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What is the protocol?
Old 06-16-2019, 11:49 AM
  #1

Part 1: My friends's son is seeing a therapist. He's in network so that means the co pay is 15 Dol. The therapist is charging him 50 because he says that GHI doesn't pay enough.
Part 2:Therapist recommended a psychiatrist so he can get ADD meds. Psychiatrist is out of network so he's 300 dollars. My question is how often should he see the psychiatrist being that he still sees the therapist. The psychiatrist is the one that can write a prescription for meds...should he return once a week, month, 3 months...what's normal?


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Old 06-16-2019, 11:55 AM
  #2

My guess on the copay... have them call their insurance. The therapist could lose her place with the insurance, but I donít doubt that they get paid less accepting insurance. He could end up with having to choose another therapist that he might not get with. Gotta consider that.

The psych will want to check in initially to see how meds are working. Probably two weeks to a month. Once they have meds that work, he could back it off, but they have to be seen at least yearly to continue writing the script.
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Old 06-16-2019, 12:01 PM
  #3

The copay thing is unethical. It’s like double billing. If the therapist doesn’t like the payout from the insurance then they need to not take that insurance.

As far as the psychiatrist goes when I refer clients for meds I want to continue to see them as usual and expect that the psychiatrist will see them pretty frequently for the first 4-6 weeks until meds are stabilized. Then ideally I’d like them to check in with the psychiatrist bi-monthly. This however is often determined by the insurance company and I have so say. There should also be an ROI in place so the therapist and psychiatrist can speak about the case as needed.


(Also I am a therapist)

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Old 06-16-2019, 12:03 PM
  #4

Part 1-- I believe that is unethical. If the therapist accepts that type of insurance, they accept the payment they receive. Private practitioners can determine whether they accept insurance and which insurance types they will accept. They know going into it what they will be getting paid from insurance. Group practices have that decided at the group level, but the "rules" should still be the same. Licensure can be pulled for unethical practice. I agree they should check with their insurance and verify what the out of pocket payment should be.

Part 2-- In my experience, meeting with the psychiatrist for med management vary from once every few weeks while they tweak the meds to once every 3-6 months for maintenance. The psychiatrist will typically set a schedule based on how their appointments are going. "Normal" depends on the needs of the individual.
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Old 06-16-2019, 12:11 PM
  #5

Thank you for the quick answers. That all makes sense. As for #1, her son really likes the therapist, so I think he's just going to pay the 50 dollars. (Better than 150 dollars I guess. ) I'll relay this info to my friend. Thank you so much!


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If the therapist is on contract with the
Old 06-16-2019, 12:22 PM
  #6

insurer, then he is essentially committing billing fraud. I would report him.

Second, I would not take my kid to see a crooked therapist.

Third, if the psych is out of network, the insurance company may have another psych he can see in-network. If the psych won't accept the insurance company's out of network copay, then he is also crooked.

GRRRR. I hate the medical profession in all its sliminess. And insurers. Hate them, too.
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Old 06-16-2019, 02:01 PM
  #7

FWIW, I can't speak to number one but I can to the second concern. I take ADHD medications and have for some time. After the initial diagnosis and medication adjustment (through the psychiatrist), I now have them proscribed by my regular doctor.
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Old 06-16-2019, 06:15 PM
  #8

I agree with calling the insurance company. The therapist charging more does not seem right. We have never had to pay more than our copay for an in network doctor. Another therapist may be the only option. Can they see a different psychiatrist, one who is in network? That seems like a very high fee to see that doctor. We switched psychs a lot for DD because it was so hard to find a good one, but when we went out of network and paid out of pocket it was still never much more than $100. As to how often they need to see the psych, usually within a month to 6 weeks after starting meds, then usually about every 4 months or so.

Nancy
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