Archive for the ‘money’ Category

You’re Going To Charge Me For Missing A Session?

Thursday, May 19th, 2011

Yeah. I am. Can we reschedule? Let’s talk about that later.

I hear ya. Yer doctor just lets you call and say you’re not going to be there and everything is fine. Same thing with the dentist and some other health professionals. Everything is jake. You call up, say you’re not getting there, they cancel your appointment and then you reschedule when you get the chance or whenever what’s bothering you kicks up again.

So what’s this about? Making sure that I don’t lose income? I’ve heard that before and the answer is, “Yes, but that’s not the main reason.” Some people stop at “Yes” and don’t hear the rest. Unfortunate. I do own up to it being, in part, about my income. Your fee is my income. I can’t double book the way physicians and dentists do so, when you don’t show, I don’t get paid for that period of time that I’ve reserved for you.

Ah, there’s another part of the “…not the main reason.” I’ve reserved the time for you. In most cases I can’t rebook the time. I realize this isn’t your problem, except that you want me to keep this time open for you every week, right? If you want me to release the time to someone else, I can do that, but then it’s that person’s if he’s willing to pay for it on a regular basis. Then you & I have to decide on a new schedule and, guess what, it’s still a regular appointment and, you guessed it, you’re going to pay for that missed session.

“Missed” session. Hmmmmm. Yeah, about that. If you don’t show up and you don’t pay it’s not a “missed” session. It becomes a “missing” session. What’s the difference. “Missing” sessions don’t exist. They didn’t happen, there’s nothing to note their passing and there’s nothing to talk about. I know you think there’s nothing to talk about if you miss a session, but that’s not true. There’s plenty to talk about and that’s why it needs to be “missed,” not “missing.” I’ll go further with that another time. Please just take my word on this one for now. If you want to think about it and tell me the difference please feel free to post a comment.

Now, about that rescheduling of our appointment. What are you asking of me with that request? Your asking me to fulfill your wish that you get a Mulligan. The “caring one,” as Harry Stack Sullivan labeled the infant’s primary care giver (often mom but not necessarily,) will do what is wanted. Your wish to be taken care of will be fulfilled no matter what the cost to anyone else. What are you asking of me? You are, in effect, asking me to cut my fee in half by giving you another session (the one you missed plus the”rescheduled” appointment) for the price of one session. Two for one. You’re presuming that I have the open time that will match yours and, maybe, that if I can’t match your time you won’t have to pay because you can’t reschedule and it’s my fault.

That doesn’t answer the question about rescheduling a session. That answer is, if I have time open and it matches your availability then, yes, I will reschedule. Once. Please.

Long ago in a galaxy far, far away I dated a woman who said, in response to my saying I felt “used” about something “Everybody uses everybody. Don’t abuse anybody.” Please.

Comments? Please feel free to post them below.

You, Your Insurance and Privacy of Our Work, Pt III

Wednesday, October 13th, 2010

OK, now for the kicker. The something more. This information that lives with your insurer and their insurers isn’t finished yet. What happens if you apply for life insurance? An auto loan? Change jobs and need to sign up for other health insurance? Apply for a credit card? Have you guessed yet?

That’s right. These worthies will often turn to an agency that they hire to collect your information, your protected health information, and that agency will then turn to me and request the records of your treatment. They will sometimes accept a summary but I have to tell them that’s what they’re going to get. What you’ve signed, after you first told them that you had this treatment (if they ask, and for life insurance they sure will,) is a consent for release of information for your medical records. That means they are going to be requesting my session notes (which are part of your official medical record.) This also means that this 4th party outside of the triangle of you, me & your insurance company (and their backers, but I included them in the triangle – so what if it’s got 4 sides? I’m a psychotherapist not a geometer) has your protected health information in its data bank. Yes, the release you signed is HIPAA compliant. They know the law & know that that’s what they have to give you. It doesn’t mean that they are as careful about disclosures as your psychotherapist (me, in this case.)

Does this chill you a bit? If it doesn’t then you’re not following the flow of your information. Wider and wider circles of dissemination.

Now, I’m not saying that if you and I keep things between us and you leave your insurance out of our relationship that you won’t at some point decide that you want life insurance and they won’t ask about treatments you’ve received. If you do they will. I won’t tell you not to tell them about treatments. That would be telling you to commit fraud and I won’t do that. I won’t tell you to lie on the application. I will tell you that, unless you are asked about treatments, in most cases (within the limits of the laws about confidentiality) it stays between you and me (maybe your accountant and Uncle Sugar if you claim it on your taxes, but I’m not going to go there.) There are limits imposed on confidentiality by law, such as if I think you are an immediate danger of committing harm to yourself or somebody else, or in case of suspected cases of child abuse but within the law what’s between you and me stays between you and me. Personally, I like it that way.

Another time I’ll tell you why I don’t like “diagnosis” as used in the DSM (or ICD,) but that’s not part of this. Let’s call it a day and I’ll go back to enjoying my cup of tea.

You, Your Insurance and Privacy of Our Work, Pt II

Wednesday, October 13th, 2010

OK, where was I before I started brewing my tea – a nice Oolong with lots of flavor, good aroma & gentle bite? Oh, yeah, about codes and privacy. This section gets a little technical but hang in there, fans – it’s worth it.

I said that those codes don’t leave much of an artifact (footprint, trace, record) that’s going to make any difference, right? Wrong! There’s a procedural code for every procedure that goes on a claim form, whether it’s medical, dental, surgical, psychotherapeutic, etc. The procedure performed becomes part of your permanent medical record in your insurer’s database. “So what” I hear you say. So this: it’s not just in your insurer’s database. It’s in their insurer’s database. They’ve gotta lay their bets off somewhere. That’s with a meta-insurer (think AIG or similar.) Someone who does risk-management and determines how much they can back the bets your insurers make. Think of it as the insurance company has sold your marker to someone. You said it was Jake for them to do that when you signed the line that said that your information could be disclosed for the purpose of obtaining payment. And you thought it was just between you, me, and your insurance company. Have another thunk because there’s more.

Anytime there’s a procedure code there’s a diagnosis. Again, this is whether the work is medical, dental, surgical, psychotherapeutic, or whatever. Now we’re beginning to where it gets sticky. Diagnosis is a serious word. It means that, based on criteria established by the Taskforce that created the Diagnostic and Statistical Manual of Mental Disorders-IV TR, you get labled with a disorder. You are no longer “the worried well,” or someone who just feels anxious. You now have a recorded disorder. This is part of that marker. The fun doesn’t stop there….

Anything that is contained in the DSM-IV is contained in a book called the ICD-9 (going on ICD-10) – “The International Classification of Diseases” published by varoius publishers all putting out the same book (it’s used world wide – International, right?) This means that where ever your record is read they all read the same diagnosis. Great, right? Maybe if the people reading that record were also psychotherapists, psychiatrists, or some kind of mental health professionals, but they may not be. Yes, some insurance companies do utilize us for review but not all the reviewers are. This means that your case is being reviewed by a clerk of some sort. This clerk gets to decide (among other things) how many sessions we can have during a given year for a particular disorder, if any at all. They can also decide that treatment has gone on long enough based on the tables they have and what instructions they’ve been given. At this point it involves more work; usually for me and for which I don’t get paid but, again, even though I mention the do-re-me it’s not about the bucks. It’s about the time it takes to appeal the decision & meanwhile the treatment and who’s going to pay for it is in Limbo (which is often somehow contiguous with Hartford, CT or someplace in Texas, maybe offshore. Who knows?)

These clerks aren’t under the same constraints about the privacy of your information (remember, that’s what this is about) as I am. They are allowed to bundle it for research as well as developing their actuarial tables and other statistical purposes. Your personal information (PHI – Protected Health Information) is not as protected anymore.

But wait, as they say on the infomercials, there’s more. See part III, coming up shortly….

You, Your Insurance And Privacy of Our Work Together

Wednesday, October 13th, 2010

“Do you take insurance?” Yeah. I’m in-network (“par,” in insurance terms – participating) with several plans and take assignment. I’m not in-network (“non-par” – I don’t par…never mind. You get the idea) with many more than I’m in with. There’s various reasons for that, none of which really matter here. Feel free to email me if you really need to know but, trust me, that’ not what this is about.

Personally, I’d rather you not use your insurance. That way we can keep things just between us (the two of us, not the two of us and a lot of other people.) I know that you want to have your insurance company pay me (“par”) for part of your treatment or reimburse you (“non-par”) for some of what you paid me. It makes absolute cents. Dollars and cents. Unless you work for the exceedingly rare, and growing rarer all the time, companies that pay your entire premium, you pay a lot for your share of the premium on your health insurance. You want to get something for that hard earned cash that’s not going into your paycheck. Even if your policy doesn’t cover “behavioral health,” you may have a flex or cafeteria plan that you can use to cover some of the period of treatment, some sessions, something.

I get it. I feel the same way about my health insurance. I want to get something back for the money that’s paid in. It’s why we have insurance, right, so that we don’t have to pay the whole ginormous cost of examinations, treatments, medications, devices, etc., etc? Yeah, that’s all real swell but there’s a good reason, maybe several, why you should consider not using your insurance for your psychotherapy/psychoanalysis/mental health treatment. Can you guess what it is?

Money? No. That’s not it. Yeah, sure, I can ask for more money from you if you pay out-of pocket than the fees that the insurance companies “negotiated” in the contract for “par” situations. Even if I can charge you more if I’m non-par because I don’t have to accept the rate the insurance company wants to pay, it’s still not about the money.Please believe me on this.

OK, I’ll give you a hint: look at the title again. The part that says “…Privacy of Our Work Together.” That’s my big concern and needs consideration on your part before you simply say “I pay for the insurance and I want to use it where ever I can.”

Have you stopped to think about how I get paid or you get reimbursed? Of course you have. I do something that goes to the insurance company and they send me a check (or deposit to my account) or I give you something, you combine that with something else, send it to the insurance company and they send you money. Simple. As easy as 3.1416.

Not so fast, Kimosabee. What’s on that claim form that goes to them? The CPT code (that tells them what procedure was performed, e.g., 90806= O(ut)P(atient) psychotherapy, 45-50″ (minutes,) no med(ication) eval(uation.) That tells them how much they pay out for what went on in the room. We can all agree that this is pretty harmless and doesn’t really do much in the way of leaving an artifact, right? Wrongo! Let’s move on to part II of this and I’ll explain more. For now my tea is ready to brew. See you in a bit!

ADD & Taxes Pt. II: The Folly of Working Hard: Completeness is the enemy of sense

Wednesday, July 14th, 2010

My last post was a bit of a disappointment to me. My “voice” was missing (what, you couldn’t hear me because it’s written, not spoken? Shirley, you jest.) I was missing a simple ingredient. Simple. That’s what I was missing.

See, I was trying to do too much in one shot. There’s only so much stuff I can cram in a 5-pound sack & I was looking at about 2o pounds. Then tried to tie it closed with a string. In the middle. The result? An overflowing, non-flowing pile of stuff that wasn’t satisfying to me, I don’t know about you.

The “simple” answer to the issue of ADD/ADHD and taxes is that there’s no “simple” answer that I can give. I can make suggestions but that’s already me imposing my thoughts. The simplest answer I know is to try things, no matter how logical, illogical, whimsical or insane they may seem until you find the method that works. If it works for you and Uncle Sugar it’s a bingo.

As for the other “simple” answer: I forgot the simple rule: Don’t work hard. Work smart. I was working too hard to try to get all my thoughts into one post. Phaugh! What a headache. It was a bad idea even if I could have done it. It was too much to organize (especially doing it inside that crowded melon between my hat & my neck.) Hard work never helped. Look at John Henry. He “…was a steel-drivin’ man (lord lord”) and, yeah, he beat that steam drill, but he died and his wife had to finish the job for him. He wasn’t even bustin’ up the mountain, he was just drilling pilot holes for the blasters (if you’ve never heard them, you gotta give them a listen. They’ll knock yer socks off) so they could bust up the mountain. The guy with the steam drill? He got to go home & have his soup. John Henry “…laid down his hammer an’ he died (lord lord.”) Where’s the percentage in that? He got a folk song written about him, but so did the guy with the steam drill. Don’t think so? Listen to the song again. It’s all about John Henry vs the Steam Drill.

What’s my point?  Zeit nicht meshugeh! There’s no “right” way to do your taxes (or anything else) as long as your in compliance with the codes, but working harder isn’t necessarily better. Working smarter, thinking about what you’re doing before you do it is often better. If someone accuses you of being lazy, go ahead and agree. Tell him (or her) that sure, you’re being lazy, but not unproductive. Remind him (or her) about John Henry. “He laid down his hammer and he died (lord lord.”) Does that sound good to you? Not me, cousins. I’ll use the steam drill any day rather than swing that sledge and go home, have my soup and, if necessary, come back tomorrow and finish up. The opposite of hard work isn’t “hardly workin.'” It’s workin’ smart.

Next up: Credit cards & psychotherapy fees.

Taxes & ADD/ADHD

Tuesday, June 22nd, 2010

TAXES? Is he kidding? I don’t have to think about that until next April. How about something useful like relationships, school, relationships at school, stress from relationships & school. How about fishing or hiking? Exercise? Why this now?

Why this now? Because now is the time to catch up on getting taxes for this tax year organized. We’re already halfway through it and you don’t know where all your receipts are, haven’t kept the checkbook balanced and/or haven’t entered everything into your accounting program that you haven’t updated, etc.

The simple fact is that taxes are a year-round reality, not just something that happens in April and, as Inspector Harry Callahan said, “Man’s got to know his limitations.” Sure, you’ve been downloading all your credit/debit transactions into your accounting program, but what about the cash purchases that you can’t download? Does your accounting program properly itemize or hasn’t it been set up to do that properly? What about the receipts for the donations of clothing, etc. to your favorite thrift store? Do you know where they all are?

ADD/ADHD comes in different “flavors:” Disorderly/energetic, distracted/daydreamy & highly structured. These aren’t distinct categories and hardly anyone is all one “flavor,” but knowing or recognizing what type you are can lead to different strategies for dealing with taxes (and money in general.)

The highly structured kind has the easiest time with taxes, right? Everything is in its place and everything is OK. But is that true? I did ask about “all” the receipts for expenditures, tracking of income, donations, etc. All means just that: ALL. One missing receipt can throw the highly organized person into a frenzy of activity, holding up everything until that one missing piece of paper is found, often just before April 15th, with all the resultant anxiety and recriminations that go with not having everything under control and in place.

The disorganized and distracted types often have the opposite problem. Instead of everything being in “its place” everything’s place is everywhere and anywhere. Receipts were put away to keep them together only now that location is forgotten and so others get put in another place or nothing was really “put away” but was left to sit where ever a wallet or something got emptied. Stuff is all over and the end of March/beginning of April is a frantic search to assemble a year’s worth of documentation, enter it somewhere, and get the taxes completed in time.

Any of this sound familiar? Many people go through this same scenario, whether they are diagnosed with ADD or just not thinking about money & taxes until the subject is shoved in their faces. It’s stressful, can lead to problems in relationships, takes time away from other things and can take over your life for a while. So what can be done?