Who is right? | Imamother

amother

Bisque

Wed, Jun 03 2015, 9:43 pm

I am not going to tell you which person I am but want to know who is right.

Parent hires a speech therapist to treat their child. Speech therapist does not participate with child's insurance plan but agrees to bill the insurance as a courtesy to family. There is a $650 deductible for child to meet before insurance will pay anything. Therapist explains to parent that the usual amount allowed by insurance is between $40-$60 per visit. Parent explains to therapist that money is very tight and asks for the least amount of services possible. Parent agrees to pay deductible which will most likely be about $40-$60 per visit as noted above.
Therapist provides service and bills insurance. Insurance processes it differently and allows $110 per visit. They do not require parent to pay deductible. Instead, they pay $70 and parent is required to pay $40. Therapist bills patient for $40. Parent explains again to therapist that money is tight and since allowable is much higher than expected, it would be very helpful if therapist could reduce the out of pocket requirement for patient. Therapist explains that parent has already agreed that cost will be about $40 per visit. Parent is upset bec. the therapist is making a lot more money than usual and wants therapist to lower the amount she needs to pay.
I know there is no right or wrong and I can see both sides, but I am interested in opinions. 1) Should the therapist give the parent a break bec. she is getting a much higher payment than usual? 2) Is it fair for the parent to ask for a reduction?
If the parent asked you, would you agree? If the therapist refused, would you as a parent fight it?

Fabulous

Wed, Jun 03 2015, 10:01 pm

ROFL wrote:

If I understand the therapist agreed to take 40-60 from patient if insurance did not cover anything ?

as far as I understood it she wants to get paid about $110 for a session: 40-60 from insurance and 40-60 from patient. She ended up getting 70 from insurance, which the parent then wanted her to prorate to the full amount she was willing to take before, which may have been as low as 80 total, 40 from each.

If you normally don't take that insurance or any insurance and you normally make approx $110 a session, I think it's fair that you can take 40 from parents, which was the low end of what you had originally requested. However, I think if you can afford and be nice and chessed you can offer to take a bit less, but not necessary. In future, just state what you need to come home with, regardless of how it works out.

imasinger

Wed, Jun 03 2015, 10:03 pm

I side with the therapist here.

It looks like, from what you posted, the therapist explained that parent cost would be $40 or so per visit. Whether it is called a deductible, or a patient pay, it is still the same $40.

Parent has no idea about what therapist would be making outside of the deductible. Private pay speech therapists can charge much more than even the $110 that the insurance covers.

The parent should either find someone in-network, or pay the previously stated cost.

If a parent asked me, if I were a therapist, for a reduction, I'd say no, unless I needed to use this situation for maaser, for some reason. It's my parnassa, and parent has no idea of my financial needs, nor should she. The professional thing to do is make a statement about my rate.

If I were a parent told something like this (and it has happened), I'd look for a therapist I could afford, or cut back on the number of sessions.

Fight it? What is there to fight? The therapist sets a rate. I can take it or leave it. And if I make a nuisance of myself, the therapist may decline the case anyway.

acccdac

Wed, Jun 03 2015, 10:04 pm

it seems like regardless of insurance parent understood that payment would be $40-60 a pop.
parent agreed to treatment
so parent should pay

if the parent thought they had to pay deductible and then insurance would then cover 100% therefore only paying a maximum of $650 out of pocket covering 11-16 sessions, then maybe after that total payment from parent should stop and therapist only collect the $650 from parent.

If the parent is claiming cant afford then the therapist needs to decide whether or not they offer a payment plan to their patients in general.

amother

Bisque

Wed, Jun 03 2015, 10:10 pm

Fabulous wrote:

The usual take-home pay of the therapist (including insurance and patient copay) is about $40-$60 per visit. $110 is significantly higher than usual. And therapist does participate with many insurance plans, just not this particular one. And therapist is a specialist in the area that the child needs help with so parents have chosen not to go elsewhere.

imasinger

Wed, Jun 03 2015, 10:15 pm

amother wrote:

Any doubt left as to which side of this debate is OP? Smile

Sorry, OP. I know it's a hard situation, but I don't think there is reasonable recourse to battle here.

May your DS see much progress in a short time!

amother

Bisque

Wed, Jun 03 2015, 10:22 pm

imasinger wrote:

Any doubt left as to which side of this debate is OP? Smile

Sorry, OP. I know it's a hard situation, but I don't think there is reasonable recourse to battle here.

May your DS see much progress in a short time!

Lol! Yes, I admit, I am the parent :-)
I know legally and halachically I am required to pay the $40 but I do feel the therapist should reduce the rate slightly. And I am trying to decide whether to fight a little more (nicely of course).

librarygirl

Wed, Jun 03 2015, 10:36 pm

Does the therapist know you can't go elsewhere? If she is getting 70 from insurance, seems to me you can tell her in a nice way you don't want to pay more than 20, or you will have to look else where. She will still be getting substantially more than her usual 40-60. It's a free country. She can set her own rates, and you are free to negotiate or leave.

amother

Jade

Wed, Jun 03 2015, 11:22 pm

amother wrote:

:arrow:

Can the therapist even accept less legally?

LittleDucky

Wed, Jun 03 2015, 11:30 pm

I am not sure about this but I think when insurance companies make "deals" with providers, they are required to make the client pay the "copay". If this is true, then the therapist does not exactly have much choice. Whether or not the family was going through insurance or not, in this case, it seems that the OOP would be the same. The only difference is the amount the therapist would be receiving...

amother

Cerulean

Wed, Jun 03 2015, 11:38 pm

I am a therapist. I think the therapist is wrong. It is standing on ceremony to require the parent to pay just because they said they would. You are already walking away with more money than you assumed you would end up with. That said, I always believe it is beneficial for the parent to pay SOMETHING, they are more invested in the therapy that way and somehow, when it is partially off their back, the therapy even seems to work better! You don't throw yourself as fully into something when you get it scot-free.

lucky14

Thu, Jun 04 2015, 12:17 am

Wasn't the therapist going to accept less than usual to begin with? Sorry, but putting myself in the therapists shoes, they have to make a living also... This situation just happened to work out in their favor and they got lucky because of insurance. But the family isn't "out" any more money then they thought they'd be to begin with.
(being that I'm someone also struggling with money I sympathize with you, but I still say the therapist didn't do anything wrong by asking for the same amount as originally asked for)

Dandelion1

Thu, Jun 04 2015, 12:26 am

I think the therapist is completely wrong, if I am understanding the situation properly. If not, please correct me.

The therapist has a rate. You said that rate is around $60.00 per session. Your insurance, which I am sure you pay dearly for, is paying $70 which is above the rate the therapist charges. So you mean to tell me that the therapist STILL wants you to pay what you were going to pay as if the insurance payed nothing?? That makes no sense whatsoever. You pay for your insurance. It is working for you by paying this bill. The therapist cannot kick up his/her price on top of that, so that no matter what the insurance pays, she/he will STILL get $40 MORE??

imaima

Thu, Jun 04 2015, 12:51 am

amother wrote:

Looks.like the therapist did a favor to the family to even start to work with them. The family should pax what they would have paid anyway.

notshanarishona

Thu, Jun 04 2015, 6:09 am

Just from the other side of the fence, the therapist might not work with your insurance because then there is a lot of red time and bureaucracy which costs her time and $. She is doing u a favor by making an exception.
I don't think its a good idea to ever fight with the actual therapist, fight with her secretary.. Very Happy

u r putting her in a very uncomfortable position.