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Health Insurance Coverage for Therapy
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Health Insurance Coverage for Therapy
Can anyone recommend a female therapist in Albany/Berkeley/El Cerrito
that not only takes Blue Cross insurance...but doesn't mind taking it?
I'm looking for someone who can see my teenage daughter. I took down
several names from the Blue Cross WEB site and was surprised by the
reception I got when I called them. The first one took three days to
call me back. When she finally did, she left me a message saying she
didn't take Blue Cross insurance and didn't know anyone who did. So,
I called another. She called me back and left a message asking what
times would work for my daughter, so I thought we were on the right
track. I called her back with some possibilities and she returned
that call to say that she didn't really have anything available that
would work for those times (though I'd given many). I took her at her
word and asked what she did have, saying that perhaps I'd have to take
my daughter out of school to meet with her. She hesitated. She did
come up with a time to suggest, that turned out to not work for us, but I got the
distinct impression that she didn't really want to work with us. It's
not me, honest! I was polite and accommodating, I promise. Has
anyone else had this experience? Why do therapists list themselves
with these insurance companies if they're not really interested in
taking those patients? Has anyone had a good experience with Blue
Cross insurance and a therapist and, if so, would you let me know who
you used? Thanks.
In Search of a BC Therapist
Your difficulty finding a therapist working on an insurance panel who has
open slots is not an unusual problem. Many therapists work to get on
insurance panels when they are early in their practices, and enjoy seeing
the variety of people referred to them. However, to be in private
practice, therapists need to make a fair amount of money to cover
expenses, taxes and make a profit.
The reality is that being in a managed care panel means seeing clients at
a much lower fee than they can charge for private fee for service. For
this reason, many therapists put a limit on how many managed care cases
they can have within their practice, and still have enough open slots to
make a living.
What this also means is that prime time slots, like afternoons and early
evenings for children and teenagers, are often reserved for fee for
service clients, leaving fewer desirable time openings.
I can see why you may feel frustrated. It's reflective of a larger
problem in the insurance industry, and there should be some way that
therapists can communicate to their panels when they are full and not
accepting new clients to help consumers avoid the frustration you are
Another idea would be to call some place like The Psychotherapy Institute
in Berkeley which has very well trained psychotherapy interns, who are
very well supervised, and who see clients at lowered fees. Other lower
fee community resources with therapy interns are Blue Oak Counseling
Center and Jewish Family and Children's Services in Berkeley.
The anonymous post last week covered this answer well. I am a therapist
who sees teens in private practice and recently decided after processing
two clients with Blue Cross/Blue Shield that I am not taking any more,
at least for the time being. The headache of the paperwork, spending
hours (when we only have 10 min breaks) trying to get someone to resolve
claims issues, and poor reimbursement rates are too problematic. This is
unfortunate because some people can only afford therapy by using
insurance. However, there are many private practice therapist, and low
fee clinics that are willing to make therapy more affordable without
going through insurance. You can ask the BC/BS providers if they would
be willing get recommendations for names through BPN, or I also
recommend The Psychotherapy Institute (adults and couples only), or Ann
Martin Center (children) or WestCoast Children's Clinic for sliding
scale therapy provided by supervised interns. Another way people reduce
the financial strain is pay out of pocket and get reimbursed by their
insurance (some plans will do this) or by an employer-based ''flex
spending account'' that you put pre-tax wages into and then pull your
I have found myself in a situation with my daughters therapist
that i dont know how to deal with.....the whole thing just makes
me feel really uncomfortable and i need some outside perspective.
My daugter started seeing a therapist in March of this year. We
are insured with Blue cross HMO and i found a MFT off their list
of providers. I also DOUBLE checked with this therapist when we
started that she was in fact a provider. She assured me that she was.
So, fast forward to September. The therapist shows me a bill that
she submitted and that was rejected for payment. That invoice
only covered the first 6 sessions (she has gone once a week since
march), it was for $300 and they rejected it. She asked me to
call....which i did, and they said that she is NOT a provider. I
got back to her.....she said she would call again and talk to
them more, as she apperently has billed for other Blue cross HMO
folks and is confused why she was rejected.
At this point, they have not paid her for that first invoice, and
im sure they wont for the months of visits that followed.
The problem is although she hasnt come out and said it clearly
yet, i know that she thinks i should be responsible for a good
chunk, if not all of the outstanding balance.
Where i come from is this: I found a therapist from the list
spacifically because i cannot afford a private one, and whatever
the reason...either she was dropped and dint know, or something,
she confirmed to me that she was a provider. After that though,
if i had known that they rejected her for that first bill i would
have switched my daughter to another provider that was covered.
The issue there is that she didnt send her first invoice for 5
months. So, we kept going (and thus racking up a bill) under the
assuption that we were being covered.
I am willing to pay for some of the first bill..... i do feel
really bad about the situation she is in. But, I really dont feel
i should be responsible for the whole $300 ...nor any of the
what do you think?
I'm a therapist in private practice. Perhaps she is confusing
Blue cross with Blue Shield. I believe one pays off-panel
providers and one doesn't. Regardless, if I was the therapist
for your daughter and this situation arose I would err on the
side of the patient and not hold patient responsible. Also,
waiting for 5 months to bill is not ethical--some ins. companies
only give you 90-120 days to bill or they won't reimburse. I
would be direct with this therapist about what you think is fair
to you, and take it from there. Good luck.
I'm afraid you are going to be financially responsible for
these bills. In future, the best source of information as far
a which providers are currently contracted with any insurance
company, is to contact that insurance company's Customer
Service Department by phone directly yourself. Printed rosters
are out of date as soon as they are printed, and individual
practitioners (especially mental health, I find) are not always
the most accurate source of information. Additionally,
especially with mental health, services are routinely carved
out by HMOs and separate vendors are used for this service
(such as UBH, etc.). In such an instance, a therapist would
need to be contracted with the mental health vendor, rather
than the insurance company.
The therapist probably had you sign a waiver when services
commenced, stating that if services turn out not to be covered,
that you would be financially responsible for them. Although
it is very poor billing practice (and poor financial
management) for the therapist not to have billed you for five
months, the reality is that if the provider is not contracted
with whomever the designated mental health network is for your
daughter, you are likely financially responsible for the
The best place for you to dispute this is with the health plan
or mental health vendor, not with the provider. Good luck, and
Managed care expert
I suggest trying to work with your insurance company at this
point, rather than worrying about what to pay the therapist. The
therapist bills your insurance as a courtesy, but the insurance
is the one making the decisions. Most insurance companies have a
process in which you can contest a decision of theirs, and the
rates of decision reversals can be surprisingly high! Most
people just don't bother to go through the process. So, get all
your ducks in a row (ie, copy of the insurance list you saw with
your therapist's name on it) and call right away to start the
Your daughter's therapist should know if she's been dropped as a network
provider. She would have been notified by mail. I would call the number on the
back of your card to find out what has happened so that you can have some
clarity about how much responsibility each of you have in the matter. You said
that you got her name off of a list. Was that the list from the Blue Cross
website? Is it possible that she is a provider, but that the diagnosis is not
covered? Your statements should have the reasons for non-payment clearly
listed. In any case, it seems fair that you pay the first bill in full, 4-6
sessions, and then your co-pay ( ususally something like $15 per session ) for
the remaining sessions because you would have been responsible for that
amount anyway. Billing insurance companies can be confusing. They do make
mistakes so it's important for you to advocate for yourself by having as much
information as possible. To add to the confusion Blue Cross and Blue Shield
seem to function as one company
except in the state of CA.
Annonymous Blue Cross therapist
This happened to me once, though not with a therapist, and I
steadfastly refused to pay the bill. The office had clearly
misstated their position (they'd said they were providers from a
particular health plan when they weren't). As I recall, I think I
also called the health plan, and they intervened. I would think,
especially with a therapist, you'd want to feel trust that has
now been clouded by this issue. They should not have waited 5
months before sending the first bill; that's just too long. Maybe
the therapist is great, and the billing dept is just
disorganized, but ultimately the doctor is in charge and should
have an office that reflects the integrity you'd hope he/she has.
I am an MFT, but don't have much experience dealing with insurance companies, so
I hope others reply who do have that experience. I can see your point of view, and
think that what you say makes sense. You saw this therapist because Blue Cross
and the therapist said that she was a provider. It is not good business practice on
the part of the therapist to not keep current with bills, say, billing at the end of the
month. Showing a bill from 5 months prior, when this is different from the
arrangement you entered does not sound like fair business practices. If you need
advice on this, you could call the California Association of Marriage and Family
Therapists, toll free at 888-89-CAMFT for advice on how to pursue this.
If the therapist was on your HMO list as a preferred provider,
then that shouldn't be the reason for her not being reimbursed.
Maybe the claim was denied because she waited 5 months to send
in the bill. Many companies require that bills be submitted
within a certain time frame - like 60 or 90 days. The other
consideration is your informed consent. Did she verbally or in
writing provide information about her office policies including
fees and reimbursement in case of problems with the insureance
Yes, I do agree that you shouldn't be responsible for the full amount. I would
recommend that you explain to therapist exactly what you wrote in your posting,
that you found a therapist from the list specifically because you cannot afford a
private one. Explain to her that you are worried that the insurance will not cover it
and it will create financial hardship for you to have to pay that amount. Most
therapist work on a sliding scale anyways and she may be able to come to some
affordable agreement with you. If she still insists that the insurance should cover it
ask her if she is willing to call with you so that it can get resolved. Let her know
how much this is bothering you (remember that she is a therapist). Maybe in the
end it is an error on the insurance's part. If you'd rather not have this conversation
face to face with the therapist, maybe you could call her and speak to her on the
phone or leave a detailed message on her voicemail to allow her to process it. I
hope it goes well and you can put this behind you.
I hope I haven't misunderstood the story, but I don't honestly
see why you should be expected to pay anything but your
contracted co-payments and/or deductibles. If your insurance
company put the therapist's name on their list of providers in
error, they, and not you, should be responsible for the
resulting charges which you incurred in good faith. If the
therapist's disappearance from the list was her fault in part,
then she should share in the loss (as she should if her delay
in billing was a contributory factor). You might consider a
token payment, for the sake of goodwill, but a fairer and
better thing to do would be to press your insurer to pay. It
sounds to me as if your insurer has been barely ethical. Help
level the field for honest insurers by not letting them get
away with it.
That said, the paperwork you signed at the beginning of
treatment very likely contains a clause in which you accepted
responsibility for whatever the insurer doesn't pay. In that
case, you could be forced to pay, and would have to press your
insurer to reimburse you.
Pretty fed up with insurance company antics!
I'll add my 2 cents even though there have been lots of good
responses relating to how to manage the insurance/therapist
issue. I am a health care provider, not a therapist, but when I
work with a family I feel I have a responsibility to work WITH a
family to help them and their child. It is a huge commitment to
take a child to therapy, and it's hard enough to worry about
whether your child is OK without being worried about bills, too.
If I were the therapist I would meet the family 95% of the way,
ask for whatever the usual copayment would be, and do my best to
help the child complete therapy. I think that kind of goodwill
always comes back to you in another form. If the money issue
bothered me, I'd refer them to someone else, but gradually. I
have been burned a few times, but it doesn't happen often.
this page was last updated: Dec 25, 2008
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