Therapy Stress Causes Shutdown

Apparently there was some sort of billing change with most insurance companies and it changed how my therapist bills. In her bill for January she charged me twice for each of my five visits: once as an office visit and once as medical services. Her explanation for the medical is that we talked about medical issues like eating issues, migraines etc.

I cannot adequately express how angry this made me. Especially as with the migraines, she did nothing to treat them. I have a doctor who treats them already. I mentioned them casually and she asked me how often I had them etc. and she made some notes for her records. How is that a medical service?

Because of her new billing she submitted charges to my insurance company for January totalling more than $1,160.00. She expected my insurance company to reduce some of it but what they did was deny some of the charges which means that I have to pay it.

The result of this has been felt throughout my internal system. My husband and I both know that we can’t afford her new billing. She says that January was unusual and wouldn’t be the norm but I now feel as if I have to guard everything I say. I dare not mention a headache or anything else for fear of being charged for a medical visit as well as an office visit.

The other consequence is that because I feel that I may no longer be able to see her, my system has shutdown. There is too much fear that issues surrounding my uncle are no longer safe because we may not have anyone to talk to.

This situation is causing an extreme amount of stress. My heart starts beating faster, I get very angry and I’ve lost my connection with the rest of my “selves”.

I haven’t seen her since the billing was processed but will see her next week. The possibility of confrontation and/or stopping therapy is really messing me up.


About CimmarianInk

Abuse Survivor Diagnosed with Bipolar Disorder PTSD and Dissociative Identity Disorder (DID) also known as Multiple Personalities
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23 Responses to Therapy Stress Causes Shutdown

  1. Freasha1964 says:

    Oh, CI, I am so sorry to hear this. How agonizing it sounds, the choices you face. I would feel betrayed if this happened to me, especially if she is the one who has final say on how the billing goes. I am relieved that you will see her next week, and as always, I agree with the parts of you that are in favor of discussing this in depth, and telling her everything you feel and all your fears. In the past, it seems to me that when you have confronted her she has handled it very well and respectfully toward you and it even has put you two closer.

    • CimmarianInk says:

      Hi Freasha,

      Yes the conversation has to happen but the possibility of loss is higher. She says billing requires two codes because they aren’t just therapists but medical practitioners. I’m so nervous that things won’t work out.

    • twistedcharlotte says:

      Hello. I’m new here so first time post. I’m from the UK so things are quite different here, so please bear with me.
      The intro to your message says that ‘it is a billing change with most insurance companies’. Is it possible for you to be able to change your insurance company to one that does not bill in this method?
      Also, is your therapist a psychiatrist or a psychotherapist? Psychiatrists are medically trained hence being able to prescribe medication, whereas a psychotherapist is not. I’m probably reading this incorrectly, but it sounds that is they ask you about any headaches you are charged for (a) her mentioning them and (b) you answering her.

      You need to bring this up in your sessions and you need to make sure it is the first thing you say to her. This is really a ‘mickey’ take in the first in charging someone who is mentally ill double for being two different ‘medical people’. I’m appauled by this method of ‘mental health care’ because it isn’t because it is causing you more and untold stress.

      I know it sounds as though it is late in the day but is there no possibility of you being able to change therapists at all, to one who does not charge how they do? I know how difficult it is to find someone you like let alone feel you can trust, but this person is now beyond the latter.

      I apologise if I have this all wrong as the US an UK mental health laws &c. are different.

      Sending warm greetings at this time.

      Cee Jay
      P.S. I’ve listed your blog on my new WP site: twistedcharlotte.

      • CimmarianInk says:

        Hi Cee Jay,

        Welcome and thank you for commenting. 🙂

        To answer your question my therapist is a Nurse Practitioner which means that she is not a doctor, however she can prescribe medication. However, she does NOT prescribe *my* meds as I have a psychiatrist who does that. All she does for me is therapy.

        The issue seems to be in her understanding of her medical responsibility towards me. She believes that because she sees me weekly it’s her job to ask questions and observe how I seem and therefore the new code changes must be used.

        She actually said she doesn’t have a choice in using the new codes. I think she believes that and she really did try to submit lower charges for February.

        I will be altering my visits to twice a month to control how much I’m charged until the insurance companies fight back to get the codes changed.

        Thanks again for commenting!

      • twistedcharlotte says:

        Hello CimmarianInk
        Thank you for adding my response and for replying.

        I have what appear to be a stupid question, but as I said I’m from the UK and things like this are different.

        You said you have a psychiatrist who prescribes you your medication and the nurse is for your therapy. Why does your psychiatrist not see you for your therapy? In the UK both are undertaken by the one person, in this case the psychiatrist. I’m just asking as the mental health system appears to be so much different I’m just trying to figure it out in my head. I hope you don’t mind the questions as I don’t mean to intrude and/or be personal.

        I *love* your blog. In the UK we have a mental health charity called MIND ( and they issue a free magazine 4 times a year called ONE IN FOUR (that 1 in every 4 people will have a mental illness of some kind), and in one of the issues there is an article on mental health blogs and blogging, and your site was listed. I’ve only just found it so am reading your previous posts from the start. I like how you write and what you write. I’ve started my blog for me so that I can see what has happened in my life and is continuing to happen. You are actually my inspiration :-).

        Thank you.

        Wishing you well with a hug.

        Cee Jay

      • CimmarianInk says:

        Hi Cee Jay,

        That’s awesome that you’re going to use blogging for your own journey. It’s been essential for me. And thank you for the compliment!

        To answer your question, in my case my psychiatrist does not do therapy. He is strictly medical and manages the medical aspects of my mental health as well as how I’m doing mentally in depth. He’s the one who prescribes my medications. He handles things when I’m depressed or manic or having other issues. He delves to find out why I’m having problems but not in a therapy way.

        My therapist is just that, a therapist. She’s for talking things out and my psychiatrist referred me to her for that purpose. She is the one defining her role and I disagree with her understanding.

  2. Karen says:

    My God! That’s outrageous! How dare she charge you over the casual mention of a migraine?!

    I’m not surprised you’re angry and anxious. What a horrible and completely unfair situation. Is there any sort of consumer rights organisation or something you could approach about it? I’m probably clutching at straws, but this is just not right. You shouldn’t have been put in such a position.

    Sending safe hugs to you hun ❤ xxx

    • CimmarianInk says:

      Hi Karen,

      She says that because they aren’t just therapists but medical practitioners that they have to use different billing now. She wasn’t sure what would happen and I can only hope that she can re-bill. If not…well I can’t even think about it yet. Thanks for the support hun.

    • CimmarianInk says:

      Oh I should add that apparently discussing my eating disorder was medical even though it’s a psychological illness. 😦

  3. kat says:

    Oh, that is awful! I can’t tell you how much I stress when I get EOB’s, especially for my therapy appointments. And mine don’t even double bill. I think that is not really kosher,to double bill like that. Call your insurance and tell them you only had one appointment for each of the days and you don’t get medical services from your therapist. Then it will be between your insurance and therapist. Every time you get a ‘wrong’ billing, call and say the same thing over. Eventually it will get settled and most likely you won’t have to pay for services that couldn’t be given by a therapist, and also for double billed appointments (I think this is really fraudulent…you have a strong leg to stand on here). But anyway, don’t argue with the therapist, just keep telling your insurance it is a) double billing and b) billing for services not rendered. You’ll get worked out. And take notes of date, time and person you spoke to. This has helped me immensely in working out this kind of thing. So sorry you have to deal with such a stressful thing. Stick it out and it’ll work out ok.

    • CimmarianInk says:

      Hi kat,

      Insurance is so stressful! I’m more freaked about my appointment because I have to see if she will rebill it on her end. Not looking forward to it. Letting the insurance company handle it is a possibility too if she won’t.

      • JuliesMum says:

        I think pushing it back on the insurance company is a really good idea. After all, they will be interested in keeping down the bill too! They may not have thought through the consequences of changing their billing system, and they may want to issue new more sensible guidelines. It does sound, I have to say, as if your therapist is being greedy in billing twice. If you have (or someone else has) agreed a rate with her in advance, then she is not playing by the rules to change it after you have seen her.

      • CimmarianInk says:

        Hi JuliesMum,

        Yes I was considering talking to my insurance company about this. The whole thing became so complicated and exhausting that I just paid the bill but I will be changing my sessions from weekly to twice a month to keep the payments in check.

        It’s not ideal but it’s possible that when the insurance companies see how much money they’re losing, they’ll fight the code changes.

  4. Bourbon says:

    I’m not surprised you have all shut down. Ideally your therapist should have actually discussed this with you before just going ahead and double billing you; I mean it obviously affects you and your therapy sessions if you’re going to have to start paying and the shock could and should have been completely avoided. I’m sorry that your therapist has let you down in this way; I hope you can talk it through with her when you next see her.

  5. Natalya says:

    Your therapist should have let you know she would be double billing you. It’s totally unfair to expect something like that to be a non issue. It also seems greedy to double bill when all you did was casually mention your headaches and eating disorder and received no treatment for them. That just stinks! I’m upset for you. Stuff like that happens all to often to the people (usually) least able to cope with it. I hope you’re able to sort out something that works for you because it really isn’t fair for you to have to start over with someone new over it.

    • CimmarianInk says:

      Hi Natalya,

      I agree with you, she should have told me and I’m very upset by this situation. I can’t even think about starting over with a new therapist yet. Therapy shouldn’t cause unnecessary stress. Thanks for listening. 🙂

      • Natalya says:

        I don’t blame you. That would upset me too. Also, I don’t like switching therapists either after I have been working with someone for awhile. Good luck 🙂

  6. castorgirl says:

    Hi CI,

    I agree with the other commenters that she should have disclosed to you prior to the billing changes, that those changes were happening. She also need to define for you what will be described as a medical vs psychological billing – as both migraines and EDs have a psychological aspect, so I’m surprised that she considered them billable for medical, considering the lack of medical attention she provided.

    I hope you’re able to talk this through with her, and have clear boundaries about what is going to happen with your bill.

    Please take care,

    • CimmarianInk says:

      Hi CG,

      This situation has me almost paralyzed by stress. I may lose her as a therapist and I may insult her. But I’m also extremely angry and feel betrayed. I feel like her billing is dishonest, probably not intentionally but I feel like she lied about services she never provided.

      And this is only January’s billing. She just submitted it and we still have February. I’m not handling it well but thank you for understanding.

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  8. JJL says:

    CI, having gone through some similar issues in the past, I can imagine how betrayed and vulnerable you must feel. I hope this resolves itself when you next see her. If not, and this NP is in network, you should get the insurance company involved. That’s what ended up helping me straighten it out with my shady psychologist. Also keep in mind that she needs your informed consent for any medical treatment. Doesn’t sound like you gave any consent let alone informed consent. Hang in there!

    • CimmarianInk says:

      Hi JJL,

      She’s out of network but my insurance has rates for those providers as well. I’m hoping the insurance companies change the codes back.

      It’s a real shame when money affects therapy and trust.

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