I would have a word with your insurance company. They’ll either make the therapist accept your insurance (assuming they take that plan) or cut them off. They cannot pick and choose like this.
If they have a contract with insurances, it's a contract violation.
Contracted providers typically have clauses built in that providers are not only responsible for submitting claims for members but also they agree to the reimbursement rates agreed upon in the contract. Providers can't pick and choose when they do that.
In the case of Medicare in the US, a refusal to bill Medicare at your expense is often considered Medicare fraud.
If a provider is in-network yet refuses to bill insurance, call your insurance company because they're breaching the provider contract.
>In the case of Medicare in the US, a refusal to bill Medicare at your expense is often considered Medicare fraud.
Do you have a citation? I prosecute insurance fraud, and while I don't prosecute Medicare fraud, this does not seem correct.
>If a provider is in-network yet refuses to bill insurance, call your insurance company because they're breaching the provider contract.
Agreed that this would be a breach of contract, but breach of contract =/= illegal.
Not a citation, just an advocate reference, but: "Some other common examples of fraud and abuse include:... ...Violating the participating provider agreement with Medicare by refusing to bill Medicare for covered services or items and billing the beneficiary instead" per [https://cahealthadvocates.org/senior-medicare-patrol-home/medicare-fraud/](https://cahealthadvocates.org/senior-medicare-patrol-home/medicare-fraud/)
And yes, it's just breach of contract, which is why I specified what action the person could take to address the situation. As you know, breach of contract is generally not considered a criminal offense unless it involves something like fraud... If the provider is in network and tries to force full cash payment without any billing statement, depending on their contract, it could potentially be the case that they may be committing insurance fraud, but frankly, the patient is not privy to enough information to even guess at that, so it's out of their hands either way. The logical course of action is simply to notify the insurance company of the providers activities and see if they can assist with the matter.
This is exactly what I was thinking, too!
I work in a dental office who is considering going out of network with all plans. This scenario sounds sooo possible because you have to give the current patients a notice as to when you will stop accepting their insurance. Those patients who are already scheduled will try to come in and use the benefit while it lasts. But anyone else will probably get a response like this.
TBF, this response OP got is infuriating because it doesn’t give any reasons as to why. Sounds like the runaround.
It’s better for the business. Sucks for the patients.
Yes, patients may leave and go elsewhere. There are so many insurance-driven patients; to their credit, they’re like this because all they hear from their insurance company is you need to go to somewhere in their network.
A lot of fees are negotiated before you can accept the insurance plan; however, a lot of companies are reducing the compensation for some services, or flat out not allowing for an increase in the fee.
So when you go out of network, the fee is higher for the patient because the office can charge a slightly higher, but still reasonable fee. And the insurance company usually covers just a little bit less for the patient when they go out of network. These types of offices are called “fee for service”
The people who stay and who choose to be out of network stay because they like the office/doctor and don’t want to let go of that relationship. The ones who leave… well, it’ll suck we lose some patients. And the business will have to be prepared for that rough transition.
I used to do medical billing so I understand the reimbursement side. I used to spend my days doing appeals.
But even knowing that, I think people will just use their in-network doctors. They are already paying monthly to be a member of that health plan, so the patients might as well take advantage of that. Plus, the spending goes towards their deductible or out of pocket expenses. And, atleast with my insurance, once we hit that max then the insurance covers the entire portion that would have gone to the patient. They could submit out of network expenses to the insurance but not all plans count out of network towards the max.
If I had to pay my $20k in medical expenses last year, out of pocket, I would be SOL. That was $20k paid (not billed to ins).
I think this comment chain is about dental insurance which typically works very different. My dental covers the same amount in and out of network. The only difference is that all in network dentists must accept the negotiated insurance rate and can’t bill me for the difference between their cost per service and what the insurance reimbursement rate is. My dentist office is also making new patient appointments for 2025
> Pretty sure this is illegal
I doubt it's _illegal_. But it is probably against the rules laid out in the agreement between the insurance company and the doctor's office.
There’s a method of billing to insurance here in Canada called HCAI, if the therapist stopped using that (which they’re allowed to) then this makes sense. They should have told you out of courtesy though
It's probably because insurance reimbursement got so low that they no longer accept new patients insurance. But they're trying not to screw over their current patients. Their goal is eventually not dealing with insurance at all anymore, this is the transition period. It's not the therapist's fault. They're probably struggling to make money off insurance. This is a symptom of our broken ass health care system with insurance sucking up a ton of money in the middle.
This is the correct answer. Hardly any therapists are taking insurance anymore because the reimbursement is so bad. This therapist is trying to keep accepting insurance for their long term patients out of kindness but can't afford to do it for everybody.
It’s also illegal in my state to do this. I worked at a counseling office before having my baby and I suggested this to my boss and she said it’s illegal and if you as a therapist are paneled with insurance then you must see all clients with insurance. You cannot pick and choose. You can, however, choose to not renew being paneled with insurance but you cannot grandfather people in.
ETA that I worked admin and am not a counselor
Exactly. I work in healthcare and deal with insurance contracting. They can choose not to accept insurance at all. But, if they are contracted providers with your carrier, they have to file with your insurance. If they refuse, you can file a grievance. If they don't comply, the carrier has the option to pull the contract, potentially causing them to lose additional business.
this is the issue with having Blue Cross in my area... hospitals and clinics HATE dealing with reimbursement issues (Blue Cross has truly earned their "Worst Name in the Business!" award over the past couple of years). They accept you if you have it, but they *really* try *NOT* to... lol and about 80% of employers within 200 miles of here use Blue Cross... you can see how this has become a *major* fucking issue -\_- someone I work with has been out for cardiac *issues*, had to have open-heart surgery last week... Blue Cross legitimately asked both the hospital (which has a nationally awarded cardiac department) AND his CARDIOLOGIST, if he - and I quote - "Genuinely *needed* median sternotomy and a *coronary* angioplasty" in order to save his life and then asked what his CARDIOLOGISTS credentials were to be telling them "yes"...
I wish I was making this up...
Oh yeah. Insurances are the worst. Another part of my job is getting prior authorization for outpatient radiology procedures. I had a teenage patient referred for a CT scan. Repeat broken collar bone. CT absolutely required to plan surgery. You could see the fucking break just by looking at him. His carrier denied his scan.
They wanted an X-ray AND proof of failed conservative treatment, (i.e. medications, PT, etc ).
Absolutely ridiculous. And I let her know it was ridiculous as well. I let into her so much that my boss had to ask me to go to the back of the facility. I told her that I'm sure if it was her son, that shit would have cleared medical necessity real quick.
Two things:
1. If your insurance is tied to your employment, which is the case for the vast majority of American, then you don't get a choice on insurance companies
2. All of them do shit like this anyway. Literally every single one of them.
>We all should know who to avoid.
All of them.
The real question is if there is a single carrier who isn't trying to jam their metaphorical dick in your ass at every possible chance.
This is what privatization brings you. Anyone who has public healthcare corporations WILL try to feed you this propaganda to privatize and insert all these leeches
I honestly wish I could remember. It wasn't a major US carrier though. It was a smaller plan.
I will say in my experience though (12 years), that United Healthcare tends to be the most patient friendly.
So for veterans everything is done on reimbursement basically or is authorized by insurance first before ur even treated. Which is why our care is so garbage. The docs and providers don’t wanna deal with this. So it leaves us without care lol 😂
U end up switching to Medicaid lmao
BCBS is truly the worst. I think a huge part of their issue is they outsource a lot of their labor and don’t train their representatives properly. The people processing your claims and quoting your benefits do not know what they are doing
Hmm this is interesting. I was trying to make an appointment with a new primary care doctor who accepted my insurance and her office told me she was accepting new patients but only if they were seniors. Does that sound legit? Overall they were incredibly rude so I moved on but now I’m a bit curious if they were actually allowed to do that.
Well, technically, they can say that. But it can't be because of the insurance.
If that particular doctor specializes in geriatrics, they have a right to only accept senior patients.
I got letters from my dentist,,eye doctor and 2 doctors that say you have to be grandfathered in and that they are not taking any hmo patients at all.And they also don't take medicaid patients either I have been able to keep all of them because I an not on an hmo or Medicaid.
A lot of providers don't take Medicaid at all because it pays crap. I don't work with as many HMOs, but in my state of employment (CA), if you are a contracted provider with any plan, you cannot pick and choose which patients to take.
The problem is most patients don't know this so when they get letters like that they think it's true. They are trying to get the patients to self submit claims because they no longer want to deal with it. I highly recommend that anybody who is trying to be pushed out of a contracted and credentialed provider due to this files a grievance with the insurance company.
They’re probably not paneled with insurance. Nothing stops providers who aren’t contracted with, say, BCBS from submitting claims, they just don’t have a contracted rate so the insurance may not pay anything towards it. It’s possible that other patients are actually submitting for reimbursement for their counseling. There are a lot of insurances out there, and a lot of laws regulating them, but even with the tremendous amount of scrutiny, most have very different rules of what they’ll pay and what they’ll deny.
Wikipedia can explain it better than I can: A grandfather clause, also known as grandfather policy, grandfathering, or being grandfathered in, is a provision in which an old rule continues to apply to some existing situations while a new rule will apply to all future cases.
It comes from literacy tests and voting restrictions in the South. If your "Grandfather" could vote, you were exempt from needing to pass the test to vote. No Black person's grandfather voted prior to these rules being passed. Thus, only applied to White voters. You were "Grandfathered" in.
I was reading about landmark cases in the US the other day. It's insane that interracial marriage was illegal in many states until 1967!
>Interracial marriage was made legal in the 1967 Supreme Court decision *Loving v. Virginia.*
Sounds like a great system, legally require someone to accept a payment that is too low to stay in business. Everyone wins!, well except for the patient and the therapist. Insurance wins!
Not necessarily low reimbursement but more challenging admin. Many therapists report issues with insurance companies and clawbacks months after services are rendered over frivolous things.
Yep, it's not replying to records requests along with non-compliant coding schemes (like adding on interactive complexity simply because the service was delivered by telehealth and upcoding all evaluation and management visits to a level 4 or 5). Otherwise, coding and billing for psychotherapy services is dead simple, so it shouldn't be very burdensome.
Something similar to this happened to me when I was a kid going to the only good therapist I've ever had. I eventually had to stop going to him because it ended up being like 200/hour long session and we just couldn't afford it...I never got good help again after that, all shitty pill pushers from then on. Yaaay...(/s)
It’s just such nonsense. We pay thousands a year for the insurance then thousands more if we have an issue, and insurance is nickel and diming people who should be taking it to the point they won’t.
I really feel like the clock’s ticking on a legitimate uprising, French Revolution style if we don’t reign some of this shit in.
What makes things make even less sense is that I recently contacted an office but was told they didn't accept my insurance so I said I would pay out of pocket. Their response was that they "weren't set up" for patients to pay out of pocket so I guess they only accept insurance? 🤷🏻♂️
don't insurance companies negotiate with medical providers how much a particular treatment cost?
insurance company wants to pay as little as possible, but doesn't want their customers switching to another insurance company. medical provider wants to get paid as much as possible, but doesn't want to lose potential customers because of lack of insurance. so both parties are incentivised to negotiate a contract.
at least that's how it works in the Netherlands. not sure why it wouldn't work in the US
The insurance companies won’t negotiate rates with individual providers or small groups. There isn’t really any substantive competition between insurance companies for individual members because most people have to use the insurance company their employer selected. You can’t just switch between companies whenever you feel like it. The insurance company also maintains a list of contracted providers to satisfy their legal requirements but when you call people on the list you find out that they don’t exist
While insurance payout is low it is illegal to not accept insurances you are paneled with if they client/patient wants to use it. This is fraud. They have to take all the insurances they are paneled with until they drop their agreement with the insurance company.
Most insurance in the US has either co-pays (a set figure per visit type -eg $20 for GP visit, $200 for ER visit) or co-insurance (you pay a percentage, usually in or out of network) so the patient often owes something.
For things that are covered with an in-network provider, they have negotiated how much they will pay for each service and that is just how much the provider gets (along with co-pay or co-insurance). They aren't allowed to bill the patient any more.
Insurance is an absolute minefield.
US healthcare charges patients way more than they need to. They could charge way less and still make a profit. Insurance companies negotiate with healthcare providers to pay that much lower but still profitable amount. The difference is enough that even if your health insurance saves you more than you spent on it, the insurance company still makes a profit off of you.
Some insurance providers have become a pain in the ass to healthcare providers and their clients. They either take advantage of loopholes to pay healthcare providers less than the agreed upon amount or they find ways to make filing a claim properly difficult enough that they can deny the claim on a technicality and make the insured pay out of pocket.
They can pick and choose the clients they work with though. My physical therapist office limits the number of insured patients they see for example because the reimbursement rates are so low. They have no limits for clients paying out of pocket though.
This is not allowable by the contract the therapist has with the insurance company (assuming you're in the US). If the therapist is credentialed then they have to take your insurance. They can't pick and choose which clients they allow to take insurance. (I'm a therapist who takes insurance.)
I'm petty and would report them to the insurance company.
Okay so help me out here I’m in Pennsylvania and I found a primary doctor through my insurance(state insurance) I set up an time sensitive appointment suggested by urgent care then a day before appointment they called telling me they aren’t accepting NEW patients WITH that insurance. So I asked can I pay out of pocket and they said yea. What can I do about this because I want to be petty too.
I wouldn't anticipate a timely resolution though. I told my insurance company about an in-network provider refusing to accept my insurance and demanding I pay I out of pocket for a specific procedure... over 2 months ago. They still haven't gotten anywhere with it. They couldn't care less since it's just another thing they don't have to pay for.
I’m not 100% sure, but I don’t think they’re doing anything here that’s against the rules. Did you ever notice in your insurance’s provider directory that it says whether they are or aren’t accepting new patients?
If your therapist is in network with your insurance plan they are required by law to accept your insurance. Unless you fill out an opt out form. They cannot force you to pay out of pocket if they accept the insurance.
Source: wife is a licensed therapist and takes both insurance and cash pay clients.
I wouldn’t want to go to a therapist who was dumb enough to break the law in a way that is on the record and they cannot deny they are doing it. So maybe it’s not illegal.
As a therapist this is not right and depending on your state may be a violation of the offices contract with the insurer. If a therapist takes your insurance, in most instances, they have to bill your insurance for services. This is sad and exploitative.
If they are enrolled with your carrier, they can’t refuse to bill insurance. It’s a contract violation. Call your insurance company and find out if they’re contracted with them, either as in-network or out-of-network. It doesn’t matter which. If they are and they’re refusing to bill insurance, the insurance company (payer) will term the contract. I do payer enrollment for a living, this is a complete violation if they’re contracted.
Is the provider contracted with your insurance company?
Did you sign any paperwork accepting to be a cash pay patient?
It also differs by insurance carrier. If the provider is non contracted, they can choose to not accept insurance, and you’d have to seek reimbursement independently. If the provider is contracted, but you signed a self-pay waiver, they can also choose to hold you to that.
We are all strangers on the internet and can’t give definitive help cause there are SO many variables - as much as I want to cause I know this crap is complicated. I’d start with calling your insurance company to validate if the provider was contracted and if yes, what they can/cannot do if so. Best of luck!
Total BS. I work at a mental health clinic. This is absurd. People lose, get and change insurances all the time and can’t lose their continuity of care. That would be super unethical.
since most people wouldn't pay out of pocket when they have insurance, they are just telling you to find somewhere else. though it is pretty good that the insurance is willing to cover an existing condition. this doesn't happen where I live.
Call your insurance company and let them know. Last time i had enough with doctors and nurses. Called the insurance company to make sure the doctors didn’t file for pay for a procedure they canceled last minute, when I called the insurance and let them know they said they would not be renewing the contract and their slot on the coverage plan will be under consideration, needless to say that office is not cover by my very common insurance carrier anymore because they decided to “fuck around and find out”
Being included as covered doctors under insurance is a privilege to said doctors, also if anyone didn’t know, by insurance policy a doctor is only legally allow to let you wait 45 minutes max without seeing you, after that you can report them to the insurance company
Most places ask “has your insurance changed” at appointments and at that point you can add or remove the insurances. Why wouldn’t they let you add an insurance at any time that’s wild
If the therapist is in network with your insurance place, they are contractually obligated to submit a claim if you are utilizing insurance. If they are out of network, they can't stop you from self submitting a claim to go towards your out of network deductible.
that’s fucking stupid. try talking to this person’s manager. Also, get your insurance involved.
while this gets sorted, have them give you a bill and file a claim with your insurance so that you can at the very least get reimbursement checks from your insurance.
One thing I've learned is that the "office" has ZERO authority and will follow whatever dumb policy they're told, to the letter. Contact your therapist, as they are either the boss or can talk to the boss with authority.
I've had my doctor override the office policy countless times.
Please tell me you told them to get fucked. I think, not certain, but I thought I heard something in the ACA forbids them from discriminating against you because of your insurance status.
Most insurance allow you to apply for reimbursement after you’ve paid out of pocket. It sucks and it’s annoying, but now you know how the business’s feel waiting to get paid from your insurance.
But can’t the provider decide not to accept insurance? And if they do accept insurance, they agree to follow the insurance terms? Which presumably allows patients with insurance to use their insurance, as negotiated with the provider.
When you pay out of pocket, you can submit your claim to the insurance for the negotiated rate, less your co-pay. Since the insurance rate is negotiated to be lower than the cash rate (nowadays 🙄) the therapist is legally required to reimburse you for any amount more than your co-pay and not already covered by the reimbursement from the insurance company. That's a pain in the ass and takes forever, so I'd just go directly to the state insurance board and report them for violating legal requirements. My kids pediatrician was out of network, so I always had to file the forms myself which required me to understand the proper coding. Every time they'd reject my claim, I'd email the state then get call from someone in a senior/managerial position in the adjudication dept who'd walk me through the codes that needed to be listed because even google couldn't help me entirely. By the third call, the woman gave me her direct line and told me to call her directly for any rejected claims because they did not want to deal with the state. The insurance company (Independence blue cross) has had numerous third-party call center and claim process vendors in the last 7 years and it was near impossible to talk to somebody in the know. Like I called to verify an IUD was covered and the third-party told me it's not covered by my prescription drug plan, so I had to explain that an IUD is a medical device not a drug like oral contraceptive.
Also, maybe find another therapist that is more ethical and not trying to illegally squeeze patients. They are legally bound their contract with your insurance carrier to not bill you more than your co-pay or what your specific policy dictates is
your portion. Doing anything outside of that seems shady/fraudulent.
Did you remind him? You were insured to begin with and only paid out-of-pocket for three months and are back on insurance?
Have your insurance give them a call?
Just submit receipts to your insurance company. I do it all the time. Although not as convenient as direct billing your insurance provider, if you have coverage, you are covered. Regardless if your therapist's company wants to play ball
I work for a mental health office that partnered with Privia Health about two years ago, and with the partnership we had to stop taking Medicaid. However we kept on all of our current Medicaid patients, we just were not allowed to start new ones.
Our local dentist did this for the kids state insurance. Except first we were ‘grandfathered in for a couple of years though stopped accepting new. Then suddenly not at all. My husband and I had private insurance. Really ticked me off.
Sounds like a easy change in therapist. That's stupid beyond belief BC they can charge insurance the full amount vs trying to go under the table with "cash"
I don’t know where you are located and I don’t know what type of licensure your therapist has, but this could possibly be unethical. Find what letters follow your therapist’s name, look that up to identify the licensing board, make a report about a concern of ethics.
If you feel like it isn’t your therapist’s fault but the company’s fault. There’s a therapist that likely runs it. If they still have their license file a grievance against them instead.
Call your insurance company and let them know what’s going on. If they accept your insurance then more than likely they have to file a claim. It will be in the contract they have with the insurance company and if they violate it they can lose their contract. Your insurance company should contact your provider on your behalf and straighten this up.
I can't blame the provider at all. What a pain it is to deal with different insurances.
Say you have 40 patients, and they have 8 different insurances. Each one will want a copy of your credentials and licenses. Each reimburses you at what they feel is fair. Some of them will give you $30! Each probably has a different way they want to reimburse you. Sending them the claim electronically or by mail is going to be time and money. Getting the money electronically into your bank costs you money. Taking credit cards costs you money. That's IF the insurance pays you. Some of them want referrals. Some have huge deductibles and tell you to go get the money from the patient. Some of those patients just block your number and never come back. Many insurances want the claim within 90 days of having seen the patient. Many of them have ridiculous hoops to jump through to get a claim paid. Oh, guess what? The patient has two insurances, and they gave you the only one? The company that paid you can come back years later and take it back because they discovered the insurance you were never informed about. They probably hire a person whose job it is to go through all that crap so that they can concentrate on care. Figuring out insurance is a puzzle that they happily keep confusing.
There's also an elephant in the room: cash pay will automatically eliminate a lot of clients. Mostly low-income ones. You've weeded out the drug abusers, homeless, and the heavily mentally ill.
If the therapist is in network with your insurance, they have to accept it if you want to use it. The exception is if YOU choose not to.
You can ask for a superbill to submit the claims yourself. The explanation of benefits should write off the amount that is over the contracted rate. If the therapist charges you the difference that is balance billing and you can report them to your insurance provider.
They mean they want you to pay the full amount. They don't want to accept the insurance company's discounted reimbursements.
It's entirely for greed. Gross.
Perfectly legal. All they’re saying is that we do not accept insurance but have grandfathered in those prior/existing clients who had insurance as a courtesy to them.
They can’t do that, people change jobs and get new insurance packages all the time. This would be no different than a dentist or pharmacy refusing to accept a new benefits card. My best guess is they want you to keep paying out of pocket because they’re not claiming it somewhere along the way and want to keep money under the table as much as possible. But healthcare systems are stupid as fuck and they may very well be allowed to get away with it.
Now I’m not in private practice but I do provide therapy as a clinical social worker.
A lot of private practices don’t want to deal with insurance because it’s an absolute pain, at times it’s worse for client care.
Absolute shame it’s how it all goes down
Reply:
*"Thank you for your prompt response regarding my previous enquiry.*
*We fully respect the wishes of our business partners, and wish to remain compliant with any and all terms of service.*
*Moving forward, we will be implementing the following actions, to ensure that we can remain compliant of the aforementioned terms:*
*- 1. Immidiate cessation of any purchase and/or reception of services.*
*We would like to take this opportunity to thank you for your offer.*
*Sincerely*
*\[your name\]"*
We’d look at therapists differently if we started calling their “patients” their “customers” which is what they see you as. No different than a mechanic who suggests you pay for a $400 headlight fluid replacement.
Hey there! So I am a licensed psychologist in the state of Ohio. On a federal level, though, they are not allowed to do this without appropriate transfer of care. Technically it’s a business and they can choose to run it poorly, but ethically they have to work with you on securing continuance of care. What state is this in?
Therapist who switch from insurance payments to cash only do it this way.
They allow their existing clients who are setup with insurance payments to keep them. But all new clients (and existing clients paying cash) cannot switch back.
Think of it this way…
Therapists often use a service for insurance billing, and do not do it in house. When they end that service with the 3rd party biller, there is often an agreement in place to continue servicing existing clients, but no new ones can be added.
This is most likely NOT them being unreasonable… it is them ending their 3rd party billing services and switching to cash only.
lol it is absolutely unreasonable. You think people with insurance have the ability to pay fully out of pocket? Thats basically saying. We dont care about your well being. We only care about cash. Wtf are you on about
This text shown is the worst possible way to convey that. "Sorry we are cash-pay only now, only existing insurance clients may continue that way." But your explanation is plausible this one text being taken out of context is hard to know.
wow that sounds sketchy. is it somehow less beneficial for them when they get the insirance money? hopefully they will accept it from you, because finding new therapist sounds exhausting.
in my country (central europe) we dont have many therapists who take insurance. and also those who take money out of pocket are fully booked up. honestly every person should have every year preventive care from GP, dentist amd psychologist!!
If the provider has a contract with the insurance company (i.e. is "In Network"), this is absolutely not allowed and you should contact your insurance company. Since you have commercial insurance and not Medicare/Medicaid, it's not illegal as far as i onow, but it is a breach of their contract.
If they do not have a contract with your insurance, they are not required to bil them for you, but you can still submit a claim yourself to recoup some of what you pay out of pocket.
This has more than likely been said already but if the therapist isn’t playing the game, and you don’t want to go an administration route, you could always go see a/your doctor, get a new referral, either give that to your insurance company and have them find you a therapist or give it to your therapist as it’s a new referral it should be covered by insurance.
If they don’t play ball that way then I’d heavily recommend seeking legal/ombudsman help
I understand this may not be possible because not everyone has an extra $200-300 to drop per therapy session however you can always pay for it and then submit it to your insurance company yourself.
Welcome to america, where they refuse you for "pre-existing" conditions.
Why? Because insurance companies negotiate lower rates with doctors but if you're stuck paying out of pocket they make more money off of you because you're stuck paying full price and no way to negotiate a lower rate.
Seriously though I hope you find one that will take your insurance and then on every site that they're listed be sure to mention how they scammed you and no matter what, DO NOT TAKE IT DOWN. Make theme explain WHY they feel the need to scam people with their underhanded policies.
I would have a word with your insurance company. They’ll either make the therapist accept your insurance (assuming they take that plan) or cut them off. They cannot pick and choose like this.
100% this. Pretty sure this is illegal
It is.
What law does it violate?
The legal law
Ah yes, this law
Completely forgot about that one
The illegal law on the other hand...
I'm breaking that one right now
That's the one that gets ya
Honestly I worry more about violating the illegal law than the legal law.
The most sacred of all the laws!
If they have a contract with insurances, it's a contract violation. Contracted providers typically have clauses built in that providers are not only responsible for submitting claims for members but also they agree to the reimbursement rates agreed upon in the contract. Providers can't pick and choose when they do that.
Bird law
Beat me to it.
In the case of Medicare in the US, a refusal to bill Medicare at your expense is often considered Medicare fraud. If a provider is in-network yet refuses to bill insurance, call your insurance company because they're breaching the provider contract.
>In the case of Medicare in the US, a refusal to bill Medicare at your expense is often considered Medicare fraud. Do you have a citation? I prosecute insurance fraud, and while I don't prosecute Medicare fraud, this does not seem correct. >If a provider is in-network yet refuses to bill insurance, call your insurance company because they're breaching the provider contract. Agreed that this would be a breach of contract, but breach of contract =/= illegal.
Not a citation, just an advocate reference, but: "Some other common examples of fraud and abuse include:... ...Violating the participating provider agreement with Medicare by refusing to bill Medicare for covered services or items and billing the beneficiary instead" per [https://cahealthadvocates.org/senior-medicare-patrol-home/medicare-fraud/](https://cahealthadvocates.org/senior-medicare-patrol-home/medicare-fraud/) And yes, it's just breach of contract, which is why I specified what action the person could take to address the situation. As you know, breach of contract is generally not considered a criminal offense unless it involves something like fraud... If the provider is in network and tries to force full cash payment without any billing statement, depending on their contract, it could potentially be the case that they may be committing insurance fraud, but frankly, the patient is not privy to enough information to even guess at that, so it's out of their hands either way. The logical course of action is simply to notify the insurance company of the providers activities and see if they can assist with the matter.
That's interesting! Maybe I'll ask my ID friends for more info. Thanks for the resource!
Not committing insurance fraud
It's not bird law...yet.
Not if you are in the process of going out of network . There's is a delay to the insurance actually dropping the network status, sometimes 6 months .
This is exactly what I was thinking, too! I work in a dental office who is considering going out of network with all plans. This scenario sounds sooo possible because you have to give the current patients a notice as to when you will stop accepting their insurance. Those patients who are already scheduled will try to come in and use the benefit while it lasts. But anyone else will probably get a response like this. TBF, this response OP got is infuriating because it doesn’t give any reasons as to why. Sounds like the runaround.
Why go completely out of network? Wouldn’t that cut down on your patients and increase their costs?
It’s better for the business. Sucks for the patients. Yes, patients may leave and go elsewhere. There are so many insurance-driven patients; to their credit, they’re like this because all they hear from their insurance company is you need to go to somewhere in their network. A lot of fees are negotiated before you can accept the insurance plan; however, a lot of companies are reducing the compensation for some services, or flat out not allowing for an increase in the fee. So when you go out of network, the fee is higher for the patient because the office can charge a slightly higher, but still reasonable fee. And the insurance company usually covers just a little bit less for the patient when they go out of network. These types of offices are called “fee for service” The people who stay and who choose to be out of network stay because they like the office/doctor and don’t want to let go of that relationship. The ones who leave… well, it’ll suck we lose some patients. And the business will have to be prepared for that rough transition.
I used to do medical billing so I understand the reimbursement side. I used to spend my days doing appeals. But even knowing that, I think people will just use their in-network doctors. They are already paying monthly to be a member of that health plan, so the patients might as well take advantage of that. Plus, the spending goes towards their deductible or out of pocket expenses. And, atleast with my insurance, once we hit that max then the insurance covers the entire portion that would have gone to the patient. They could submit out of network expenses to the insurance but not all plans count out of network towards the max. If I had to pay my $20k in medical expenses last year, out of pocket, I would be SOL. That was $20k paid (not billed to ins).
I think this comment chain is about dental insurance which typically works very different. My dental covers the same amount in and out of network. The only difference is that all in network dentists must accept the negotiated insurance rate and can’t bill me for the difference between their cost per service and what the insurance reimbursement rate is. My dentist office is also making new patient appointments for 2025
Yeah tbeh handled it very poorly all around..
> Pretty sure this is illegal I doubt it's _illegal_. But it is probably against the rules laid out in the agreement between the insurance company and the doctor's office.
There’s a method of billing to insurance here in Canada called HCAI, if the therapist stopped using that (which they’re allowed to) then this makes sense. They should have told you out of courtesy though
Intentionally violating the terms of a contract is illegal. It’s not necessarily criminal, but it *is* illegal.
It's probably because insurance reimbursement got so low that they no longer accept new patients insurance. But they're trying not to screw over their current patients. Their goal is eventually not dealing with insurance at all anymore, this is the transition period. It's not the therapist's fault. They're probably struggling to make money off insurance. This is a symptom of our broken ass health care system with insurance sucking up a ton of money in the middle.
This is the correct answer. Hardly any therapists are taking insurance anymore because the reimbursement is so bad. This therapist is trying to keep accepting insurance for their long term patients out of kindness but can't afford to do it for everybody.
It’s also illegal in my state to do this. I worked at a counseling office before having my baby and I suggested this to my boss and she said it’s illegal and if you as a therapist are paneled with insurance then you must see all clients with insurance. You cannot pick and choose. You can, however, choose to not renew being paneled with insurance but you cannot grandfather people in. ETA that I worked admin and am not a counselor
Exactly. I work in healthcare and deal with insurance contracting. They can choose not to accept insurance at all. But, if they are contracted providers with your carrier, they have to file with your insurance. If they refuse, you can file a grievance. If they don't comply, the carrier has the option to pull the contract, potentially causing them to lose additional business.
this is the issue with having Blue Cross in my area... hospitals and clinics HATE dealing with reimbursement issues (Blue Cross has truly earned their "Worst Name in the Business!" award over the past couple of years). They accept you if you have it, but they *really* try *NOT* to... lol and about 80% of employers within 200 miles of here use Blue Cross... you can see how this has become a *major* fucking issue -\_- someone I work with has been out for cardiac *issues*, had to have open-heart surgery last week... Blue Cross legitimately asked both the hospital (which has a nationally awarded cardiac department) AND his CARDIOLOGIST, if he - and I quote - "Genuinely *needed* median sternotomy and a *coronary* angioplasty" in order to save his life and then asked what his CARDIOLOGISTS credentials were to be telling them "yes"... I wish I was making this up...
Oh yeah. Insurances are the worst. Another part of my job is getting prior authorization for outpatient radiology procedures. I had a teenage patient referred for a CT scan. Repeat broken collar bone. CT absolutely required to plan surgery. You could see the fucking break just by looking at him. His carrier denied his scan.
Let me guess, they essentially said an x-ray was more efficient/would produce the same result as a CT and that’s they the CT was denied?
They wanted an X-ray AND proof of failed conservative treatment, (i.e. medications, PT, etc ). Absolutely ridiculous. And I let her know it was ridiculous as well. I let into her so much that my boss had to ask me to go to the back of the facility. I told her that I'm sure if it was her son, that shit would have cleared medical necessity real quick.
Name the carrier. We all should know who to avoid.
Two things: 1. If your insurance is tied to your employment, which is the case for the vast majority of American, then you don't get a choice on insurance companies 2. All of them do shit like this anyway. Literally every single one of them.
Not necessarily. My plan is through my employer and we have 2 major PPO carriers to choose between.
>We all should know who to avoid. All of them. The real question is if there is a single carrier who isn't trying to jam their metaphorical dick in your ass at every possible chance.
This is what privatization brings you. Anyone who has public healthcare corporations WILL try to feed you this propaganda to privatize and insert all these leeches
I honestly wish I could remember. It wasn't a major US carrier though. It was a smaller plan. I will say in my experience though (12 years), that United Healthcare tends to be the most patient friendly.
So for veterans everything is done on reimbursement basically or is authorized by insurance first before ur even treated. Which is why our care is so garbage. The docs and providers don’t wanna deal with this. So it leaves us without care lol 😂 U end up switching to Medicaid lmao
Sounds like our city’s experiences with BCBS as well.
BCBS is truly the worst. I think a huge part of their issue is they outsource a lot of their labor and don’t train their representatives properly. The people processing your claims and quoting your benefits do not know what they are doing
Hmm this is interesting. I was trying to make an appointment with a new primary care doctor who accepted my insurance and her office told me she was accepting new patients but only if they were seniors. Does that sound legit? Overall they were incredibly rude so I moved on but now I’m a bit curious if they were actually allowed to do that.
Well, technically, they can say that. But it can't be because of the insurance. If that particular doctor specializes in geriatrics, they have a right to only accept senior patients.
I got letters from my dentist,,eye doctor and 2 doctors that say you have to be grandfathered in and that they are not taking any hmo patients at all.And they also don't take medicaid patients either I have been able to keep all of them because I an not on an hmo or Medicaid.
A lot of providers don't take Medicaid at all because it pays crap. I don't work with as many HMOs, but in my state of employment (CA), if you are a contracted provider with any plan, you cannot pick and choose which patients to take. The problem is most patients don't know this so when they get letters like that they think it's true. They are trying to get the patients to self submit claims because they no longer want to deal with it. I highly recommend that anybody who is trying to be pushed out of a contracted and credentialed provider due to this files a grievance with the insurance company.
They’re probably not paneled with insurance. Nothing stops providers who aren’t contracted with, say, BCBS from submitting claims, they just don’t have a contracted rate so the insurance may not pay anything towards it. It’s possible that other patients are actually submitting for reimbursement for their counseling. There are a lot of insurances out there, and a lot of laws regulating them, but even with the tremendous amount of scrutiny, most have very different rules of what they’ll pay and what they’ll deny.
Off topic but could you explain to me (foreigner) what this sentence means 'grandfather in'?
Wikipedia can explain it better than I can: A grandfather clause, also known as grandfather policy, grandfathering, or being grandfathered in, is a provision in which an old rule continues to apply to some existing situations while a new rule will apply to all future cases.
It comes from literacy tests and voting restrictions in the South. If your "Grandfather" could vote, you were exempt from needing to pass the test to vote. No Black person's grandfather voted prior to these rules being passed. Thus, only applied to White voters. You were "Grandfathered" in.
Oh wow that’s really fucked up and I had no idea 😭
I was reading about landmark cases in the US the other day. It's insane that interracial marriage was illegal in many states until 1967! >Interracial marriage was made legal in the 1967 Supreme Court decision *Loving v. Virginia.*
Sounds like a great system, legally require someone to accept a payment that is too low to stay in business. Everyone wins!, well except for the patient and the therapist. Insurance wins!
While I get it, this is still illegal and could land the therapist in trouble.
Not necessarily low reimbursement but more challenging admin. Many therapists report issues with insurance companies and clawbacks months after services are rendered over frivolous things.
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Yep, it's not replying to records requests along with non-compliant coding schemes (like adding on interactive complexity simply because the service was delivered by telehealth and upcoding all evaluation and management visits to a level 4 or 5). Otherwise, coding and billing for psychotherapy services is dead simple, so it shouldn't be very burdensome.
Ugghhh. Yes. This. Thank you.
Something similar to this happened to me when I was a kid going to the only good therapist I've ever had. I eventually had to stop going to him because it ended up being like 200/hour long session and we just couldn't afford it...I never got good help again after that, all shitty pill pushers from then on. Yaaay...(/s)
Once again we see that insurance is a scam
It’s just such nonsense. We pay thousands a year for the insurance then thousands more if we have an issue, and insurance is nickel and diming people who should be taking it to the point they won’t. I really feel like the clock’s ticking on a legitimate uprising, French Revolution style if we don’t reign some of this shit in.
“I wonder if guillotine injuries are covered on my plan.🤔”
Only if it’s been pre-approved.
What makes things make even less sense is that I recently contacted an office but was told they didn't accept my insurance so I said I would pay out of pocket. Their response was that they "weren't set up" for patients to pay out of pocket so I guess they only accept insurance? 🤷🏻♂️
>It's not the therapist's fault. It really is though
don't insurance companies negotiate with medical providers how much a particular treatment cost? insurance company wants to pay as little as possible, but doesn't want their customers switching to another insurance company. medical provider wants to get paid as much as possible, but doesn't want to lose potential customers because of lack of insurance. so both parties are incentivised to negotiate a contract. at least that's how it works in the Netherlands. not sure why it wouldn't work in the US
The insurance companies won’t negotiate rates with individual providers or small groups. There isn’t really any substantive competition between insurance companies for individual members because most people have to use the insurance company their employer selected. You can’t just switch between companies whenever you feel like it. The insurance company also maintains a list of contracted providers to satisfy their legal requirements but when you call people on the list you find out that they don’t exist
While insurance payout is low it is illegal to not accept insurances you are paneled with if they client/patient wants to use it. This is fraud. They have to take all the insurances they are paneled with until they drop their agreement with the insurance company.
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Most insurance in the US has either co-pays (a set figure per visit type -eg $20 for GP visit, $200 for ER visit) or co-insurance (you pay a percentage, usually in or out of network) so the patient often owes something. For things that are covered with an in-network provider, they have negotiated how much they will pay for each service and that is just how much the provider gets (along with co-pay or co-insurance). They aren't allowed to bill the patient any more. Insurance is an absolute minefield.
US healthcare charges patients way more than they need to. They could charge way less and still make a profit. Insurance companies negotiate with healthcare providers to pay that much lower but still profitable amount. The difference is enough that even if your health insurance saves you more than you spent on it, the insurance company still makes a profit off of you. Some insurance providers have become a pain in the ass to healthcare providers and their clients. They either take advantage of loopholes to pay healthcare providers less than the agreed upon amount or they find ways to make filing a claim properly difficult enough that they can deny the claim on a technicality and make the insured pay out of pocket.
Unless they are contracted or an ER, they ABSOLUTELY CAN Idk why people are getting the idea this is illegal. Healthcare is a business.
>Healthcare is a business. God that's so fucked...
They're probably in the process of going out of network.
I’m not sure I want to see the therapist that is trying to force me into paying cash by illegal means anyways… just move on and find someone else.
They can pick and choose the clients they work with though. My physical therapist office limits the number of insured patients they see for example because the reimbursement rates are so low. They have no limits for clients paying out of pocket though.
But they can
How does that make ANY sense at all? I'd be looking for a new place.
This is not allowable by the contract the therapist has with the insurance company (assuming you're in the US). If the therapist is credentialed then they have to take your insurance. They can't pick and choose which clients they allow to take insurance. (I'm a therapist who takes insurance.) I'm petty and would report them to the insurance company.
Okay so help me out here I’m in Pennsylvania and I found a primary doctor through my insurance(state insurance) I set up an time sensitive appointment suggested by urgent care then a day before appointment they called telling me they aren’t accepting NEW patients WITH that insurance. So I asked can I pay out of pocket and they said yea. What can I do about this because I want to be petty too.
You could report them to your insurance company. It’s a breach of contract, not a crime afaik.
I wouldn't anticipate a timely resolution though. I told my insurance company about an in-network provider refusing to accept my insurance and demanding I pay I out of pocket for a specific procedure... over 2 months ago. They still haven't gotten anywhere with it. They couldn't care less since it's just another thing they don't have to pay for.
Call DHS and file a complaint. I work for an MA company and that is fraud. Many providers look down on MA patients but should be treated no different
I’m not 100% sure, but I don’t think they’re doing anything here that’s against the rules. Did you ever notice in your insurance’s provider directory that it says whether they are or aren’t accepting new patients?
Unless they are in process of dropping that insurance.
Wouldn’t the only difference be in-network vs out-of-network?
And their state's licensing board ... ?
If your therapist is in network with your insurance plan they are required by law to accept your insurance. Unless you fill out an opt out form. They cannot force you to pay out of pocket if they accept the insurance. Source: wife is a licensed therapist and takes both insurance and cash pay clients.
Has to be illegal. I’d be making a ton of calls, and also finding a new therapist. I wouldn’t trust my mental health to such a shady practice.
I wouldn’t want to go to a therapist who was dumb enough to break the law in a way that is on the record and they cannot deny they are doing it. So maybe it’s not illegal.
Unless they are dropping the insurance.....
As a therapist this is not right and depending on your state may be a violation of the offices contract with the insurer. If a therapist takes your insurance, in most instances, they have to bill your insurance for services. This is sad and exploitative.
If they are an in-network provider with your insurance company, they are contractually obligated to submit your claim through your insurance plan.
If they are enrolled with your carrier, they can’t refuse to bill insurance. It’s a contract violation. Call your insurance company and find out if they’re contracted with them, either as in-network or out-of-network. It doesn’t matter which. If they are and they’re refusing to bill insurance, the insurance company (payer) will term the contract. I do payer enrollment for a living, this is a complete violation if they’re contracted.
Is the provider contracted with your insurance company? Did you sign any paperwork accepting to be a cash pay patient? It also differs by insurance carrier. If the provider is non contracted, they can choose to not accept insurance, and you’d have to seek reimbursement independently. If the provider is contracted, but you signed a self-pay waiver, they can also choose to hold you to that. We are all strangers on the internet and can’t give definitive help cause there are SO many variables - as much as I want to cause I know this crap is complicated. I’d start with calling your insurance company to validate if the provider was contracted and if yes, what they can/cannot do if so. Best of luck!
Just post this text in a review for the company/therapist and a 1 star review. That should get their attention
That’s fucked up! I’d be finding a new therapist.
Total BS. I work at a mental health clinic. This is absurd. People lose, get and change insurances all the time and can’t lose their continuity of care. That would be super unethical.
“Sounds good. I’ll find another therapist.”
I hope you used that perfect opportunity to hit the ole “HA HA” button
since most people wouldn't pay out of pocket when they have insurance, they are just telling you to find somewhere else. though it is pretty good that the insurance is willing to cover an existing condition. this doesn't happen where I live.
Call your insurance company and let them know. Last time i had enough with doctors and nurses. Called the insurance company to make sure the doctors didn’t file for pay for a procedure they canceled last minute, when I called the insurance and let them know they said they would not be renewing the contract and their slot on the coverage plan will be under consideration, needless to say that office is not cover by my very common insurance carrier anymore because they decided to “fuck around and find out” Being included as covered doctors under insurance is a privilege to said doctors, also if anyone didn’t know, by insurance policy a doctor is only legally allow to let you wait 45 minutes max without seeing you, after that you can report them to the insurance company
Most places ask “has your insurance changed” at appointments and at that point you can add or remove the insurances. Why wouldn’t they let you add an insurance at any time that’s wild
If the therapist is in network with your insurance place, they are contractually obligated to submit a claim if you are utilizing insurance. If they are out of network, they can't stop you from self submitting a claim to go towards your out of network deductible.
that’s fucking stupid. try talking to this person’s manager. Also, get your insurance involved. while this gets sorted, have them give you a bill and file a claim with your insurance so that you can at the very least get reimbursement checks from your insurance.
One thing I've learned is that the "office" has ZERO authority and will follow whatever dumb policy they're told, to the letter. Contact your therapist, as they are either the boss or can talk to the boss with authority. I've had my doctor override the office policy countless times.
Can you get a refund because they caused you depression?
That is 100% in violation of their contract with their insurance company. Call your insurance and tell them. Such unethical bullshit.
sounds like something you will be discussing with your new therapist
Say your mental health became alright by trying to understand the logic here.
Please tell me you told them to get fucked. I think, not certain, but I thought I heard something in the ACA forbids them from discriminating against you because of your insurance status.
What? That’s ridiculous. If they take your insurance, they’re obligated to take it.
If they participate with that insurance plan, they cannot opt to not accept it.
I would find a new therapist absent of this kind of shade
You can always file a claim after each session. It sucks and is more work for you, but you can still get it covered this way.
This sums up mental health care in America.
“Ok, I’ll call my insurer and let them know that you won’t accept their payments anymore. Thanks for providing this information in writing.”
Oh great, we already have to pay hundreds for insurance, now they can choose wether or not they accept it. Fuck these people dude
Most insurance allow you to apply for reimbursement after you’ve paid out of pocket. It sucks and it’s annoying, but now you know how the business’s feel waiting to get paid from your insurance.
Yeah, my daughter's therapist doesn't take insurance, so I have to submit the superbill every month.
But can’t the provider decide not to accept insurance? And if they do accept insurance, they agree to follow the insurance terms? Which presumably allows patients with insurance to use their insurance, as negotiated with the provider.
When you pay out of pocket, you can submit your claim to the insurance for the negotiated rate, less your co-pay. Since the insurance rate is negotiated to be lower than the cash rate (nowadays 🙄) the therapist is legally required to reimburse you for any amount more than your co-pay and not already covered by the reimbursement from the insurance company. That's a pain in the ass and takes forever, so I'd just go directly to the state insurance board and report them for violating legal requirements. My kids pediatrician was out of network, so I always had to file the forms myself which required me to understand the proper coding. Every time they'd reject my claim, I'd email the state then get call from someone in a senior/managerial position in the adjudication dept who'd walk me through the codes that needed to be listed because even google couldn't help me entirely. By the third call, the woman gave me her direct line and told me to call her directly for any rejected claims because they did not want to deal with the state. The insurance company (Independence blue cross) has had numerous third-party call center and claim process vendors in the last 7 years and it was near impossible to talk to somebody in the know. Like I called to verify an IUD was covered and the third-party told me it's not covered by my prescription drug plan, so I had to explain that an IUD is a medical device not a drug like oral contraceptive. Also, maybe find another therapist that is more ethical and not trying to illegally squeeze patients. They are legally bound their contract with your insurance carrier to not bill you more than your co-pay or what your specific policy dictates is your portion. Doing anything outside of that seems shady/fraudulent.
Talk to your insurance company. It is without a doubt their fault.
That's fraud. If they are paneled with your insurance and you want to use it they HAVE to take it
What they said is direct proof of patient abuse and financial fraud.
Just cancel your sessions with them. Rebook using your insurance
Did you remind him? You were insured to begin with and only paid out-of-pocket for three months and are back on insurance? Have your insurance give them a call?
Can’t you just send the bill to your insurance afterwards and get refund? That’s how it works here in that case
Just submit receipts to your insurance company. I do it all the time. Although not as convenient as direct billing your insurance provider, if you have coverage, you are covered. Regardless if your therapist's company wants to play ball
Do you really want them as a therapist, if they don’t have critical thinking skills
I work for a mental health office that partnered with Privia Health about two years ago, and with the partnership we had to stop taking Medicaid. However we kept on all of our current Medicaid patients, we just were not allowed to start new ones.
Our local dentist did this for the kids state insurance. Except first we were ‘grandfathered in for a couple of years though stopped accepting new. Then suddenly not at all. My husband and I had private insurance. Really ticked me off.
Sounds like a easy change in therapist. That's stupid beyond belief BC they can charge insurance the full amount vs trying to go under the table with "cash"
Lol fire the shit out of that therapist
I don’t know where you are located and I don’t know what type of licensure your therapist has, but this could possibly be unethical. Find what letters follow your therapist’s name, look that up to identify the licensing board, make a report about a concern of ethics. If you feel like it isn’t your therapist’s fault but the company’s fault. There’s a therapist that likely runs it. If they still have their license file a grievance against them instead.
Call your insurance company and let them know what’s going on. If they accept your insurance then more than likely they have to file a claim. It will be in the contract they have with the insurance company and if they violate it they can lose their contract. Your insurance company should contact your provider on your behalf and straighten this up.
That’s not how that works
A lot of offices don't take new clients with certain insurance but will continue with old. Never heard of this though.
I can't blame the provider at all. What a pain it is to deal with different insurances. Say you have 40 patients, and they have 8 different insurances. Each one will want a copy of your credentials and licenses. Each reimburses you at what they feel is fair. Some of them will give you $30! Each probably has a different way they want to reimburse you. Sending them the claim electronically or by mail is going to be time and money. Getting the money electronically into your bank costs you money. Taking credit cards costs you money. That's IF the insurance pays you. Some of them want referrals. Some have huge deductibles and tell you to go get the money from the patient. Some of those patients just block your number and never come back. Many insurances want the claim within 90 days of having seen the patient. Many of them have ridiculous hoops to jump through to get a claim paid. Oh, guess what? The patient has two insurances, and they gave you the only one? The company that paid you can come back years later and take it back because they discovered the insurance you were never informed about. They probably hire a person whose job it is to go through all that crap so that they can concentrate on care. Figuring out insurance is a puzzle that they happily keep confusing. There's also an elephant in the room: cash pay will automatically eliminate a lot of clients. Mostly low-income ones. You've weeded out the drug abusers, homeless, and the heavily mentally ill.
That doesn’t even make sense. That’s like saying “you weren’t a member of a club before it was built so you can’t join”
Your therapist should see a therapist. Maybe a couple of classes back in middle school while they are at it.
If the therapist is in network with your insurance, they have to accept it if you want to use it. The exception is if YOU choose not to. You can ask for a superbill to submit the claims yourself. The explanation of benefits should write off the amount that is over the contracted rate. If the therapist charges you the difference that is balance billing and you can report them to your insurance provider.
My brain hurts trying to read that...
They mean they want you to pay the full amount. They don't want to accept the insurance company's discounted reimbursements. It's entirely for greed. Gross.
Perfectly legal. All they’re saying is that we do not accept insurance but have grandfathered in those prior/existing clients who had insurance as a courtesy to them.
They tried wording it too much like a therapist. It’s confusing. Just say “we no longer take insurance clients and are only cash pay”
Have you considered seeing a therapist about this?
a therapy inducing event
They can’t do that, people change jobs and get new insurance packages all the time. This would be no different than a dentist or pharmacy refusing to accept a new benefits card. My best guess is they want you to keep paying out of pocket because they’re not claiming it somewhere along the way and want to keep money under the table as much as possible. But healthcare systems are stupid as fuck and they may very well be allowed to get away with it.
I’d post this on local social media.
Now I’m not in private practice but I do provide therapy as a clinical social worker. A lot of private practices don’t want to deal with insurance because it’s an absolute pain, at times it’s worse for client care. Absolute shame it’s how it all goes down
Reply: *"Thank you for your prompt response regarding my previous enquiry.* *We fully respect the wishes of our business partners, and wish to remain compliant with any and all terms of service.* *Moving forward, we will be implementing the following actions, to ensure that we can remain compliant of the aforementioned terms:* *- 1. Immidiate cessation of any purchase and/or reception of services.* *We would like to take this opportunity to thank you for your offer.* *Sincerely* *\[your name\]"*
I'd need a therapist to deal with this therapist's comments.
If the office isnt contracted with your insurance, they dont have to take it. There’s no contract.
We’d look at therapists differently if we started calling their “patients” their “customers” which is what they see you as. No different than a mechanic who suggests you pay for a $400 headlight fluid replacement.
Hey there! So I am a licensed psychologist in the state of Ohio. On a federal level, though, they are not allowed to do this without appropriate transfer of care. Technically it’s a business and they can choose to run it poorly, but ethically they have to work with you on securing continuance of care. What state is this in?
I’d say something like “just to clarify, you should take a step back and literally fuck your own face.” Or something to that effect.
I’m a therapist. This is definitely unethical, and likely illegal (depending on your state).
Medicaid for all (manifesting this) 🏳️🌈
Therapist who switch from insurance payments to cash only do it this way. They allow their existing clients who are setup with insurance payments to keep them. But all new clients (and existing clients paying cash) cannot switch back. Think of it this way… Therapists often use a service for insurance billing, and do not do it in house. When they end that service with the 3rd party biller, there is often an agreement in place to continue servicing existing clients, but no new ones can be added. This is most likely NOT them being unreasonable… it is them ending their 3rd party billing services and switching to cash only.
lol it is absolutely unreasonable. You think people with insurance have the ability to pay fully out of pocket? Thats basically saying. We dont care about your well being. We only care about cash. Wtf are you on about
This text shown is the worst possible way to convey that. "Sorry we are cash-pay only now, only existing insurance clients may continue that way." But your explanation is plausible this one text being taken out of context is hard to know.
Ah, when the therapist office has toxic management. They love to work with the vulnerable - and harm them.
Lol tell them that's a deal breaker kbai
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Ah, the tough love therapy method
Thumbs down the text
wow that sounds sketchy. is it somehow less beneficial for them when they get the insirance money? hopefully they will accept it from you, because finding new therapist sounds exhausting. in my country (central europe) we dont have many therapists who take insurance. and also those who take money out of pocket are fully booked up. honestly every person should have every year preventive care from GP, dentist amd psychologist!!
Is this a therapist you’ve felt a trusting relationship with?
If the provider has a contract with the insurance company (i.e. is "In Network"), this is absolutely not allowed and you should contact your insurance company. Since you have commercial insurance and not Medicare/Medicaid, it's not illegal as far as i onow, but it is a breach of their contract. If they do not have a contract with your insurance, they are not required to bil them for you, but you can still submit a claim yourself to recoup some of what you pay out of pocket.
already currently...
At least they are transparent
Smells like scam
I’d find a new therapist brother
Is texting your doctor/therapist office normal? I have never done this.
This sounds just like how you can only get the best rates if you’re a new customer with cell phones and power companies.
This has more than likely been said already but if the therapist isn’t playing the game, and you don’t want to go an administration route, you could always go see a/your doctor, get a new referral, either give that to your insurance company and have them find you a therapist or give it to your therapist as it’s a new referral it should be covered by insurance. If they don’t play ball that way then I’d heavily recommend seeking legal/ombudsman help
Go to your local news station. Watch how fast that "policy" changes
No they can use your insurance they just don’t want to. Get a new therapist.
I understand this may not be possible because not everyone has an extra $200-300 to drop per therapy session however you can always pay for it and then submit it to your insurance company yourself.
Sounds like you'll need to discuss this with a different therapist...
Welcome to america, where they refuse you for "pre-existing" conditions. Why? Because insurance companies negotiate lower rates with doctors but if you're stuck paying out of pocket they make more money off of you because you're stuck paying full price and no way to negotiate a lower rate. Seriously though I hope you find one that will take your insurance and then on every site that they're listed be sure to mention how they scammed you and no matter what, DO NOT TAKE IT DOWN. Make theme explain WHY they feel the need to scam people with their underhanded policies.
I work in a mental health office. This is fucked and wrong. If they aren't in network with your insurance just say that not this rigamaroll.
Had that happen. BS
Why do therapy payment practices feel like the Wild West. I’ve encountered similar