Quote:
Originally Posted by wheeler
I have been seeing my T for 7 years. During this time my T always took my insurance and I only paid my copay. She would bill insurance for $190/hr and they would reimburse her $130, which I know is normal when they contract with an insurance.
I now have new insurance and my T does not take it. I asked her if she would reduce my fee cause I would have to pay out of pocket, she said No, but she would only charge me what insurance pays, which is the $130. Which is too much for me to afford. Unfortunately this led to quite a rupture.
I found out my insurance will pay for out of network, but I have to pay a deductible first. So she sent me her ‘simple bill’ which is just is a text with the monthly total, which for January was 2 times at $130. However because I have to submit an ‘official’ bill she has to provide me with more info, diagnosis, treatment code….etc. When she sent this new bill back she was charging $190/hr.
I will be meeting with her today and of course I have to talk to her about this, and I am so afraid of the conversation. It just won’t end well.
I imagine that she will say that I will have to pay the difference between what my new insurance will reimburse me to her fee of $190.
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I'm so sorry you're dealing with this. Insurance stuff led to a rupture with my T at one point (it was a very complicated situation). It's such a touchy topic. I hope you can work it out so that it's affordable for you.
When she did the official bill, maybe she just put in the $190 in error? I get a discount from my T, and they way he does his invoices is that they list his full fee, then he lists my discount as a "courtesy deduction," then the final total (what I actually pay him) at the bottom.
Also, you should be able to find out from your insurance how much they reimburse. They probably have a limit of what they'll cover for a 45-minute or 60-minute (depending on her billing code) session. Say they reimburse 50% for out of network (that's what mine does, so just using as an example). They might only allow, say, $170 for a session. So then they'd just be giving you $85 back, rather than $95. (Hope that makes sense!)
I imagine she'll need to include quite a few things on her bill, like an NPI number (I think that's what it is?), Tax ID, address of her business, diagnostic code, plus a session code.
I can try to help if you have any questions--feel free to PM me.