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JB Umphrey
JB Umphrey, Attorney
Category: Legal
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Experience:  Explains legal matters based on 14+ years experience.
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I recently stopped seeing a therapist whom I had seen for 2

Customer Question

I recently stopped seeing a therapist whom I had seen for 2 1/2 years. I found out that while she agreed to see me at the rate of $130/hour, she has submitted bills to the insurance company for $160/hour. Is there a problem with this? I have also become aware of the fact that while she sometimes saw me for 1 2/3 session, she billed it as a double session.

Five months after terminating my treatment with her, she has presented me with a $12,500 bill that she says I still owe. I was paying her a monthly co-pay and she did not tell me during my treatment that I was accruing a debt. I need to be in contact with the insurance company to try and figure out how I could possibly owe her this amount and I am worried about revealing to them the discrepancy in her billing.
Submitted: 2 years ago.
Category: Legal
Expert:  JB Umphrey replied 2 years ago.
Hi and thank you for using JustAnswer!

I am sorry to learn of these circumstances. Please clarify:

1. Did you have a written fee agreement with her?

2. She never sent you monthly or quarterly billing statements?

3. Is she also located in California?

4. Why did you stop seeing her?

5. What type of license does she have?
Customer: replied 2 years ago.

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.

Expert:  JB Umphrey replied 2 years ago.
Thank you. Please clarify: are you under the impression that because she only saw you for 45 min. she should not have billed for one hour?
Customer: replied 2 years ago.

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.

Customer: replied 2 years ago.

I should have said that she billed her "session" at $160 to the insurance company, while billing me only $130.

Customer: replied 2 years ago.

I should have said that she billed her "session" at $160 to the insurance company, while billing me only $130/session.

Expert:  JB Umphrey replied 2 years ago.
Thank you.

You may want to consider contacting her to discuss the bill and try to resolve the matter that way.

If it doesn't work, then consider filing a complaint against her with the California the Board of Psychology.

You can file your complaint online or in writing as explained at this link: http://www.psychboard.ca.gov/consumers/complaints.shtml

It has been my pleasure to assist you today with your information needs. It is my goal that you are satisfied. No expert can promise you an answer that is favorable to your circumstances. But I will do my very best to explain the legal principles that are related to the facts you’ve described so that you can better understand the “why” of things.

Please let me know if there is anything else I can provide to give you excellent service!"

Customer: replied 2 years ago.
What I am wondering is whether it was unethical for her to charge me one rate and then submit a bill for a different amount to the insurance company.
Expert:  JB Umphrey replied 2 years ago.
I can't speculate on that because I do not know what the limitations are in her written contract with the insurance company. She may or may not be allowed to do that. It depends on their contract.

She can explain that to the state board when they investigate her complaint.
Customer: replied 2 years ago.
The Board of Registration does not get involved in issues regarding finacial problems or fee disputes.
Customer: replied 2 years ago.
To further explain. She did not have an agreement with the insurance company. She gave me bills to submit to the insurance company to be reimbursed. In the private billing she has given me she charged $130/session. In the bills she gave me to submit to them she charged $160/session. The insurance company had agreed .. through me ... to pay 80% of her fee. If she charged $160/session the payment from the insurance company would obviously be larger than if she submitted a bill for the actual amount of $130/session.
Expert:  JB Umphrey replied 2 years ago.
Thank you for that important clarification.

Did you give her the $130 insurance reimbursements that you received?
Customer: replied 2 years ago.

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.

Expert:  JB Umphrey replied 2 years ago.
So now she is seeking the extra $30/session from you, right?
Customer: replied 2 years ago.

No, that is not really correct. I don't feel we are understanding each other.

Expert:  JB Umphrey replied 2 years ago.
I agree. What then is the basis of her bill to you?
Customer: replied 2 years ago.

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.

Expert:  JB Umphrey replied 2 years ago.
So, you paid her $90 for a session (insurance reimbursement) and now she's billing you for the $70 difference?
Customer: replied 2 years ago.
No
Expert:  JB Umphrey replied 2 years ago.
Then please clarify:

1. What did she bill.

2. How much were you reimbursed from insurance?

3. How much of that reimbursement did you give to her?

4. What is the basis of her current bill to you?
Customer: replied 2 years ago.

did you receive my last email? The reply to your questions?

Expert:  JB Umphrey replied 2 years ago.
Sorry, I did not receive it. Please try again.
Customer: replied 2 years ago.

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.

Expert:  JB Umphrey replied 2 years ago.
I apologize for the frustration. However, when you use the term "agree" you've also said that there was no written free agreement. You have no written fee agreement to hold her to, correct?
Customer: replied 2 years ago.

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?

Expert:  JB Umphrey replied 2 years ago.
If she has prepared such an accounting then you may want to consider writing to her about that and explaining why you do not believe that you owe her any money (enclose the accounting to show the rate). Then, make an appointment to meet with her to review the billing discrepancy.
Customer: replied 2 years ago.
I still am not being clear ... if I tell my insurance company that she submitted a false balance "owing" to try and get more money from them will it be a problem for her?
Expert:  JB Umphrey replied 2 years ago.
No, it should not be a problem for her. They pay her based upon their set rates -- not the rate she submits to them. They just say we're paying $x and that's it.
Customer: replied 2 years ago.
She also was seeing me for a session and a half and then billing it as a double session.
Expert:  JB Umphrey replied 2 years ago.
Most likely, the insurance company doesn't have a billing code for 1.5 sessions. But you can ask her about it and seek her clarification when you arrange to have your meeting with her.
Customer: replied 2 years ago.
Thank you
Expert:  JB Umphrey replied 2 years ago.
You are very welcome! Best wishes!
Customer: replied 2 years ago.
I am sorry, but I must take a little time to absorb our conversation before I accept your answer. I will do so however.
Expert:  JB Umphrey replied 2 years ago.
Very well. Thank you.

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