Step 4: Call my insurer. My new therapist’s clinic didn’t take my husband’s insurance, despite the fact that he works for the biggest employer in town… But really, who can blame them for not wanting to negotiate their rates down and submit to scrutiny from case managers. So, nervously, I called my insurance company.
Um… I said, I just moved here from California. I was seeing a therapist there. I want to see someone here. I have a history and diagnosis of major depression. (I didn’t say Borderline because – hey, insurance doesn’t cover personality disorders! Subterfuge - what fun.) Oh, no problem, they said. “You have unlimited visits and we don’t require pre-authorization for visits.” That sounds… good, I thought.
Um… what if I find a therapist I like but they’re not in your network? That’s fine, they said. “Just download the claim from our website, submit it and we’ll pay 70%.” Also, not terrible news.
Step 5: Paperwork. I asked my therapist if they’d help me with the claims. No, she said, “we’re not really set up for that.” Uh… I’m not really ‘set up’ for it either! I’m just the patient. But I don’t have a choice! Good point, she conceded.
So I did the forms. They were incredibly complicated. But I’d filled out similar forms in CA so I worked it out. I called the insurance company one last time, just to double-check some details. Oh yeah, I said, “as long as I’m calling, I wanted to ask. You guys pay 70% of ‘reasonable and customary’ for out-of-network providers. What do you consider reasonable and customary?” I was put on hold. For a long time.
Turns out, they consider $130 per hour a reasonable rate. My therapist charges $150. That meant that each week I’d be paying 30% of $130 PLUS that extra, unreasonable, uncustomary $20. Add to that the $15 per week for group. So my therapy was going to cost us about $75 a week. I don’t know about you, but I think that’s a LOT of money.
Step 6: Negotiate. I went to my therapist and oulined the situation. I asked if the clinic would be willing to offer me a reduced rate. Would they lower their hourly rate just $20 or even $10 to make up for the difference in the insurance? It’s not my fault they don’t take my insurance. It’s not my fault the insurance sets their rates absurdly low… I picked THEM instead of some in-network bozo that knows nothing about personality disorders*.
*My insurance company did provide me with a list of hundreds of in-network providers. How would I use this, I wonder? How would I know if any of these people know how to treat my VERY controversial, VERY divisive, VERY tricky diagnosis? Should I call all of them and see who’s taking new clients? The good ones are likely booked up. Should I interview the ones who ARE available? That would take lots of visits and co-pays! And ultimately, I’d still be paying $30-40 a week for an in-network provider.
My therapist said that she thought it was a reasonable request. She’d talk to her partners and get back to me. She got back to me today. She said that neither she nor practice could afford to reduce their rates right now. She suggested we talk about it again in January and see if things have changed. I was disappointed, but I felt… responsible.
Step 7: Pray. I’m sure there’s a yearly maximum or some other catch hidden somewhere.
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