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Read at Your Own “Risk”

March 27, 2010

Remember the Monty Python skit about the joke that was so funny that everyone who read it actually died, writhing, from laughter? This post is sort of like that, except you may die, writhing, from boredom. I’m imperiling you to talk about . . . health insurance. I apologize in advance for endangering you. If you are on the fence about continuing to read, I can dangle the carrot that it includes some interpersonal drama between me and my therapist, should you find that sort of thing compelling.

For all of the health insurance debate in the news, I’ve had it pretty good. I had a job with insurance, and now that I’m working part time, we pay for me to get it through my husband’s job.

I started to see my therapist nearly three years ago, when, three months before we got married, my soon-to-be-husband person insisted I find someone to help me cope with my sister’s ALS diagnosis. He found me a therapist with experience in how chronic health problems affect families.

I’ve always paid her out of pocket, and gotten a high percentage of what I pay — about 80% — reimbursed from my insurance company. Aside from the administrative suckitude of having to switch insurance companies, plus the fact that we’re now paying a higher premium, I wasn’t sure if she would be covered.

But hey! The fact-finding intrepid reporter in our house determined she is actually part of the plan I’m now on. It’s a little plan — one that subcontracts to do the mental health coverage for one of the larger insurance companies.

Over a few weeks, I discuss the situation with her. I wish I had puppets to act it out, but if I had puppets I would have to have written out their parts, nagged them to rehearse, and then filmed them, and you know that this is not a particularly media-rich experience.

Anyhow, this is what happened. Please imagine puppets if it suits you.

These charming finger puppets are red herrings.

Week One: I tell her about the insurance. She is confused but says “Hey, good for you, but what’s the company called? Not sure I’ve heard of that. Let me look into this.”

Week Two: She tells me that she is indeed a part of that plan, and has been since 1991. However, in nineteen years, I’m the first (1st) person who has ever tried to take advantage of it. “Wow,” we both agree. She’s tells me that she’s still looking into it.

Week Three: She tells me at the very end of a session that she determined that while I’m covered, the rate that she will get is way less. She’ll net 60% of what I pay her. She’d like to discuss this with me. But not then because we are ending the session.

Week Four: I’ve had a really frustrating day so when I call — part of the badness of the day was not being able to go in person —and I’m all hyped up about all sorts of stuff. I launch right into my problems, including finances. Anyhow, we’re 22 minutes in to a 55 minute session and talk of money becomes the segue to bring up the insurance.

She tells me that the situation makes her uncomfortable and that getting paid that little doesn’t make sense to her because her services have a particular value associated with them. Plus, she’ll have to do paperwork, which she doesn’t want to have to do. And that while it seems like it must be “great” for me, to only have to pay a $20 c0-pay, what do I think about what it will be like for her.

And then she asks me what I think.

What I Think

1. It’s not just $20. I pay to be insured. It is expensive.

2. I *really* don’t want to find a new therapist, but

3. at the moment I’m not in a position to make up the difference between what I currently pay and what she’d get under the plan, since part of the reason I had to switch insurances is that my salary got cut in half, and all of my benefits went away. PLUS

4. I feel strongly that if I am qualified to receive a particular health benefit, I should not have to pay a supplement to get it.

Number 4? That should be in all caps. She did not suggest a supplement, when pressed as to what she was suggesting, she said she wasn’t suggesting anything, that we were just talking things out. But the choices clearly seem like a) I pay a supplement b) we don’t use my insurance or c) I am cut loose from the flock of patients and what, set out to pasture?

How I Feel

And then, I start to feel a sinking, sick feeling. I feel somehow like I’m getting broken up with. I feel like this person who I pay to care about me and listen to my problems is ready to dropkick me out of her life. Or, see the pasture metaphor above. Picture me dressed like a sheep, and her, pointing to the edge of the rocky field, wearing one of those shepherd hats, the kind where you tie a rope around your head.

I just did a Google image search on “shepherd” to make sure that that’s the sort of hat I meant, and it is.

Therapy is obviously a very unusual relationship because it’s personal and mercenary at the same time. It’s so weird to tell someone ALL ABOUT HOW YOU ARE and then never know how they are.

Things I Know About Her:

i. She, like me, wears 3 weddings rings — 2 bands surrounding an engagement ring.

ii. On at least one occasion she, like 70% of other humans in New York City, spent the weekend in the Berkshires.

And that sums it up.

Whereas, she knows everything about me. I am stuck. I don’t want to have to try again with someone new. I feel quite strongly about number 4, but . . . I’m starting to cry. I don’t feel like crying about this in front of her. I need time to think. I need a therapist. And I mean, I really felt like she liked me. A ridiculous thing to say about your therapist, but I felt like she was on my side. And now I feel like I was just paying her. I tell her politely that I’d prefer to end the session and determine what needed to be determined via email.


She tells me that staying on the phone is PART OF THE THERAPY. That our relationship is part of the therapy.

So, what do I think of her part of the situation? Can I see her side?

CAN’T WE GET OFF THE PHONE? No, because now staying on the phone feels like a personal challenge. Too bad we’re only on the phone, rather than meeting in person, because now she cannot see that I’M NOT BLINKING! LIKE A TENACIOUS WILD ANIMAL WHO WILL NOT BACK DOWN!

Yuck. This is sad.

9 Comments leave one →
  1. March 28, 2010 12:21 pm

    Opinionated comment to follow. Read at your therapist’s own risk.

    Goodness gracious…If in 19 years you are the first person to use a plan that she participates in, sounds like she’s had it easy for a good long while.

    If she participates on the plan, it should be on the terms of the plan, period. (In fact, I would guess by law it probably has to be under the terms of the plan…not with extra compensation from you.) If “getting paid that little doesn’t make sense to her” she needs to work it out with the plan administrator, not you. If she doesn’t like it, she shouldn’t have agreed to participate in the plan. (Unfortunately, if she doesn’t like it, she may choose not to continue participating at some future date.)

    However, how SHE feels about what she is paid under a plan she agreed to participate in is not your problem. You are not doing something inappropriate, unprofessional, insensitive, etc., by seeking coverage though a plan that she agreed to participate in! Therefore, it is not your shared issue to discuss in therapy. It is her issue. She is welcome to talk to her husband/friend/therapist/fellow bloggers about HER feelings about paperwork (for a medical professional? SHOCKING!) or the compensation rate (again from the plan that SHE agreed to participate in), but there’s nothing to talk out with you other than what needs to be done administratively for you to be covered.

    Ok. End of opinionated comment.

    Phooey. Insurance issues suck.

  2. frankly manny permalink
    March 28, 2010 1:59 pm

    Re: Andrea’s comment, hear, hear! Although, I don’t know what legal wonkishness might hold purview over what she can and cannot do regarding supplemental payment or holding to a plan she has juxtaposed herself to, but there should be some legal wonkishness that holds purview over what she can and cannot do.

    Anyway. Sorry about your therapist who is more the problem, I think, than the health insurance, in this one particular instance.

    Also, I do not know what type of hat you are referring to, even with the rope description thrown in, so please, next time, post pictorial references relating to any descriptions you might make regarding any sorts of hats, or lemurs.

  3. Axuve Espinosa permalink
    March 28, 2010 3:39 pm

    [imagine a comment by natasha comes before this one]

    great post, and really awful situation. what natasha said makes sense to me. my insurance pays my therapist much less than his full rate, but he accepts it.

  4. March 28, 2010 5:04 pm

    great post. as a therapist i think you are in the right. she should not have signed up to be part of that plan if she didn’t want the pay cut. it’s not legal or fair for you to have to pay a suppplement anyway. it should be that she takes the pay cut and continues with you or you find someone new even if you do like her. there are other therapists … See Moreout there that will take your plan. why are you paying for all this healtlh insurance if you can’t use it! i take pay cuts from patients for all kinds of reasons and reach some kind of deal that is ok for both parties but this is not something you can compromise. you can’t be forced to pay extra as that is unethical on her part and not legal.

  5. marie permalink
    March 28, 2010 5:09 pm

    uuum…i am so outraged right now!

  6. marie permalink
    March 28, 2010 6:46 pm

    ps, i love andrea’s comment. here,here. and ditto.

  7. Murray permalink
    March 29, 2010 12:48 pm

    I’d be pissed if the discussing of billing and insurance became part of my therapist’s billable time. That’s bogus. I had a strange “breakup” with a therapist many years ago. The situation was somewhat reversed, in that I was initiating the breakup with her… but it got kind of ugly and she kept some of my money that I don’t think she should have kept, but I didn’t want to fight about it. Her argument was that we should continue to discuss the issue (the issue being my money that she had for sessions I wasn’t going to use – because I wasn’t going to pay her anymore!!); and my reluctance to continue the discussion was evidence that I needed more “treatment.” That made it clear to me that in my case “treatment” was synonymous with “billable hours” and she was actually taking advantage of me. In the end, she kept the money. I stopped HIRING her. Left me feeling quite cynical about the whole enterprise.

  8. March 30, 2010 6:44 pm

    My skin is crawling right now!! It usually does when I think about therapists…but this…ICK!

    (I didn’t even realize that was you who came over to my blog! How funny…it’s great to hear from you! Great to read through your blog, I love the way you write about things.)

  9. Amy permalink
    April 24, 2010 10:17 pm

    Yuck indeed. Maybe that’s why even though I technically could have become a therapist (after grad school) I never did. The power differential is not right. Plus, who needs ’em? (Although your sister’s diagnosis is a good reason, I’m not saying that.) But geez. Cut her loose.

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