Question for those who do psychodynamic/psychoanalytic therapy

I’m not really sure. I can say that I’m pretty accommodating and I’m comfortable in that role. Right now I feel like I’ve stepped out of that role and would like to get back in it. I don’t want to have confrontation over something that, after some reflection, might be sort of petty. Do I want to feel special or important? I guess I do, but not sure it’s a necessity.

It's interesting that you are so concerned with a hypothetical, enough to email him. Do you have a current therapy plan?

Thinking about this, I noticed that when I think about it from a 'no show' or a cancellation due to ambivalence mentality, there is a desire for my T to hold my space. There's even a sense of wanting my T to spend that time thinking about or working on things related to me. I'm paying for the hour after all. I'm sure this has something to do with desire to feeling or perceive my importance in someone else's life.

Given that your T has a 14 day policy, I'd agree that emotions change a lot over 14 days. So, it would make sense to want your T to hold the spot in case you changed your mind. It could also lead to more waiting until closer to your session before declaring your absence; which in and of itself is another big ball of things to explore.

When I think about it from the perspective of logistics, there's not so much of a need to have the time held for me and feileacan's comment about there being a lost hour regardless if it is at my time slot or someone else's, makes sense. I'd say that if a T was able to book their schedule in such a way that someone was seen in all time slots, then they shouldn't charge you as I feel it would be unethical to double charge for an hour. I could see this if someone needed/wanted an extra session of the week rather than a move of schedule.

Thanks for your thoughts. Elio. I sort of hate to admit it, but you may be right about my wanting him to think about me. I can’t remember for sure, but I thought he once said he would do that during my time (maybe just for a minute) if I wasn’t there and I quite like it. When I acknowledge feelings like this, at some point, it makes me want to no show or cancel because I’m aware that it’s also kind of ridiculous (or young?) and I don’t want to have ridiculous thoughts and no showing or cancelling is a way to stop that behavior.

Here’s how my T explained his whole 14 day cancellation policy. He said he’s had this policy for 19 years and he does it because it protects himself but also because he does “depth work” and sometimes things get stirred up in session and a client will leave the office saying “I’m not coming back.” With the current policy, they’re a little more likely to come back and talk which he believes is better for them. He said something about there being more of a container. Regarding giving someone’s set spot away, he said he doesn’t see many new clients. He sees people anywhere from 1 to 4 times per week and he implied he doesn’t have a lot of openings. If someone has to cancel unexpectedly within less than 14 days, he will offer them another spot if available and not charge them. He did say that he has decided not to ever offer any of my spots to another client. I replied that when I’m on vacation and when I cancel well in advance he should definitely give my times away and I don’t always want him to save my time to which he smiled and said, “no, of course, you don’t want any special treatment.” When I cancel on short notice, then change my mind, he said he completely understands that my desire to cancel was genuine and that it felt good to express it because it gives me a sense of control. And it’s ok to change my mind.

It's pretty common practice that if you don't cancel an appointment within the cancellation policy, you are charged for the appointment. It isn't just a therapy policy. I've seen the same policy with medical doctors. Typically, you sign a billing policy agreeing to the cancellation policy. What they do with you time slot if you don't adhere to the cancellation policy is up to them.

Yes, thanks. My concern wasn’t being charged tough. I really have no intention of trying to get out of paying. My concern was more that if I’m paying for the appointment, can he give it to someone else? In the type of therapy I’m doing I have the same set times every single week, and it’s essentially like I’m renting that time from him. If I give at least 14 days notice, then I do not pay, and I give up my time and he can do whatever he wants with it. But what if I cancel with less than the agreed amount of time I still pay, but can he give it to someone else? I‘m learning that it’s probably a more complicated topic than it seems.

I had to think on this one a while. I'm still not sure what my conclusion is, but I think that's in part due to an awareness of my own hypocrisy. As stopdog said, most people who find themselves able to take advantage of a situation where they can collect both a fee for a cancellation while also making money by rescheduling someone else into a timeslot will do so. Technically speaking, in the paperwork I have read (not just for therapists but for a couple doctors as well), the money charged is termed a cancellation or no-show fee, they don't say you will be charged for a session (in the ones I have read). So when you cancel, you are then paying for a different product, even if the amount is the same. You aren't paying for the time anymore.

Does it seem kind of icky to charge a cancellation fee when the slot is rebooked? Honestly, yes, especially when you have a 14 day cancellation window and sessions aren't cheap. At the same time, I have to admit that when I was doing a lot of dog sitting, I had a cancellation penalty. I used Rover and it was automatically enforced, so I couldn't control whether someone was charged the fee even when I got another booking. But I probably would have kept the cancellation fees anyway if I'm being honest.

I don't see why it would not be appropriate.

They typically have a cancellation policy with each client, so if you can't make it, it seems reasonable for you to pay. IF they then manage to get another / new client, then I don't see why it would be unethical for them to have them take - not your slot but the slot you cancelled.

What they do with other clients is their business and none of my concern.

Why should they lose any potential money because of a client not showing up.

I think the issue is more the possible double-dipping financial--getting a cancellation fee from a client PLUS booking a different client in that slot, so getting double the money.

Yes, this is it. Although the way he explained it is the way feileacan suggested, I think. He is not putting a new client in my spot, but would offer it to an existing client who just can’t make it to their usual time that week. I’m probably ok with that, I guess.

I am also one of those who thinks such a long cancellation policy (two weeks, even one week!) is utterly unfair and only makes sense from the point of view of a greedy and perhaps lazy therapist. Everyone can get ill suddenly or experience other emergency, I absolutely don't see why that is not respected. If someone does that repeatedly/frequently then it's a different issue, but paying for something that is completely out of your control and realistic responsibility? Why? Most jobs also allow a reasonable number of unexpected/unplanned sick and personal days.

In any case, I personally would not care at all if the T made double income from a spot, it is not my business to think about whatever does not affect me after agreeing on a policy pertaining to my participation. But I had the opposite a couple times with my psychoanalyst: when I cancelled late, that meaning less that 24 hours, I was charged but he let me submit the sessions I did not attend for insurance reimbursement because I was actually billed a normal fee. No clue if he ever scheduled other clients for those times, never even occurred to me to ask. Honestly, in my private business, it happened that the client was billed for chronic late cancellations (less than 24 hours) and I filled the time with other paid work.

Isn't that medical billing fraud (on both your parts)? Insurance does not pay for services that are not rendered. I assume there was a billing code that was submitted that made it seem like a session took place.

Yes. I just shared a situation I was involved in and how I feel about these things. Not suggesting it is not fraud. My other T was doing tax fraud because he made me pay cash and didn't report part of it while I still submitted all sessions for reimbursement, so he took the risk of providing the invoice. He does that with a number of clients, he told me, as well as some clients refuse the cash payment. I have no clue why he had to tell me those things, perhaps because it was kinda obvious that he says on website he takes credit card or cash and straight asked me for cash when I requested a reduced fee. I am sure all of this is common. I don't think these guys are saints, including insurance companies.

I would actually be curious as to the exact law on making double income and billing insurance for a session that didn't take place but the client was changed. Does anyone know?

I don't think there's a law against the double income, just the part where insurance is paying for something that isn't happening. There's no law saying they can't charge the session fee as a cancellation fee to the client, then charge another client for that same timeslot.

I don't know the specific section or statute, and individual states may have additional legislation about this on the books, but HIPAA specifically makes health care fraud a federal offense with a minimum term of 10 years (I think that's just for health care providers), believe it or not. You might look there for some details. Otherwise, I'd say a provider providing any sort of documentation and signing off on it that a certain billing code was provided when it wasn't would be fraud that doesn't really need to be specifically codified into its own separate law to make it specifically illegal because it is by definition fraud.