Listed therapists seem reluctant to accept our insurance

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

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 experiencing.

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. anonymous

Insurance won't pay therapist - she wants me to pay

Hi there, 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 following invoices.

what do you think? thanks anon

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 service.

The best place for you to dispute this is with the health plan or mental health vendor, not with the provider. Good luck, and patient beware. Managed care expert

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!