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I sent an angry email to my electricity distribution company asking them why they were charging me twice every month for the same bill.Here is their response:“Thank you for your email. We apologize for the delayed response.Our records indicate your account is registered for pre-authorized payment, meaning the balance due will automatically be withdrawn from your financial account upon its due date. The duplicate payments received each month appear to be made manually. (…) As your account has registered for pre-authorized payment, you are not required to process bill payments manually.”

In the U.S - WAY TOO MUCH!!I spend about 15–20% of my time dealing with insurance companies - advocating for patients whose carriers deny coverage for the treatment they need. I’ve long since given up expecting logical arguments, or honesty, from them.Each insurance company has a list of “covered procedures” and if the patient needs something that’s not on the list, it is denied. If they need a study, procedure, or medication refill more often than the standard interval, it’s denied.After the first denial, we set up a “peer-to-peer” call. I talk to a doctor (who makes calls for an insurance company because for some reason, they can’t practice medicine). They quote the coverage policy and emphasize that they can’t make the decision - but quote their book which says I can go on to the appeal process.On the appeal, we send medical records and relevant published clinical trials supporting the patient’s need for the procedure. This may take a month (an average amount of time that each insurance company specifies in it’s manual). Maybe 20% of the time, this results in approval, but 80% require another appeal.This time, they let you talk to an outside reviewer - usually a doctor who is actually practicing medicine. I have success with probably 50% of those.After the final denial, the patient has to go to the State Insurance Commission or hire a lawyer.Since I take care of cancer patients, most of them can’t wait for treatment as long as this process takes, so many of them just have something cheaper done. We refer to this as “Denial by Delay”.My personal oncologist and I recently went through this process for some studies I needed following treatment for my cancer. The insurance company’s book said that pre-authorization was not required, so I had them performed, but then they refused to pay for them. More recently, I actually got a pre-authorization - just to be on the safe side - and they still denied it after it was done. Overall, I spent almost a year going through the appeals process - with the help of my doctor. Finally, I enlisted the help of the State Insurance Commission and they got results in 30 days. I didn’t think to call them initially - after all, the tests were medically necessary - like I said, I’ve given up expecting logic or honesty from insurance companies.From now on, I’ll suggest the State Insurance Commission to my patients earlier in the process.

Asking for professional advice from the patient, even in passing. As a clinical director, I had to have a “boundaries chat” with a therapist who said she’d asked her veterinarian client for tips on various breeds. She’d started the sentence with “I asked my friend about Irish Wolfhounds, actually it was my client the vet . . .” Another time it was stock market advice from a broker.Talking about “interesting patients,” even without identifying them, for entertainment purposes, in social settings. (I see very little of this on Quora, when patients are obviously heavily fictionalized, and discussed for educational purposes only.)Hinting about seeing celebrity or other well known persons as clients. I would always cut those discussions off when I saw where they were going.Fudging on pre-authorization requests to insurance companies, exaggerating patients’ dysfunction or risk.Using “therapy tricks” to manipulate clients. I always hated this one, and felt it was never justified even if it got “good results.” After empathy and unconditional positive regard, Carl Rogers considered genuineness a critical component of client-centered therapy.