Let’s say there’s a shrink. Let’s call the shrink Marriette, just for the purpose of simplifying this story. Let’s say that Mariette is a highly paid Manhattan shrink. And let’s say that for a number of years a patient of hers, who I shall refer to here as Zauren, has paid Marriette out of pocket and sought reimbursement from Zauren’s insurance company. Let’s call that plan, Loxford, just for identification purposes.
OK, now, let’s say that Zauren, due to circumstances beyond her control, suddenly has a new insurance company. Let’s call the new insurance company, Flemblem.
Zauren was sad that she was no longer on Loxford, but then she began looking into which of her current healthcare providers are Flemblem network providers, she was delighted to discover that Marriette IS a Flemblem network provider! Oh fortuitous delight! Imagine, after all these years of paying Marriette directly, and through the nose, Zauren could finally experience the joy of having her health insurance company pay Marriette directly!
Let’s say, then, hypothetically, that the next day, Zauren took the train into Manhattan to see Marriette. But when Zauren walks in, Marriette has a surprise for her, and it isn’t a birthday party.
Marriette has a letter in her hand, from Flemblem, telling her that she is Zauren’s provider, and per the contract that Marriette signed with Flemblem, Marriette must treat Zauren under the terms of the contract, which say that Marriette is to be paid by Flemblem, with a copay by Lauren.
Marriette is not happy.
Marriette demands to know why Zauren is no longer a member of Loxford.
“Not by choice.”
Marriette informs Zauren that Flemblem doesn’t pay even close to what Zauren was paying out of pocket.
Marriette tells Zauren that there is no way that Marriette can accept such a pittance for her services.
“I understand. So, why don’t you terminate your contract with Flemblem and become an out-of-network provider the way you are with Loxford? Seems simple enough.”
Marriette tells Zauren that Marriette cannot go off of Flemblem because Marriette has another patient who is on the Flemblem plan.
“I’m sorry…what? You take what Flemblem gives you for this other patient, but you won’t take it for me?”
Marriette offers an obtuse reason for needing to not rock the boat with the other patient. She suggests perhaps Zauren might not mind paying out of pocket and NOT submitting it through Flemblem.
Zauren gets up to leave. Clearly, this is not going to be resolved in this manner, Zauren thinks. Clearly, Marriette is under a legal obligation to take Zauren’s insurance, but she is refusing to do so. But just as clearly, Zauren understands that she cannot MAKE Marriette continue to see her as a patient if she does not want to, for any reason, so long as it is not an illegal reason, which this is, but what difference does that really make when one is being told by one’s shrink that another patient’s needs are more important to said shrink, and that said shrink is willing to make insane and illegal financial demands of her?
Let’s say that Marriette encourages Zauren to stay anyway to talk about the hurt and betrayal Zauren feels. Let’s say that Zauren stays for 10 more minutes and then leaves and takes a day to think about it, and to call her insurance company to ask if a provider is permitted to pick and choose which patients said provider will see on the plan and to ask her patients to pay out of pocket and not submit it through insurance.
Let’s say that Zauren realizes, after a day of moping, that she hasn’t got time for the pain. And Zauren summarily terminates her relationship with Marriette over the phone – by leaving a message – and asks Marriette to not call her back because there is nothing more to say.
Then let’s say that Marriette disregards Zauren’s request and demands a face-to-face meeting. And Marriette bolsters her “case” for a face-to-face meeting by pointing out that Zauren has a history of “executing” relationships summarily, and this is just another example of that sort of pathological behavior.
Finally, let’s just say that Zauren just says no to emotional manipulation by one to whom she entrusted her mental health.
Not that any of this happened necessarily.
But let’s just say that it did. What do we think of this?
[*edited for Zauren/Flauren disambiguation]