[Calilady]

My ex-t and I had an arrangement where she gave me a super bill and I'd submit to my insurance company and they'd reimburse me and I'd remit the payment to her.

She said she would accept whatever the insurance paid out, which looked to be 70% of the normal rate for out-of-network providers.

The first six sessions were billed and because I have a HRA, she rec'd her entire fee for each of those sessions ($125). My insurance hired a third party benefits administrator, so reimbursements are taking longer than usual to come in. I still send payments to her when I receive them.

Today, I just rec'd notification from my insurance that they are no longer going by the INDIVIDUAL deductible, but by the FAMILY deductible (apparently, they only keep the individual deductible amount on their site, for looks, I guess). This means that because of this change, I'll owe about $1200 more out of pocket than I had anticipated (the FAMILY deductible is twice the INDIVIDUAL amount).

So, I have to pay out of pocket. My ex-t said she would accept the 70% rate that my insurance pays when my HRA is extinguished. Well, I've tapped the HRA out and now have to pay this myself, whereas she and I both thought that the insurance would be paying it...I hadn't anticipated this change, resulting in the deductible not being met.

I really don't want to contact her and dredge all that up again, as I'm in "no contact" right now, simply because of how much it hurts.

What would you do? Would you send her the 70% out of pocket or remit the entire portion that she billed?

I feel like I SHOULD send her the entire amount, even though she agreed to the 70% (via my insurance), but I'm unsure as to why. I feel like I want to apologize to her for only send the 70% in, even though it's the same dang thing my insurance would have paid out.

[ruh roh]

If she said she would accept the 70% when your HSA is tapped, then that's what I would pay now that it's tapped.

Originally Posted by Calilady

My ex-t and I had an arrangement where she gave me a super bill and I'd submit to my insurance company and they'd reimburse me and I'd remit the payment to her.

She said she would accept whatever the insurance paid out, which looked to be 70% of the normal rate for out-of-network providers.

The first six sessions were billed and because I have a HRA, she rec'd her entire fee for each of those sessions ($125). My insurance hired a third party benefits administrator, so reimbursements are taking longer than usual to come in. I still send payments to her when I receive them.

Today, I just rec'd notification from my insurance that they are no longer going by the INDIVIDUAL deductible, but by the FAMILY deductible (apparently, they only keep the individual deductible amount on their site, for looks, I guess). This means that because of this change, I'll owe about $1200 more out of pocket than I had anticipated (the FAMILY deductible is twice the INDIVIDUAL amount).

So, I have to pay out of pocket. My ex-t said she would accept the 70% rate that my insurance pays when my HRA is extinguished. Well, I've tapped the HRA out and now have to pay this myself.

I really don't want to contact her and dredge all that up again, as I'm in "no contact" right now, simply because of how much it hurts.

What would you do? Would you send her the 70% out of pocket or remit the entire portion that she billed?

I feel like I SHOULD send her the entire amount, even though she agreed to the 70% (via my insurance), but I'm unsure as to why.

I feel like you SHOULD send her the 70%. You had an arrangement that you both agreed too. She asked for the 70%, so I would do exactly that.

[Calilady]

Thank you guys. This sucks so bad, having to deal with all of this and then the billing aspect.

I'm not sure why I feel like crap paying out that 70%. It's exactly what the insurance would have paid out and what she was going to accept from them.

[AllHeart]

I would send in the 70% that you agreed upon, without apologies. If she has an issue with it she will contact you.

[guilloche]

I understand not wanting to be in contact with her. I'm sorry that it's so painful!

Could you send the 70% with a very brief, professional note explaining what's going on? I'm thinking that it might be easier for you than more immediate forms of contact (i.e. phone, email).

Like: "Dear T. I have depleted the funds from my HRA, and my insurance is now requiring me to meet a $ZZZZ deductible - therefore it is not covering any of my sessions. We previously agreed that, in these circumstances, I'd be able to pay 70% of your normal fee (to match what the insurance should be paying). I'm enclosing $XXX (70% of the billed amount, $YYYY). Thank you. Sincerely... <signed>"

I'd probably leave it at that, and let her reach out if she feels that you owe her more. No need to apologize, though I understand... my last T raised his rates, but kept me at the old rate, and I really struggled with it (even though it was still very expensive) - it felt like I was taking advantage.

By the way - why is your insurance charging you the family deductible? Is it just you - no spouse/partner/kids on the police? That sounds *very* suspect to me. You might want to look into it a bit more... I'm not sure how they can do that.

Good luck!

[Calilady]

It's my soon to be ex-husband and I on the policy, through his work. I have no idea why this changed. Previously, there was the two amounts, individual and then family. Now it's just the family amount, although I can see technically see the individual amount.

It's ridiculous and came as quite a shocker today.

Originally Posted by guilloche

I understand not wanting to be in contact with her. I'm sorry that it's so painful!

Could you send the 70% with a very brief, professional note explaining what's going on? I'm thinking that it might be easier for you than more immediate forms of contact (i.e. phone, email).

Like: "Dear T. I have depleted the funds from my HRA, and my insurance is now requiring me to meet a $ZZZZ deductible - therefore it is not covering any of my sessions. We previously agreed that, in these circumstances, I'd be able to pay 70% of your normal fee (to match what the insurance should be paying). I'm enclosing $XXX (70% of the billed amount, $YYYY). Thank you. Sincerely... <signed>"

I'd probably leave it at that, and let her reach out if she feels that you owe her more. No need to apologize, though I understand... my last T raised his rates, but kept me at the old rate, and I really struggled with it (even though it was still very expensive) - it felt like I was taking advantage.

By the way - why is your insurance charging you the family deductible? Is it just you - no spouse/partner/kids on the police? That sounds *very* suspect to me. You might want to look into it a bit more... I'm not sure how they can do that.

Good luck!

[healinginprogress]

Did the services occur before the change was announced? If so, I'd argue with the insurance that they need to pay the charges.