Disastrous therapy

[thenavigator]

I came here because I figure members of this forum are more likely to have experience with therapy. This is partly a finance question, but also I'm just angry and anxious over some absurd bills.

I recently moved away from abusive family, back to an area I lived in previously. I saw my former PCP to get reestablished on my medications. I told him I intended to seek therapy, so he referred me to an in-house social worker, telling me this person was in-network.

The first session went well, with the therapist saying some genuinely kind and encouraging things. He told me it would be treated as an intake, which is billed higher, but that further sessions would cost significantly less. Sessions were to be two weeks apart and capped at 12, at which point he would refer me elsewhere if needed.

The second session was a waste. I had spent the time between brooding about all of the things I wanted to get off my chest, while also being stressed by a packed work schedule and the many chores I had to take care of after moving. By the time our second meeting rolled around, just showing up felt like another chore, and I was not in the headspace to articulate all of the things I wanted to say. The therapist badly misread and misjudged me, claiming I had "given up."

He also insisted during out initial meeting that we should focus on the future, not the past. On some level I agree with this, but I have a ton of bad history, recent and otherwise. I feel (or at least felt) that it's important to process some of this, and that a proper psychologist would appreciate that.

Thankfully, our third session was canceled because my therapist was unexpectedly out of the office. I say thankfully because when I checked the web portal later, it showed I owe $531 for the first session, with another $448 still pending. I was told $350 for the intake and expected $100 for each session thereafter. Instead, I'm looking at $979 for two hours, one of which wasn't particularly helpful. All of this from a social worker (LCSW), not even a fully trained psychologist.

I chose a medical plan specifically with mental healthcare in mind. Initially, it looked like my insurance covered a portion of the first session, but now it shows no coverage and states this individual is out-of-network. (Again, my PCP explicitly stated he was in-network.) On top of these insane bills, I've been paying a higher premium on my medical insurance for nothing.

I'm trying not to be cynical and think to myself, "this is what I get for trying to reach out and seek help." I do feel my providers lied to or otherwise misled me. I can't message the therapist and don't want to risk getting nasty over the phone, but I've messaged the billing department and my PCP to give them a chance to make this right. I have enough other problems, and I'm paralyzed with worry now.

If they don't reduce the amount owed, how likely is it to impact my credit if I refuse payment? Are these bills at all reasonable, with or without insurance?

[Batya33]

 

I'm sorry this is so stressful.  I really don't have enough of a background for the input I'd thought of giving.  

[boltnrun]

My psychologist was not getting paid by my insurance company so she agreed to take a greatly reduced fee. I just lay her direct.

However, in your case you were misled. I would contact the billing office in addition to your insurance company's customer service department. Oftentimes providers charge the insurance a lot more in the hopes they'll get paid more. But you shouldn't have to pay more in that case. At the very least they should reduce the fee and allow you to make payments on the remaining balance.

And definitely do not attend any more sessions. Ask your insurance to give you the names of some therapists who are definitely in network.

Sorry your experience was bad. Therapy itself isn't bad, so I hope you're not soured on it.

[DancingFool]

First take a deep breath.

Second, all medical bills can and should be challenged. You've already contacted billing, which is good. Contact your PCP also. Now, don't expect billing to just fold without a fight, so do be ready to put up a fight and by that I mean stay firm and negotiate with them that you'll only pay what you were told.

Third, your credit score/report should not be affected. As of July 2022, all three credit reporting agencies will be removing most medical debt from the credit reports/scores. Yes people are still liable to pay up or settle, but it will no longer have the same impact on people's credit scores. Also, any medical debt under $500 cannot even be placed on anyone's report going forward. Google for exact details of this.

Fourth, talk to your PCP, but also accept some personal responsibility. While your PCP might have genuinely believed that this counselor is in network, ultimately it's your personal responsibility to verify things that will affect you financially. In short, step away from the "they betrayed me" narrative to the more reasonable "I should check these things" narrative. It's not on your PCP to hold your hand and ascertain these things on your behalf. 

Fifth, again goes to personal responsibility. If you don't like the qualification or lack of, of whoever you are being referred to, then speak up. It's that simple. Ditto for if you meet with whatever therapist and you just don't click with their approach. Therapy is only effective if you work with a therapist whose methods and approach are actually helpful and effective for you and that's personal. Sometimes you have to try out a few before you find the right one. It is more like trial and error than a sure thing first time out of the gate.

So, talk to your PCP. Give them some feedback and they might be able to give you some additional referrals that might work better for you. Check yourself if they are in or out of network and what their fees are. Get that in writing/e-mail before you go there. If your PCP has nothing, then go through your insurance to get some names and go from there. Also, if you feel like you have too much going on at this moment and will not be able to concentrate on therapy, then maybe give yourself a little bit of time to let all other things simmer down a bit. There will never be an ideal time, but there is a difference between putting out ten fires at once and just general life busy.

[thenavigator]

Thank you, guys. I think I should be focusing more on spontaneous discussions like this (online and in person), rather than penting things up for a week or two, then risk no longer being in the mood to talk to the person I'm paying to listen.

It's being reinforced in other areas of my life that I can't trust other people to give me accurate information or advocate for me. In an ideal world, maybe. These are still highly educated, well-paid professionals who should know what they're talking about. My PCP didn't just refer me to this therapist - they work in the same building!

I wanted to meet with him one last time to see if we could get back on track, and run through the subjects most important to me while I still had the chance. However, I was already expecting to wrap things up, and this confirmed it. I'll try to relax knowing that they can and should be expecting pushback on the bills.

[DancingFool]

39 minutes ago, thenavigator said:

It's being reinforced in other areas of my life that I can't trust other people to give me accurate information or advocate for me. In an ideal world, maybe. These are still highly educated, well-paid professionals who should know what they're talking about. My PCP didn't just refer me to this therapist - they work in the same building!

This kind of thinking can really drive you down in life. This situation has nothing to do with trust.

It doesn't matter how educated or well paid someone is. ALL people screw up. It doesn't matter that they work in the same building. The actual fact is that your PCP is NOT an expert on your insurance and who is and isn't in your network. That is not their area of expertise and certainly not their actual business.

To live life, you have to give people some benefit of the doubt that whatever they did was not intentionally evil or meant to harm you, only that they acted with the knowledge they have. Again, your PCP is not in the business of checking your insurance for you and holding your hand about that. You are an adult who should be doing the work of verifying if that is important to you, which it should be. Please take some ownership of the issues instead of trying to blame everyone else.

[boltnrun]

2 hours ago, boltnrun said:

I just lay her direct.

Wow, that was a bad autocorrect. I PAY her direct.

Once again, stupid phone.

[Tinydance]

3 hours ago, boltnrun said:

Wow, that was a bad autocorrect. I PAY her direct.

Once again, stupid phone.

Sure sure 😜

[Tinydance]

I'm not sure if I can be of much help as I'm in Australia and I'm actually silently now thanking God that we have mostly free Healthcare here lol Your situation sounds really stressful and frustrating and I'm sorry you had to go through that  😞

I think the main issue here is probably your insurance company and I think you should definitely challenge them. I think their stuff up caused most of the problems here. If it was listed that this social worker should be covered then it should be and they can't go back on that. I would definitely dispute everything if I was you.

It doesn't really sound to me like the therapist did anything wrong, except maybe having high fees? Were you made aware of the fees before you had your appointments? I think most places let you know the costs, right? Do you think it's the insurance company's and therapist's fault you weren't aware of the costs or do you think you may have overlooked something? I'm not accusing you, just wondering.

It sounds like maybe you're not really feeling a connection or good rapport with the therapist. You seemed glad the last appointment was cancelled. I would recommend looking for someone else if you're just not vibing with this person.

[Wiseman2]

7 hours ago, thenavigator said:

 it shows no coverage and states this individual is out-of-network. Again, my PCP explicitly stated he was in-network.

Sorry this happened. Speak with the insurance company. They're the ones who won't cover these out-of-network charges.

Always check with your insurance before going to a provider.  You can choose another PCP, no?

See if you can get a referral to an in-network psychiatrist. Some insurance will only cover a small percentage or a handful of  mental health visits.

Carefully review your plan and see if you can get a directory of in-network providers. Most have this and always check before going to a provider.

Unfortunately many HMO style networks require pre-authorization. The PCP is basically a gatekeeper in this type of insurance.

It's the insurance provider that you need to talk to and get information on. The PCP is not responsible for choosing someone in-network, you are.

Talking to the billing department may or may not help. It depends whether they can bill your insurance.

You may be better off going to a mental health clinic with a sliding scale.

As an aside, most modern mental health care focuses on the present and future, except for a history intake. This is because ruminating about an unchangeable past has been shown to exacerbate the helplessness and hopelessness of depression. The concept of belaboring  the past hasn't been used for half a century since some antiquated freudian theories were abandoned for more effective psychotherapy.

[Batya33]

8 hours ago, DancingFool said:

This kind of thinking can really drive you down in life. This situation has nothing to do with trust.

It doesn't matter how educated or well paid someone is. ALL people screw up. It doesn't matter that they work in the same building. The actual fact is that your PCP is NOT an expert on your insurance and who is and isn't in your network. That is not their area of expertise and certainly not their actual business.

To live life, you have to give people some benefit of the doubt that whatever they did was not intentionally evil or meant to harm you, only that they acted with the knowledge they have. Again, your PCP is not in the business of checking your insurance for you and holding your hand about that. You are an adult who should be doing the work of verifying if that is important to you, which it should be. Please take some ownership of the issues instead of trying to blame everyone else.

I agree and I have to deal with a lot of errors made by customer service people between my medical appointments and my son's and ordering so much more online because of the pandemic.  I hate having to deal with my health insurance company -it's brought me to tears -but I am persistent and dogged with it and for example last year I received $500 reimbursement after being given the run around for hours and various lame excuses.  It's stressful but no it did not shake my trust in anyone.  I would reread what she wrote above.  

[catfeeder]

If the practice is in your network, and they told you this therapist is part of their practice, I'd challenge not only the inflated charges from them, but also the insurance company for turning down a charge from the covered practice. 

Also, limiting a client's focus to the present and future sounds more like a coaching tactic rather than a therapeutic one.

Remember, the therapist works for you. You don't need to agree on everything, but your treatment plan? That requires your approval. Plus, if you don't agree with an approach, it's natural to resist it--so it's like being set up to work against yourself.

Consider contacting a local university with PhD or PsyD programs. They usually offer supervised sessions at an extra-affordable rate.

[thenavigator]

I didn't receive further emails and only saw this late last night.

As mentioned, I've had many other problems outside of this. I refinanced my car before moving, and delays have complicated the transfer to my new state, locking me into a far more expensive insurance policy than I need now. The DMV in my former state has earned their reputation and then some. Dealing with them and refinance company has been maddeningly frustrating, riddled with misinformation and lack of communication at every turn. I called the refinance company recently, expecting it to turn nasty, but that just isn't me. As much as I feel the need to vent at someone, I managed to be assertive without getting mean.

Still, between that and this therapy debacle, my trust has absolutely been shaken in other people's competence and their commitment to my well-being, even when paid to look after my best interests. I'd rather be pleasantly surprised and grateful when other people do their jobs well, instead of being consistently disappointed by stupidity and apathy. It still boils down to what other people are saying: Double-check everything and advocate for myself.

I called my insurance earlier and confirmed that as far as they can see, this therapist has never been in-network. I'll call back and see if I can challenge that status based on what my providers stated. I messaged my PCP and the billing department over the weekend, but haven't heard anything. I'd like to think they're in dialogue with my insurance and I'll hear back soon. If they never respond, expecting me to just shut up and pay the bill, I won't respect them for it regardless of who's at fault. This has generated enough ill will that I expect to be looking for a new PCP no matter the outcome.

One other reason to not pursue therapy further is that I haven't had enough time to myself. I've had too many errands and chores following the move. We've even been fighting with the leasing company and property manager because multiple appliances were broken upon move-in, and they tried to push responsibility on us or each other. I was doing laundry in the bathtub for the first month and a half after I arrived. I need a vacation, but I only recently started accumulating PTO and don't have nearly enough. My free time is precious to me, and I just don't want any extra obligations on my days off.

[boltnrun]

1 hour ago, thenavigator said:

My free time is precious to me, and I just don't want any extra obligations on my days off.

I would imagine if you broke your leg you wouldn't put off seeing a doctor because you don't want "extra obligations".

Why should your mental and emotional health be any different? It's just as important as your physical health if not more so.

[Batya33]

Why didn't you call your insurance company in advance to confirm? I've found that in network docs can suddenly be out of network, etc. I'm sorry for all of your challenges -I know it starts to feel cumulative.  I can relate.  How often do you do very vigorous cardio type excercise -whether outdoors, cleaning your house, at a gym - for at least 20 minutes at a time?  that helps me a lot when I'm feeling this irritable and overwhelmed.

[thenavigator]

5 hours ago, boltnrun said:

Why should your mental and emotional health be any different? It's just as important as your physical health if not more so.

I've been unable to function in the past due to severe panic attacks, so I know what the consequences of neglecting my mental health are. I know I need to build a support network, build my self-esteem, pursue a more fulfilling career path, etc. I'm finally in a place where I feel capable of doing that, at my own pace. I expected therapy to be more than life coaching; I don't want to spend good money and time for that, while also feeling pressured to pursue goals at someone else's pace.

5 hours ago, Batya33 said:

Why didn't you call your insurance company in advance to confirm? I've found that in network docs can suddenly be out of network, etc. I'm sorry for all of your challenges -I know it starts to feel cumulative.  I can relate.  How often do you do very vigorous cardio type excercise -whether outdoors, cleaning your house, at a gym - for at least 20 minutes at a time?  that helps me a lot when I'm feeling this irritable and overwhelmed.

I didn't know this person existed until my doctor recommended him. He did so specifically because he thought this therapist was in-network. I accepted because I trusted my doctor. Lesson learned, moving on.

I'm still too self-conscious for the gym, but I recently bought some home workout equipment and clothes. I'm considering the Brazilian Jiu-Jitsu place nearby. I think some physical contact would help keep me mentally grounded, and martial arts seems more beginner-friendly.

[Tinydance]

I would recommend communicating with everyone by E-mail so that it can be recorded and you have proof later. For example, I communicate mostly by E-mail at my job with my colleagues and clients because I want everything to be in recorded form and even so that I can refer to it later. 

That's your personal choice if to get therapy or not but if you need it then it might be in your best interests to continue with it. I could be wrong but you seem angry at the therapist because your insurance company didn't cover it. That's actually not the therapist's fault so I don't think you should be directing your frustrations at them. If you just didn't feel a connection with them, there's nothing wrong with that but it's also not their fault. I've had this before too where I just didn't feel a click with a therapist or their techniques didn't appeal to me but they were still a nice person and trying to do their job. If you didn't like that therapist then you can find someone else. 

[Batya33]

1 hour ago, thenavigator said:

'm still too self-conscious for the gym, but I recently bought some home workout equipment and clothes. I'm considering the Brazilian Jiu-Jitsu place nearby. I think some physical contact would help keep me mentally grounded, and martial arts seems more beginner-friendly.

Are you too self conscious to briskly walk? To dance in your living room for 20 minutes or do a workout video? To scrub your floors on hands and knees? Run up and down stairs?  I do at least 30 minutes of cardio exercise daily - for many years.  Awesome for my mental health.  I do it when we travel too - I power walked in Death Valley, on a hiking trail in Disney World, and on a treadmill in Sweden at 4am.  I make it work because it works for me- for my health.  I highly suggest you make it work and not make excuses.

[thenavigator]

2 hours ago, Batya33 said:

Are you too self conscious to briskly walk? To dance in your living room for 20 minutes or do a workout video? To scrub your floors on hands and knees? Run up and down stairs?  I do at least 30 minutes of cardio exercise daily - for many years.  Awesome for my mental health.  I do it when we travel too - I power walked in Death Valley, on a hiking trail in Disney World, and on a treadmill in Sweden at 4am.  I make it work because it works for me- for my health.  I highly suggest you make it work and not make excuses. 

I work hard at a physically demanding job; I see plenty of physical activity without having to twirl around the living room for 20 minutes when I get home. I already stated I bought exercise equipment, with the clear implication that I am fitting it into my daily routine.

I've avoided forums like this in the past because people tend to focus on the negative, pointing out the obvious to the point of beating a dead horse. This was done with my mistake of not confirming my provider's network status. I've already said I won't let it happen again.

I've also noticed long-time users tend to be more interested in winning arguments, probably to prove their wisdom and superiority. I've been accused multiple times now of not taking accountability - after pulling myself out of crippling anxiety and depression, returning to the workforce, and moving 600 miles to escape a highly abusive and dysfunctional family.

I'm not going to spend most of my time on this forum defending myself, so I'm simply not coming back. Goodbye.

[Batya33]

I stand by my suggestions whether or not you work at a physically demanding job because I was focused on the mental health benefits.  From your dismissive comments I see you are trying to deflect and focus on venting as opposed to taking some responsibility for your choices.  I am sorry you were mislead by your provider.  I don't have the cynical attitude you do but when it comes to insurance coverage I always reconfirm.

[Tinydance]

11 hours ago, thenavigator said:

I work hard at a physically demanding job; I see plenty of physical activity without having to twirl around the living room for 20 minutes when I get home. I already stated I bought exercise equipment, with the clear implication that I am fitting it into my daily routine.

I've avoided forums like this in the past because people tend to focus on the negative, pointing out the obvious to the point of beating a dead horse. This was done with my mistake of not confirming my provider's network status. I've already said I won't let it happen again.

I've also noticed long-time users tend to be more interested in winning arguments, probably to prove their wisdom and superiority. I've been accused multiple times now of not taking accountability - after pulling myself out of crippling anxiety and depression, returning to the workforce, and moving 600 miles to escape a highly abusive and dysfunctional family.

I'm not going to spend most of my time on this forum defending myself, so I'm simply not coming back. Goodbye.

OK but if you admit you didn't double check the provider and it was your mistake then it's not the insurance company's or therapist's fault? It's OK to feel angry and frustrated and vent. If you have crippling depression and anxiety then you probably do really need the therapy then. You said you didn't like the therapist or something because they didn't concentrate on your past and you were glad the last session was cancelled. You also said the costs of therapy bother you so from a financial perspective wouldn't you rather concentrate on the present and future when working in therapy? If you talk about the past, there's nothing you can do about it and you just spend more money on something you can't change.

[Seraphim]

I have had therapy for totally crippling anxiety and panic attacks . It is not life coaching but they don’t hold our hand either . They lead us and nudge us in directions we need to go but we have to do the work.