Therapy through insurance, therapist seems confused

February 20, 2018 7:00 AM

I started mental health therapy through my insurance for the first time. I thought it would be great because yay, my health insurance covers it! But my therapist has just started accepting insurance, and seems confused, and it has been a month since she has filed a claim for our weekly meetings, and I'm really anxious that something will go wrong with billing and I'll have to pay out of pocket. Anyone do therapy through insurance?

I have a PPO. After concern, I read that doing reimbursements are the best way to do therapy with insurance, but oops too late to do that now, and also I'm afraid I won't be able to afford that with the weekly meetings. So instead I found a therapist who said she would diagnose me with anxiety, bill to my insurance, and then I would pay a co-pay.

Our first meeting was a month ago, I paid a co-pay in cash, and she said she would start filing the claim to the insurance. That was a month ago and she has yet to do it, though promises she will do it "this week" which was last week ago. I told her I was very anxious about this, because this is my first time I've used insurance and know that if something goes wrong, I could owe a lot of money. (And she's not getting paid either besides my co-pay! So I'm anxious about that.) She said she hears me and understands, that she will work hard to file the claim, and since I seem so anxious, we should talk about this anxiety in our next session.

But I'm afraid to go to the next session until she bills me and I know I'll be alright with insurance covering our sessions. She says she would like me to continue because it's important to my anxiety, and she believes the best way to know a patient is with consistent weekly meetings. BUT my anxiety would be quelled if I knew she was filing the claims and everything was A-OK with insurance!

I want to put a pause on therapy sessions until she gets billing done. She would rather me not do this, and offered to do a sliding scale if somehow the insurance denies or something messes up. I just feel like I would feel better with a pause in sessions until billing is figured out rather than go for 5 more sessions with a total of 15 messed up bills than 10 messed up bills. Does that make sense? Or am I blowing this out of proportion and insurance will probably be ok? I spoke to my insurance and they said as long as it's a medical necessity, therapy would be covered. I would be diagnosed with general anxiety disorder and I would hope that gets me covered.

I like this therapist! I just don't want to freak out about money while she tries to file a claim for the past month. What should I do? Should I still continue or is it ok to push back more on a hiatus until she gets claims sorted? I do feel like I need the consistent therapy but I'd rather be anxious at home than anxious at therapy AND at home worrying about insurance.

posted by buttonedup to Health & Fitness (10 answers total)

Best answer: I don't think you're out of line. Is she a solo practitioner or does she work in an office? If the latter I'd ask her if you can talk to the billing specialist directly. If the former I think you're entitled to push back. If you can't afford to take the risk, you can't afford it. "Sorry, that won't be possible [for me to come in until this gets sorted out]." If she doesn't have time or assistance to do this, that's on her.
posted by AFABulous at 7:15 AM on February 20, 2018 [3 favorites]

Response by poster: She is a solo practitioner, so she directly deals with billing. It just seems she's too busy to get to the billing yet sigh.
posted by buttonedup at 7:42 AM on February 20, 2018

I think you are on the right track. I had a therapist who pulled this with me, and filed claims for multiple months of weekly visits in one go. It worked out but it was a PITA and I was hit with a sizable co-pay collection all at one time (at least you don't have to face that!). It sounds like you have talked to the insurance company so you have some record of the info given in that conversation. Once you receive an EOB that indicates she *has* filed a claim, and that the reimbursement is as you expect, would you feel comfortable going on a regular schedule then, even if she isn't timely about her billing? If that's the case, tell her that and maybe she can make that first claim happen so you can proceed.
posted by emkelley at 7:46 AM on February 20, 2018

I don't think it's unusual for providers to only do billing once a month or so, or to submit claims in a batched fashion. Especially if she's trying to get it all sorted out. Why not try going this week and seeing if she's submitted the claims yet?

BTW it will take awhile for stuff to wind through the system, so even if she files today, insurance may take several weeks to process it. In general I usually get bills/follow up stuff from my insurance 1-2 months after an appointment.
posted by john_snow at 7:50 AM on February 20, 2018

Best answer: "I would be delighted to keep seeing you. I just don't want to get hit with an unexpected bill. You think my insurance covers our sessions, and I think so too. So how about you agree that I won't owe anything beyond the copay, so long as I keep you up-to-date on my insurance situation, regardless of what insurance does? And if it turns out later that my insurance reimburses you less than you expect or need, we can re-negotiate for future sessions at that time."

(send this by email so you have it in writing)
posted by novalis_dt at 7:51 AM on February 20, 2018 [4 favorites]

Does that make sense? Or am I blowing this out of proportion and insurance will probably be ok?

Both? I have anxiety and am uptight about money issues in particular and this is partly on your therapist to understand and manage and partly on you to not overdetermine the situation. So if she's not filing, okay, then what is her plan? Open-ended "I'll try" is sort of garbage. At the same time if what she is telling you is "I'll make it work" and charge you nearly nothing if it turns out for some crazy reason insurance doesn't come through (as they said they would) I think that's acceptable and you should take that. So I am with novalis_dt: put this out to her in writing. You can't MAKE her file an insurance claim in a timely fashion (and making your peace with this aspect of it is probably helpful from an anxiety perspective) but you can work with her to set expectations about what will happen if things don't go as planned.
posted by jessamyn at 7:55 AM on February 20, 2018

???? This is unacceptable. I've never had this problem with my therapist, who did do batch claims but took only co-pay every week. And she filed the first one pretty quickly and we made sure my insurance worked. State your needs and expectations, making sure your finances work is important!
posted by yueliang at 8:33 AM on February 20, 2018

Seems like filing the first claim and making sure it works should be a high priority for her. You may want to make sure she understands that she probably has a limited window to submit claims at all, though -- I know my psych practice will eat any claims that are denied for being submitted too late. I believe the window for my practice/insurance is 30 days, but yours might easily vary.
posted by chesty_a_arthur at 9:14 AM on February 20, 2018

I have had this problem twice. It is absolutely the therapist's responsibility to properly submit the paperwork. You should make sure they accept whatever you're using, but having done that, they should take care of it. Their learning curve is their problem, but not getting paid until they solve the problem is a good motivator. If you find out from your insurer what the co-pay should be, you ought to be in the clear.
posted by ubiquity at 9:23 AM on February 20, 2018

Best answer: I think others have you pretty well covered, but just another thought, every practitioner I've ever been to, even smaller practices like you describe with this therapist, has made me sign something along the lines of "We'll make every effort to collect from your insurance but if they won't cover costs, you are responsible for the cost of this care." If you signed something like that, you might point to it as a source for your (logical) anxiety about the whole thing.
posted by Tandem Affinity at 11:09 AM on February 20, 2018 [2 favorites]