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rhyl

Really Angry And Really Upset

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I have a psychiatrist that I've been seeing for 15 years or so. He used to have private practice (or one where he was a partner with a few others) and then about 2 years ago he was offered a job as the medical director of a newish mental health facility. I followed him there. Billing practices were a lot different at the new facility. When he was in private practice, they were pretty understanding about late payments. They sent notices, but never sent you to collections. The new facility sends you to collections after 90 days, I think. My psychiatrist joked about it once, saying that they just don't like to have to deal with old, past payments in billing and basically want to get the stuff off their desks. (I actually didn't find that funny, but figured he wouldn't understand)

I've had a lot of financial issues in the last 2 years and have had problems paying my bills on time. They always eventually get paid, but a few have ended up in collections. I've also, though, had a lot of trouble with the billing department. For example, I sent in a payment for $100 in February. A couple of weeks later, about 5 days after my appointment, I got a bill from a collection agency for $100 dated for the date of service for the appointment 5 days prior. That made no sense. I hadn't even gotten a bill for it yet. And, I'd already paid the past due $100. So I called the facility and the girl there said they had gotten the $100 but hadn't applied it to the old payment because, "oh, that's just too hard," so they applied it to the payment for the appointment, which hadn't even gone through the insurance yet. So they attached the wrong date of service to an old debt. OMG.

So today, I get a certified letter from my psychiatrist and he says he has found it necessary to "terminate our professional relationship" because I'm having trouble reconciling my balances and he's assuming the services they are providing me are too much of a financial burden for me. This is totally out of the blue. We never talked about it, he never called, just sends a ******* letter. After 15 years.

It is so hard to treat my depression, and he has always been so patient and persistent in doing so. I can't start over, from the beginning with someone else. I am so mad. I feel so...disregarded. Like I wasn't important enough or my feelings weren't important enough to give just an ounce of consideration to. He knew that I've lost therapists 4 other times in difficult ways and that I've had trouble dealing with that. Why would he do this to me???

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I would definitely call him - this doesn't sound right. I wonder since it is a more formal office now if someone just prepares form letters and he signs a pile of them without really looking at "who" they are being sent to. Your 15 year history is worth fighting for. There must be some misunderstanding/oversight...

Edited by Thimble

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I have to say that the same thing occurred to me on reading it and I agree with Thimble. It's possible this is truly him but from what you describe it may very possibly be them. I do truly hope so for your sake. It is so hard to build trust and always has long term impacts of future treatment. An appointment to discuss it or a telephone conversation at the very least would be the correct way to break it off. I also think it would be wrong to do without some warning ahead of time to give you a chance to change things. It doesn't sound like he has addressed this with you in the past. A "we will have to consider if you can continue with me if you cannot afford the services" would have been better if he thought it could come to this. I think it's a certainty they are laying down the law with him but he needs to get up the courage to deal with it directly with you if that is the case. Its possible he knows nothing about this though.

Truly sorry as it must be beyond devastating.

Edited by Fizzle

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Somebody else said that, but it doesn't read like a form letter and he really is too careful for that. I don't think I could talk to him again...I'm way too angry for that.

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Oh dear. If that is the case then I think he is a total coward on top of being unprofessional.

Could you write him a letter? I would see what you can get from this that will help you hereafter. What would help to minimise the damage?

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Oh dear. If that is the case then I think he is a total coward on top of being unprofessional.

Could you write him a letter? I would see what you can get from this that will help you hereafter. What would help to minimise the damage?

I definitely want to write him a letter. I also want to write a letter to someone at the facility above him. Problem is, he's the Chief Medical Officer. That pretty much means I have to go to the Board of Directors. But I've been thinking about that, and that might be a good thing, because I really believe it's a problem within the facility.

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I feel like that is really horrible what happened to you. I would be so angry too. I think your anger is justified. A letter might be good for you to write. At least you would have a chance to put your feelings on paper.

From what you wrote, it seems their billing practices are really done poorly. Anyways, sorry you have to go through this.

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That pretty much means I have to go to the Board of Directors. But I've been thinking about that, and that might be a good thing, because I really believe it's a problem within the facility.

From what you have said I agree. It seems the problem is pervasive and the whole place needs to be shaken up. If you manage to do this then you could be helping others. And giving yourself a sense of being empowered again.

I hope you manage to find a way to keep this from affecting your ability to get help - as much as is possible.

Edited by Fizzle

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I'm still having a really hard time with this. Thanks everyone for your support. I did write two letters today - I have one more to write. I made it through the day without crying (until I got home), but now I really feeling like c*tting. I was doing some searches online for other psychiatrists and found one who was even worse - he spells it out on his web site that if you are "high maintenance" - and he defines that, in part, by saying it includes people who don't pay their bills immediately - then you shouldn't even bother calling for an appointment. I don't get it. I mean, I know that doctors need to make a living just like everybody else, but do they have to be so cruel about it? No wonder people with mental health issues aren't getting the treatment they need. Charge them $200/hour then demand immediate payment. Guess what? Not everybody can pay that. It makes me want to scream.

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I am so glad you are writing the letters and that your voice will be heard - I hope your psychiatrist will surprise you with his reaction/response and that he will fight to save the relationship with you ...fight to keep you. I am so proud of you for standing up regardless. And I do believe there are other psychiatrists out there for you that will be able to help you and that aren't solely financially driven and can be flexible in terms of payment.

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Rhyl, I can't believe this happened to you!! I've lived in fear of this happening with my psychiatrist. The office he works at, they constantly have billing problems, you don't see one person come in wihout them having a surprise billing issue! I constantly live in fear because you aren't ever allowed to directly speak to the doctor, so how would the doctor know if the office dumped you?? I'm always scared to get on their bad side in fear that I will recieve something like you did. You would think that a psychiatrist office would have more gentle and empathetic people working there, NOPE. There are some of the meaniest and nastiest people I've ever ran into at a doctors office.

This is why I've really truly lost all of my faith in the mental health system. I've seen WAY more damaged being done because of them.

Rhyl, please don't hurt yourself, I know how these things can trigger that inside of us. There's this sense of betrayal and hurt that is on such a profoundly deeper level, you've come to know this person, and they know you so well, 15 years!! Of course this is going to hurt DEEPLY. They can't just send you a letter and suddenly it's done with. I really think it's the office that sent it and not the doctor. In my doctor's office, he's oblivious to half the stuff the receptionists and billing people are doing. It's so sad. But please don't harm yourself, I know it's so hard, but we are here if you need to get out the emotions! *HUGS*

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You did an amazing job by writing the letters and should be very proud of yourself. I often freeze up when upset. You are speaking up for yourself and that is important. I hope you get some sense of empowerment from it.

Lets hope that this incident will lead to a different door opening for you that helps you with your recovery. Sometimes bad things result in good later down the line. One step at a time is the way to go.

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Trying very hard to move in a forward direction, but finding that we are now losing trust in everybody. I was doing so much better; I find it really disheartening that I can't hold up through this...

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Don't be hard on yourself. Any one of us would have great difficulty in a situation such as this. It's normal.

Many people are trustworthy and this bad act from this pdoc doesn't negate all the good things you and he may have achieved in the past. It doesn't mean that he hasn't cared about your well being.He messed up big time and the shame is on him.

Sometimes it helps me to write out all the positive interactions or relationships I have when I feel I am sinking into pervasive distrust. So that I can refer back to it and try to bring myself back again.

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Thanks, Fizzle. I sent a letter to him in response to his letter last night. Basically told him I thought his actions were unprofessional and unethical and I was disappointed that he was unable to discuss the whole situation with me before terminating in such an abrupt manner. Esp. after such a long time. I tried to remained reasoned, although I think I may have said that, when we start seeing patients and their suffering as dollar signs and not as human beings in need of compassion, maybe it's time to quit. :p I didn't say what I wanted to say, which I can't say here, either, because it's *really* not nice.

I called the center yesterday morning to check my balance. $58.58. Wow. I hope I didn't bankrupt them. I paid it, in full, so I'm at 0.00 now.

I don't know why everything has to be so hard.

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I hope you write out a letter and say everything that you really want to say! Let it all out. If it's mostly 4 letter words that that's perfectly OK. Then maybe burn the thing and dance around the fire!

I hope the letter makes him think. I have to say that I am taken aback by the $58. I guess it is possible that he has his own issues. That isn't any excuse for not being human with his patients though. I have to say that the way it has been handled is bizarre as well as being unprofessional.

Professionals are taught to see money in terms of boundaries. Both when it comes to treating their patients and when it comes to managing themselves. A psychiatrist who isn't able to discuss the issue early on directly in appointments shouldn't be practising and it probably is time for them to retire.

If he is in burnout or something similar then it is better that you are with someone else anyway.

Try to keep hold of the good as well so that you don't loose all trust.

Edited by Fizzle

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I once was told that if you send a certified letter that the person addressed is the one that has to reiceve the letter. I'm not sure if I'm remembering this correctly, but it would be worth a shot to send a certified letter!

I still think this was beyond messed up an unprofessional. I can't say enough how sorry I am that something like this had to happen to you. You clearly don't deserve such treatment. I honestly have started to lose more and more trust in the mental health field. I hear so many horror stories, and been through my own. I can only imagine the pain you are feeling, I don't know what it is, but therapist/psychiatrist have a way of making a normal painful experience feel a million times worse...

Keep us updated on everything that happes. And you are such a strong person, we are here for you!!

Edited by Bring Me To Life

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Really suicidal today. Besides the psychiatrist thing, I'm having a lot of money issues and I called today to see if I could set up a payment program to pay off the balance on my credit card. They wouldn't, and referred me to a credit counselor, someone my brother has seen and had a lot of trouble with. In the meantime, the bank is pushing for money by Friday to at least pay my current payment due (which I don't have and I told them that when I first called), and they won't do anything with the account until I work something out with someone else.

I have a ton of bills. Medical, a couple of credit cards, normal basic stuff. I guess I don't have to worry about the stupid psychiatrist anymore. I'm gonna stop the a-d, probably some other meds. I am so tired of it all. I just don't want to do it anymore. I don't know who to trust, I'm afraid to talk to anybody. My therapist seems to get it, to understand, and to want to help, but I don't know if I want to even continue with him.

There's just too much, you know? It's all so overwhelming.

rhyl

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Rhyl. That sounds very hard. I'm afraid I'm not much help when it comes to debt and what to do.

What I will say though is please don't think there is no way out. What I have realised over the years is that there is always a way forward. It is usually far from ideal but it is an option nonetheless.

Many many people have been in severe financial difficulty and have still built a life back up afterwards.

I know what it means to have mental health issues and to have to deal with big stressors. It is very far from ideal and tends to set things off. Do try to take one small step at a time though as it is astonishing where we can get to by doing that.

Do do all you can to get yourself to stay open with your therapist. Your hypervigilence is likely to be up and that tends to make us want to throw the baby out with the bathwater. When like that I try to recognise it for what it is - a purely reflex reaction where my brain thinks its protecting me when it isn't appropriate. it sounds like your t is cares about you and is a good therapist.

There are people who love and care about you and there are many good people in the world.

I hope today went OK and you found a solution of sorts. Let us know how you are doing.

Edited by Fizzle

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Still not doing so good today. Got sort of a response from my pdoc's office to the letter I wrote - they returned the medical authorization I enclosed and included their own, so that I can have my records sent to my therapist. That tells me two things. The letter he sent was not a mistake and he truly doesn't give a about me; all he cares about is the money.

Been thinking more and more about dying today. While I know that moving forward is a possibility, I'm just really not all that interested anymore.

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Rhyl,

I don't defend his conduct at all as I think it is shocking and unprofessional the way he handled it.

I don't think it necessarily means that he has never cared about you though. Sadly professionals are just human. He may have his own issues around money (not saying he doesn't have any money and rather mean it in a different way). That doesn't change that what he did was wrong but I don't think it is a definite at all that he never cared and was only in it for the money. In fact I think its unlikely.

People can feel like their boundaries are being trodden on if they are not paid and that can connect to many feelings. He also was not direct about this in his sessions with you which is not only the main thing that I believe is not professional but again hints at something else going on that is about him and not you.

Bad SI does pass eventually. You wont be seeing things clearly in this regard at present because you are hurting a lot - we never can when "there" - so I hope you manage to hang in there a little.

Edited by Fizzle

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Ok, so it's been about a month and I thought I was doing better. Well, I guess I *am* doing a little better; I'm not crying all the time anymore, and I'm talking to my therapist a little - it isn't as hard to trust him as it was. But I'm still desperately sad and angry about my pdoc - I was on my insurance web site last night, looking for eye care providers and I decided to look for psychiatrists just to see what was out there, and I ran across his name and photo at one of the local hospitals. All I could think was that I'm *not* going to be able to make an appt to see anyone else - the idea makes me physically ill. I think it's because of the trust issue - if I was with him for so long, and he terminated me with so little care, then how can I trust anyone again with any personal, private information?

And now, my therapist thinks I should go to my family doc for the Prozac, but I *really* don't want to do that, either. I have this really awful, horrible sense of being controlled. It comes from a lot of places. Past stuff. I don't know how to get over it.

I know I need the Prozac, but I don't know how to get rid of this feeling. And I know the Prozac is going to stop working eventually, because that's what happens. Then what? I can't trust my family doc to prescribe something new, because he doesn't routinely prescribe those drugs, my depression is hard to treat, and I've been on a lot of different things.

rhyl

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I think its the most normal thing in the world to still be terribly upset and angry. Whats really good is that you have kept up with therapy and are starting to trust more again.

I won't make any pat comments about trusting someone new. I have too many trust issues of my own. It seems to me that trust is often just gained by doing and having that connection play out with others. When I try to think ahead about how it can be possible then I am overwhelmed. I try to take very small steps and hope it changes as i go. The unfortunate thing of course is that without your meds things are not going to be easy,

Whenever someone betrays my trust or I feel they have, then past stuff always comes up for me and I think it is that above all else that makes it so complicated and hard. I would react exactly as you have. If you pull this apart a bit then the truth is that noone is trying to control you. Your pdoc probably behaved disgracefully because of his own stuff and your t is just concerned and cares about you, You are an adult now and you have many options open to you. This one door is closed and although it feels to you that all others are too at present, there are many open doors for you to choose from and many reliable people in the world. You may even end up with someone more suitable. I find as I have more experience I have more knowledge of what I need and how to get it.

You can do this.

Edited by Fizzle

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Thanks, Fizzle. You, of course, make complete sense. :-) And I, of course, don't believe a word of it. LOL I know exactly what you're saying. I mean, in my head, I know what you're saying. But I just can't feel it. Everybody feels dangerous. In some sense I feel "controlled" and in some other, weird sense, I feel "used." It feels like it will never, ever get any better. I was thinking today that I'm just so tired. It's always one thing right after another. And even the in-between things really aren't worth getting out of bed for.

When will it all just stop?

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