future sessions she will take $60 upfront from you and not bill insurance. Then you submit the receipt for reimbursement. Then you know you are out max $60 and you might get some money back.
Back to top

LittleDucky




 
 
    
 

Post Fri, Jun 05 2015, 1:16 am
Scrabble123 wrote:
I have a totally different opinion. I think that the therapist should charge the amount that she usually charges... $60 let's say and insurance would probably cover a percentage of that and leave the mother paying a co-pay of $21.00 or such (I just a 36% since $40 is $36 percent of $110). She does not have to charge the insurance $110 if her rate is $60 and the parent's co-pay should be from the actual price that the therapist charges and not a different price because the therapist got lucky that the insurance let's her charge more than usual.


So the therapist should lose out of her income? She did a favor for the potential client. Now her income will be less than it theoretically could be...
Plus the insurance has a set rate for different treatments. The therapist does not set these rates. He or she does not have a choice.
And working with an insurance company is a huge headache. Especially one that is not part of the network and is a new one. Each company has its own procedures that need to be followed. Each one requires documentation, phone calls, submitting paperwork etc and they don't get paid any extra. It is a downside for accepting insurance which is why many places only work with certain insurance companies that they are familiar with and know that it is worth their time.
If I was that therapist I would tell the client's mother: I did you a favor. These are the terms. If you are going to continue to squabble about it, I don't think we will be a good fit for each other. Parents are a major part of the therapeutic relationship when treating a child and if you are upset at me and do not trust me, then this will not work. To best treat your child I need to have you fully on board. Here is the name of another therapist. I am sorry I cannot be of more help.
Back to top

imaima




 
 
    
 

Post Fri, Jun 05 2015, 2:12 am
amother wrote:
OP here. Boy, did I open a can of worms! I think the problem is that the therapist never told me how much her actual expected reimbursement is. She told me most insurances allow somewhere between $40-$60. (Copay and insurance combined). Because we thought it would be applied to the deductible, I assumed I would pay the $40-$60. I believe the $110 she billed insurance is an inflated number that she never expects to get. (ever been to a lab like quest diagnostics-they will bill insurance for like $200 and the allowable is $17?) Because she is not contracted with insurance, they alowed her full amount with no discount.
So I still agree that she is legally and halachically allowed to bill me my portion; I still maintain it would be a mentshlish thing to do to lower my copay since she is making way more than she typically does. And because she is not contracted, I dont think she has any legal requirement to bill me the full coinsurance.
Regardless of the above, I spoke to my husband and he feels we should pay the full amount.
We are hoping we won't need services much longer.
I have learned the hard way to either 1) not go out of network in the future or 2) be much more clear about the payment prior to starting services.


Really OP? Just because you are poor, it doesn't mean that the therapist should be poor too. She does her job and charges accordingly. There must be a reason why you sought her out and not someone who is covered by your insurance. So you have to pay the price.
First you imposed on her as a patient and then as a nebach case.
Back to top

princessleah




 
 
    
 

Post Fri, Jun 05 2015, 10:26 am
I want to know what kind of amazing insurance you have OP. Where most insurances are paying out $40-$60/session yours pays the full rate to someone who is not even in network??? Sign me up for this insurance STAT!
Back to top
Page 3 of 3 Previous  1  2  3 Recent Topics




Post new topic   Reply to topic    Forum -> Relationships -> Manners & Etiquette

Related Topics Replies Last Post
Anyone else's day feeling pretty regular right now?
by amother
5 Sun, Mar 24 2024, 4:22 pm View last post
Conspiracy theorists right again!
by amother
7 Fri, Mar 15 2024, 8:44 am View last post
Can you help me find the right shirt?
by amother
13 Mon, Mar 04 2024, 5:53 pm View last post
[ Poll ] Help with Bar Mitzvah right before Purim
by amother
7 Mon, Feb 26 2024, 11:48 am View last post
Apparently I’m doing it all wrong or am I doing it right.. 13 Sun, Feb 25 2024, 11:50 pm View last post