An very unpleasant leave from my psychiatrist?
August 8, 2013 8:33 PM   Subscribe

I went back to my psychiatrist to pick up a bill and a probably exchange of the Rx he just prescribed which I found is inappropriate for my medical condition. He asked me for $150 for this visit. Is it reasonable?

He talked with me for about 15min and spent most of the time talking about irrelevant things, and not even 1 min on the new med's usage, purpose, side effects, cautions etc.

AND he asked me for $150. (I pay him $300/hour out of my own pocket since he does not accept insurance).

I am a student with no income right now. If not for this disabling condition I would never think about spending my half month's rent each week for 1 hour's BS. I call it BS because for 5 sessions already he was wasting most of the session time on irrelevant things and not even got into the problem I need to solve!

SO I told him I'm not willing to pay this fee and he asked why.
I said I feel it's not very reasonable:
1. The exchange of Rx is due to his mistake. And He can take just 5 min to explain.
2. He has been wasting large mount of the session time on irrelevant things.
3. My primary care doctor(who is a 5star patients' choice specilist!) reviews my medical record for 1hour without charging me anything.
He said:
1. He was trying to help me by talking about those irrelevant things which he though were my concerns.
2. Everyone is different.
I said:
But you didn't helped me.
He said:
I just helped you by giving you the Rx.
I said:
Can you make it $100?
He said ok and charged me.

I packed my bag in silence and stand up and left without saying anything. Before I shut the door he asked "will you call me on Friday(to report on the feeling of the new med)?" I said yes.

He will be on vacation from next week for about a month and we scheduled an appointment before this unpleasant meeting when he get back.

I was thinking about to leave this psychiatrist from now on. But in such an awkward way? I have to say generally, especially initially I liked him a lot, I thought he was compassionate and knowledgeable, but as I have more sessions I feel he's not that good and the thought that he is just another all for money shrink who just want you to be on meds so you keep coming back makes me lost the trust to him.

Btw, my original problem is ADD, but recently I have some really serious life crisis, now he says I have anxiety, and a little bit depression so I stopped Concerta and just got some Zoloft.

Anybody have any opinions for all this experience? should I give more time? be more patient/ should I leave this doctor and find a new one due to this awkward financial problem? What should I say to him? Now I realized my act was not that appropriate but I really tried my best and I don't know what would I do at that situation.

Sorry my English is not good because it's not my first language. And btw my psychiatrist is a German.

posted by pack2themoon to Health & Fitness (20 answers total) 1 user marked this as a favorite
I would pay the bill and let him know you'll be leaving his practice and going to a new psychiatrist from now on. When you pay the bill and give him the news, ask for a copy of your records to take to the new physician.

If you don't feel good about having him as a doctor, you should definitely move on!
posted by theraflu at 8:42 PM on August 8, 2013 [5 favorites]

If you're not happy, find someone else.
posted by heyjude at 8:46 PM on August 8, 2013

In the month he is gone, go see someone else, but do not cancel your appointment with original Dr. Then you will have something or someone to compare your Dr. to. Then decide which of the two is better. Go to that doctor.
posted by JohnnyGunn at 8:46 PM on August 8, 2013 [3 favorites]

the thought that he is just another all for money shrink who just want you to be on meds so you keep coming back makes me lost the trust to him

For what it's worth, you seem to have kind of an odd view of psychiatry, but if you are feeling this way with this doctor, you two may not be a good fit. It's not cheating on him to try to find someone you get along better with.
posted by fiercecupcake at 8:57 PM on August 8, 2013 [3 favorites]

If you were agreeing to see him without insurance coverage, you likely signed an agreement saying you would pay for his services. Since no insurance company was setting the rates, he's allowed to charge whatever he wants. If you signed such an agreement, you should pay him what he's charging.

(If you never signed anything, that's probably an ethical violation on his part, and that's a different thing.)
posted by jaguar at 9:28 PM on August 8, 2013

Also, yes, change psychiatrists. This one does not seem like he's helping you.
posted by jaguar at 9:28 PM on August 8, 2013 [2 favorites]

Best answer: If you're a student with no income, what are you doing seeing a cash-only physician? Your post implies that you have insurance but he just doesn't accept it. You definitely need a new doc in that case. But please understand that the reason why so many psychiatrists are opening cash-only practices is because reimbursement for mental health care is very low, it doesn't mean he's just a money-grubber.

I think it's unclear what is going on here and what the other side of the story is. You say you went to this appointment to discuss the fact that you had one prescription from him that you did not want to use, and you got a new one from him. You say that the original prescription "was inappropriate" and "his mistake" - but I don't understand whether this was an actual prescription-writing error or if you just didn't like the side effects of the medication/it didn't work for you, or what exactly you mean by "inappropriate".

If there was an actual prescribing error, he should be willing to waive the charge for the visit to get the new prescription.

If you just didn't like the prescription you had and you wanted to try something different, that is not his mistake, and you should not try to get out of paying for it. People have varying reactions to psychiatric medications and there are a lot of off-label uses, side effect issues that result in people trying out multiple medications before finding the one that works for them. If this is what is going on here, he is just doing his job, and you should pay him for it.

Full disclosure on my part: I am a physician, so my opinion is biased, but I would say the fact that your primary care physician can spend an hour reviewing your chart and not get paid for it is actually one of the travesties of our health care system, rather than the fact that your psychiatrist wants to get paid for having an appointment with you being the travesty.
posted by treehorn+bunny at 10:06 PM on August 8, 2013 [13 favorites]

Also, I'm a little confused by the math here - you had a 15 minute appointment and you pay him $300/hour, then the appointment should cost $75, shouldn't it?
posted by treehorn+bunny at 10:09 PM on August 8, 2013

The symptoms of ADD/ADHD can sometimes be very similar to symptoms of depression or anxiety. If you think he made a mistake in your diagnosis/prescription, it could simply be because of the way you described your major concerns and presenting problem, not necessarily because it was an "inappropriate" medication for your condition.
posted by so_gracefully at 10:39 PM on August 8, 2013

My Psychiatrist has 20 minute appointments that are specifically for Meds Management. They cost $140. He also has 50 minute appointments that are $280, I think, but those are for Psychotherapy.

I don't feel like this is a rip off, as he conducts these appointments really efficiently. And, for what I need, I only see him every 6 months or so. These are for meds that my GP is never going to prescribe, yet I don't need an entire hour going through all the feels just to get my Lamictal tweaked a bit.

If you're dissatisfied with your current Psychiatrist, definitely consult with another doctor and change over if appropriate. But, short Meds Management appointments are pretty common, from my experience.
posted by spinifex23 at 11:04 PM on August 8, 2013 [1 favorite]

Let me jump in and suggest that, if you're not trusting this individual, you might want to consider making a change. Also, it isn't unusual for someone to visit a psychiatrist (which costs more) on a monthly basis for medication review, but do the actual therapy with a psychotherapist (Social Worker, Psychologist, LLP, etc), the cost should be significantly less than $300 per visit.
posted by HuronBob at 3:21 AM on August 9, 2013 [2 favorites]

I and my family members have used the services of many psychiatrists over the years, and it's not unusual for them to charge one fee X for a one-hour (really 50 minutes) visit (either psychotherapy or initial intake) and another fee that is more than X ÷ 4 for 15-minute medication management visits. Part of the fee is for things like handling billing and reviewing charts, which takes the same amount of time for a 15-minute visit as for a 50-minute visit.
posted by drlith at 3:55 AM on August 9, 2013

Re meds management, shop around. I've been taking Adderall for 10+ years. I call my doctor when I need a refill (~once per month) and a couple of days later there is an envelope with my name on it at the front desk of his office. I take the prescription and leave $20.
posted by she's not there at 5:00 AM on August 9, 2013

Do you live near me? Because I had a psychiatrist that did shit like this. I dropped him the moment my insurance changed, got my meds through my GP, and never looked back.

If I thought he was helping me beyond rewriting my prescriptions every few months, I'd have felt differently, but I've got no compunction about leaving a psychiatrist who acts like little more than a $300/hour pill dispenser.
posted by Metroid Baby at 5:04 AM on August 9, 2013 [1 favorite]

I've known situations where the Psychiatrist is used only to discuss meds, and then a Psychologist is used for therapy. Seriously.

A good GP can prescribe depression and anxiety meds, and there are a lot of choices for talk-therapy, counselors, Licensed Clinical Social Workers, friends with good common sense.

If you have insurance, save your money and use it to see someone on THEIR list. If you don't, look into sliding-scale options offered through local agencies.

As for this particular relationship. You have my permission to drop this guy. Shit, I'd do it based on cost alone.
posted by Ruthless Bunny at 5:17 AM on August 9, 2013 [2 favorites]

I have never been to a psychiatrist but this sounds like BS.
posted by St. Peepsburg at 7:51 AM on August 9, 2013

Even if his charging you that much is fair, I still think you should look for a different doctor. You don't really trust him, and one really needs to be able to trust a psychiatrist. It's true that trust doesn't develop quickly, but part of his job is to help you feel safe and comfortable in your relationship with him. It's especially unfortunate that he failed to do this right before a month-long break.
posted by wryly at 12:01 PM on August 9, 2013

You're the boss. You're not happy with this guy, you don't trust him any more, it's time to move on and find someone else. At $300/hour you'd better be satisfied!

I'd just say that you're going to find a different therapist, that the problems weren't all his fault, but you're going to try someone new. You don't need to explain a lot. You're just being courteous as you say goodbye. Don't get sucked into an argument.

If you're a poor student perhaps you can find someone who charges on a sliding scale--I've heard of such things in the U.S. At least call around and check out other rates. I would be surprised if $300/hour, cash only, is a competitive market rate (if so, I guess I went into the wrong profession).
posted by mattu at 4:33 PM on August 9, 2013

Response by poster: Thank you all very much.
You helped me clarified the issue a lot better, thank you.

A little bit update:

Today I called my psychiatrist as I promised and he asked me to, but he didn't answer or call me back by now. I guess I called a little bit too late, at 5:30pm Friday (and he will be on vacation next Monday), but our last appointment was till 6:15pm so I guess it's a ok time when he's done with his sessions of the day.

I don't know how to express my feelings right now. One week ago I was still emotionally dependent on him, and now because of the unpleasant confrontation of money issue:
1. He has grudge against me?
2. He simply stopped caring about me as a patient who was just given a new med?
3. He guess I will not be back so he dropped me first?

The drama here is that I actually didn't start the new med by accident because the pharmacy took 2 days to order it and during the waiting time I did some online research and decided not to take it in a rush, especially when considering the situation under which he prescribed it (I asked for sth he never thought about, I paid him and he wrote the Rx, seriously?). Now he does not answer the phone or call back, what if I had bad reactions due to the new med suppose I am on it right now? fear.

My confusion also comes from the fact that: my neuropsychological problem may partly be related to some underlying medical issues and I am seeing several medical drs right now. Ironically when I expressed my concerns about my mental status to them, they all said I'm too smart and told me I am totally normal psychiatrically.

I have been in a little doubt about the psychiatric industry for some time since my first unpleasant, actually traumatic experience with them, and this time I thought I found a good one. Now I'm thinking about to move away from psychiatrists all together might be better for me? My insurance is very bad that almost no psychiatrists with good reviews online can be found on its list, and I'm very cautious to go to a mediocre or bad one. I am trying to find a ADD coach or therapist because psych med seems will unevitablly make you depend on someone that's not cool?
posted by pack2themoon at 7:13 PM on August 9, 2013

Psychoactive medication is generally very, very helpful for people with AD/HD. I think you probably need to find a provider who will prescribe medication for your condition. Psychiatrists can do this, as can most GPs, though I would not rely on a GP unless you already have a medication that is working well for you. However, in most states, the only people who can prescribe medications are those with an "MD" or "DO" after their names.

If you also want ongoing therapy, I would recommend finding an non-MD psychotherapist. Psychologists, social workers, marriage & family therapists, and professional counselors can give you weekly therapy. I would avoid anyone calling themselves a "life coach," since there is no governing body regulating anyone who calls themselves a "life coach" (which means that anyone can call themself a "coach" without any credentials or training).

As has been mentioned, most people see psychiatrists once every 4-8 weeks for medication management and see Masters-level therapists for weekly therapy. I think you may want to look into that sort of arrangement.
posted by jaguar at 11:22 PM on August 9, 2013

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