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I did not have a written fee agreement, although there was a written explanation of her policies. It did not reflect anything that applied to me personally. She simply agreed to see me at a reduced rate of $130/hour
She sent me statements to submit to the insurance company which listed her 45 min session at $160/hour. I submitted those bills and the insurance company paid her. I did not know how much the insurance company was paying.
Yes, she is in California.
I stopped seeing her for a number of reasons. My therapy with her was extremely unproductive and frought with problems between us. She found out that I had elective surgery and said she would no longer give me the discount and I told her that then I simply had to quit. I told her I was already stretched financially and couldn't pay any more. I had tried to quit a number of time but she would call and call and pressure me to continue. She also kept pressuring me to increase my hours .. I went from seeing her one session a week, as originally agreed upon .. to four sessions a week. I was paying quite a large co pay every month .. but she and I never discussed if the co pay was actually enough. I told her often I was worried about it but never got a clear answer from her.
She is a licensed Phychologist.
No, I understand that her session are 45 min. and that is what her fee is based upon.
I was just trying to be precise in my communication with you.
I should have said that she billed her "session" at $160 to the insurance company, while billing me only $130.
I should have said that she billed her "session" at $160 to the insurance company, while billing me only $130/session.
Any payment I got from the insurance company I gave directly to her.
It is important to understand that the insurance company was paying 80% of her bill, not the whole amount. Therefore they would be actually paying more than 80% of the actual fee if she charged it at a higher rate.
Unfortunately, the reality was that they were only paying 80% of what they considered to be a reasonable fee and not the $160/ session that she was charging. After the fact, when she realized this, she then submitted this horrifically burdensome bill to me in the amount of $12,500.
No, that is not really correct. I don't feel we are understanding each other.
She thought the insurance company was paying 80% of $160/session. After I terminated my care with her, she then realized they had only paid 80% of what they considered a reasonable fee, which was, I believe, about $90/session.
Why she wasn't aware of this during the time I was seeing her I do not know. She obviously was not keeping accurate of clear finacial records.
She is now billing me for the difference between those two amounts.
I need to contact the insurance company and get an accounting from them. However, if I show them the actual accounting of what was billed to me, they will realize that she was submitting bills to them in a different amount than she was actually charging me .. in an attempt to have them reimburse a larger amount than they had agreed to. I am wondering if this was unethical, or even illegal of her.
To restate .. she was misrepresenting her bills when submitting them to the insurance company in an attempt to have them pay a larger portion than they had agreed to.
I of course am rather dismayed to be presented with a bill of this amount after the fact when I was giving her all that the insurance company was paying, and I was paying her a huge copay .. which amount she never clarified.
did you receive my last email? The reply to your questions?
Oh my goodness .. well, I will try to be bried and clear!
1. She was billing me $130/session. We agreed upon a $30/session co-pay. She submitted bills to the insurance for $160/session. She thought she could get more from the insurance if she submitted the bill for the larger amount, thus getting 80% of $160 rather than 80% of the true amount, $130.
2. I was sent reimbursment checks from the insurance company and gave it all to her.
3. The reimbursment was actaully 80% of the insurance company's "allowed" amount .. which was $90/session.
4. She is now billing me the difference between our agreed upon co-pay and the amount the insurance company actaully paid.
I don't think so, not completely sure ... I do not think she would deny it however.
Also, my main question... I have an accounting from her in which she lists her charge to me to be $130/session. Her bills to the insurance company are billed at $160/session. Is this a problem for her?
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