Sorry, my friends, I am here to rant today because I simply don’t know what else to do. I feel like I’m about to crack. My husband is tired of me talking incessantly about the insurance snafus so I don’t want to burden him any more. Ordinarily, if I cannot make sense of things after speaking with him, I visit my therapist to air out my concerns; however, because I have more-than-valid reasons that there’ll be yet another problem trying to process the claim should I schedule a session, I refuse to go. My husband says the whole thing is simple and doesn’t understand why I continue to lament the situation when it can be so easily solved. “Just go to someone else,” he told me earlier today, “Or pay them their hourly rate and get the help you need.” As much as I’d love to follow his advice, there’s a slight problem. Number one, ‘just going to someone else’ is a lot more complicated than it sounds. Number two, we don’t have the means to pay $108 per session 2x – 3x per month.
I wish I didn’t have to ‘claim’ or ‘acknowledge’ mental illness as part of my make up, but I do. It is one layer of many. Because of my depression and anxiety, I require ‘therapy’ to navigate this world. I’ve been going to therapists for 34+ years. Starting over again with someone new is unthinkable. It makes me shudder. I’ve been battling insurance providers for years in order to see qualified therapists and they don’t make it easy. The last therapist I saw was pretty decent and I met up with her a handful of times for therapy but I reached my breaking point and completely stopped going when her billing person couldn’t seem to understand the complexities of processing claims through Tricare and sent me an invoice for an outstanding balance in excess of $600. I had to go through all the same B.S. I am currently going through, repeatedly calling Tricare and then relaying that information to the billing person to assist her with ensuring the claims were processed and paid, which they eventually were.
As a client and/or patient, I don’t think that should be my role. In a perfect world, I should be able to simply walk into the office, pay my copay, spend an hour with the therapist (working on understanding and overcoming the latest hurdles in my life), and head home afterward (or run errands or take a walk or do whatever the hell I choose with my time). As things currently stand, it seems like for every hour I spend in therapy, I spend 3-4 hours and/or (in this case) several days trying to straighten out the insurance and billing matters. It’s like taking one step forward and two steps back. I am grateful I have not experienced these same challenges when it comes to processing claims for my medical care. It makes me gun-shy to schedule an appointment, when doing so inevitably leads to a huge hassle finding (or fighting) my way through the billing and payment labyrinth once it’s all said and done.
As grateful as I am for having medical insurance because I know a lot of people aren’t able to afford it, I just don’t understand why it has to be so f-ing complicated (for the patient or the physician/provider). With the previous therapist I had, she was ‘newly authorized’ and it was always ridiculous things that held up the payment. The majority of the claims were initially denied because a specific box on the form had not been checked. It was either that, or the ‘referring’ provider’s name was not listed, or the wrong ‘code’ was used. With my current therapist, the insurance provider held up a claim for over a year because the initial claim (which was resubmitted multiple times with the correct info afterward) had the wrong ‘sub ID#’. In fact, my therapist’s name was in the database twice. Under the first ID, she was not authorized and under the second ID, she was.
After speaking with at least a dozen different representatives, one of them finally took it upon herself to see to it that the first sub ID was removed, eliminating any further confusion. How I wish that was the only hurdle! Do you want to know what happened this time? If you don’t, I completely understand. I’m venting and you probably have your own troubles so if you don’t care to read on, I won’t hold it against you. This is the thing. I had three therapy sessions in January. If any of you were following me around Christmas, you know that I was not in a good emotional space. I went days without speaking to anyone because my depression was at an all-time low. Those sessions helped me ‘find my way back’. They were invaluable. And after each session, from what I’ve been told, the billing department submitted a claim to Tricare for payment.
According to the counseling office’s client coordinator, who I had an opportunity to speak with today, the only correspondence or communication they received after submitting the claims was a letter denying one of the claims, stating it was due to the fact the my primary insurance provider was Medicare. That’s all they got. I, on the other hand, got completely different information when I called Tricare. I was told (the first time I called) that the first claim submitted had been approved and applied to my deductible. The female agent also stated that there was no record of any other claims being submitted for the month of January. Let me add that this was after I received a voicemail message and an email from the billing department indicating that their office is not authorized through Medicare and that I am now considered ‘self pay’ and need to pony up several hundred dollars (which nearly sent me through the roof).
The predicament for the counseling office is who are they to believe? I want them to believe me because I’ve invested dozens of hours seeking clarification from the insurance provider and relaying it back to them. And after contacting Tricare again this afternoon and speaking with yet another representative in their claims department, I found out that with the exception of the claim that was recently and errantly denied and returned, all other claims have been approved and processed. Unlike what the female agent told me last week, two (rather than one) of the three claims from January have been processed. I do have to admit, it was a relief getting an opportunity to ‘state my case’ and share the frustration I’ve been experiencing with the client care coordinator today. I kept trying to call and the woman in billing kept intercepting my calls so I continued calling back until I was able to reach someone else.
I have lost faith in her ability to process my claims accurately. Each time we speak, something gets misconstrued. I did share that with their office and indicated that I would prefer that an alternate person reach out to me from now on regarding my account. Anyhow, it was helpful to know that their office received correspondence from Tricare that stated the opposite of what I’d been told. It helps me to understand why they did what they did; however, had they simply called Tricare after they received the correspondence in order to clear up any confusion, none of this would have happened. It would have been a simple misunderstanding and easily corrected. But that’s not what occurred and now I am left trying to figure out what to do next. The only thing that seems logical is to try to select from the scant list provided by Tricare, an ‘authorized, in-network’ therapist who is actually ‘good’ and accepting new patients at this time.
If you have ever sought therapy, the metaphor that aligns the most with that ‘challenge’ is ‘like trying to find a needle in a haystack’. It is no simple feat. It takes energy and courage and resilience to begin once again on that arduous journey that often leads to disappointment. Unfortunately, for all of us with Tricare coverage, most of the really good therapists won’t accept or allow it because of the reputation it has developed by creating so many hoops for people to jump through. Most physicians and mental health providers would rather not bother with Tricare because it’s too much trouble. Several of them have told me so. And that’s unfortunate because people with Tricare are primarily military members and/or their dependents and could really benefit from quality counseling services. I don’t know. I’m so tired of thinking about it. I’m on day 4 and completely exhausted.
As much as I’ve tried to ‘see things from a new perspective’ in order to get past all of this, I’m struggling, my friends. I don’t understand why some things I yearn for require so little effort while others take hard work, dedication, frustration, determination, sleepless nights, blood, sweat, and a lot of tears. I’ve even developed an eye twitch as a result of all of the stress. All I want to do is see a decent therapist, figure out my ‘stuff’, and enjoy what’s left of my ‘borrowed time’. Why must life be so complicated? Thank you so much for stopping by. For the folks that are ‘following’ me, I am grateful for you and the continued interest you have in reading about the variety of things I talk about each day. I’m no poet laureate or anyone with significant credentials to speak of but I do enjoy the opportunity to share things about my life and family or to just make simple random observations. If all goes well and I haven’t run you off, I trust you will return tomorrow as will I.