Billing > Billing

doctor charging more than co-pay

(1/4) > >>

slcoop1234:
I have been seeing a therapist (Ph.D.) for about 10 years. In January2011, my insurance was changed to a new company. This company has a contract with my therapist to pay him less than the old copmany paid him, but he agreed to that. The new co-pay also is less than the co-pay was under the old company. My therapist wants me to pay more than the required co-pay because he says that this company does not pay enough and he is worth more. He told me that he would no longer keep me as a patient if I did not agree to pay the extra money. He says that he has other patients who also have this company and who pay more than the required co-pay, more than he is asking of me.

Does anyone have any thoughts on this. It seems that I am stuck, doesn't it? I really have trouble affording the amount requested, which I told the therapist. He said I should cut back somewhere.

PMRNC:
Ok, he cannot just TELL you he won't see you anymore, he has to follow procedures for patient termination and it's not that cut/dry that he can terminate a patient over something that hasn't happened yet (copay's leading to high balance).  Terminating a patient is not as easy as just telling them, in fact that's against the law. 

However..   He does have a right to expect you to pay the full balance of the difference SO LONG as he is non participating with your insurance carrier. IF he is participating, he is obligated to only collect up to the carriers allowable amount.  So if he's NON participating, you would owe him the difference between what was billed and what the carrier paid. In fact provider's are obligated to collect patient out-of-pocket's and you are obligated under your own policy to pay out of pocket expenses, this is the cost sharing provision of your plan's policy.

slcoop1234:
I guess that I was not clear. YES, he IS participating. That is why he gets a certain amount from the insurance company. They have a contract. Also, I KNOW that he cannot just get rid of me, that there are procedures that he must follow. However, I have been seeing this guy for over TEN YEARS. Do you really think that I want to change therapists?

PMRNC:
If he is participating you only are obligated to pay him the copay (out of pocket) anything over the allowable he has to adjust off, according to his contract with that carrier. So if the new carriers "allowable" is less, that's not your problem.  If he is asking you to pay the difference between the old carriers allowable and the new carriers allowable that's completely against the contract he has with the carrier. I understand you don't want to change therapists, so I would approach him with this information gently and see what he says. If he still insists, well, you could go to your insurance carrier and they would take the matter up with him. 

slcoop1234:
Thanks for your answer. I have been paying him the extra since January of 2011. I am having  trouble affording it, so I did ask him about it (yes, gently). That is when he told me that he was worth more, and that other patients were paying him more, too. In fact, more than I am paying. He is unhappy with the amount the carrier pays. I told him that the stated copay is what I should pay and that is when he said he did not have to keep me as a patient. Of course, if I call the carrier, and they take it up with him, he will know it was me. Moreover, they will probably drop him. Then  I would not have any coverage to go to him at all. So I really am sunk, right?

Navigation

[0] Message Index

[#] Next page