[Squirrel1983]

So I was checking claims online and saw they haven't paid my psychologist for my last 2 visits because they are claiming she is out-of-network now. She didn't tell me, so I'm a little confused by this. How would she not know she was no longer in-network?

I called the insurance company and they said they would try reprocessing the claims referencing the previous in-network ones to see if it can be paid, but not to get my hopes up.

I don't want to find a new T. I am comfortable with my current one, but I can't afford to see her out-of-network (as my insurance will pay nothing until I meet a 5000 buck deductible).

I emailed my pdoc asking him for a recommendation of a new T (explained the situation to him as well). I know there are a couple in his office, but I don't know if they are covered by my insurance or not. May ask my current T for a recommendation too if she truly is no longer covered.

This sucks!!

Any advice from anyone as I may have to find a new T after having the one I have had for a year?

[sconnie892]

I don't have words of advice, but just wanted to say I'm sorry you have to deal with this. Insurance can be so frustrating.

[mixedup_emotions]

Ugh!!! I can relate to having insurance issues, but I ended up paying out of pocket for mine when I needed to, even though it was a terrible strain on my resources. I may be facing that again when I reach my cap of 30 visits...and considering I am not working full time yet with very limited income - and being a single mom with a mortgage - I have no idea what I am going to do when I am faced with this again in a couple months. (BTW, I've been seeing my T for about 3-1/2 years.)

I wonder if you can work something out with your existing T....perhaps a lower rate, or a change in the duration of visits (which is one thing I did - cut my sessions from 2x/week to 1x/week).

Or, talk to your T about recommending another T. Since your T knows you, your T may have an idea of who may be a good fit for you.

In any case, try to give yourself the time you need to wind down with this T and give yourself proper closure....

[Squirrel1983]

Originally Posted by mixedup_emotions

Ugh!!! I can relate to having insurance issues, but I ended up paying out of pocket for mine when I needed to, even though it was a terrible strain on my resources. I may be facing that again when I reach my cap of 30 visits...and considering I am not working full time yet with very limited income - and being a single mom with a mortgage - I have no idea what I am going to do when I am faced with this again in a couple months. (BTW, I've been seeing my T for about 3-1/2 years.)

I wonder if you can work something out with your existing T....perhaps a lower rate, or a change in the duration of visits (which is one thing I did - cut my sessions from 2x/week to 1x/week).

Or, talk to your T about recommending another T. Since your T knows you, your T may have an idea of who may be a good fit for you.

In any case, try to give yourself the time you need to wind down with this T and give yourself proper closure....

I'm hoping I can possibly work out a lower rate with current T. I really like her and would rather not change. I only see her once every 2 weeks (cut back after insurance complained I was seeing her too much (when she was in network)). She does let me email between sessions and responds, so I would hate to get a new T that doesn't allow this.

If worse comes to worse, maybe one of the T in pdocs office is covered under my insurance. I sent pdoc an email asking who they were and explaining my situation and asking who he would recommend so I can check if they are covered on my insurance. If I have to switch my first choice would probably be to one in pdoc's office as they would have access to my file there.

I hate my luck.

[googley]

Have you talked about this with your T, about her being out of network? It could be something that she overlooked, but didn't mean to let happen. I hope you are able to find a way to keep seeing your current T. Not being able to keep seeing your T really sucks.

[Squirrel1983]

UPDATE:

Just got an email response from T. She says as far as she knows she is still in-network and that this is just another one of insurance's tricks to not pay claims. She says "reprocessing" is always next after a deny as they hope people will forget about it so they don't have to pay. (Yes, my T hates insurance companies.) She said most people don't stay on top of it so it's a breath of fresh air that I am. She said not to worry and to enjoy the holiday weeked. Now just to wait.

Ack!

[Crescent Moon]

Originally Posted by Squirrel1983

So I was checking claims online and saw they haven't paid my psychologist for my last 2 visits because they are claiming she is out-of-network now. She didn't tell me, so I'm a little confused by this. How would she not know she was no longer in-network

Claims processors do make mistakes. I've had to deal with my share of it.

You can go to the insurance company's website and find their current list of in-network providers, to see if your therapist is still on there.

In the meantime, hang in there! It will probably work out fine.

Originally Posted by Squirrel1983

UPDATE:

Just got an email response from T. She says as far as she knows she is still in-network and that this is just another one of insurance's tricks to not pay claims. She says "reprocessing" is always next after a deny as they hope people will forget about it so they don't have to pay. (Yes, my T hates insurance companies.) She said most people don't stay on top of it so it's a breath of fresh air that I am. She said not to worry and to enjoy the holiday weeked. Now just to wait.

Ack!

Definitely a typical insurance ploy. They really do rely on the majority of people who don't really know what their benefits are and who will accept whatever they say without question. I've literally had to take days off from work in the past so I could stay on the phone with insurance people to get things taken care of. So incredibly aggravating. Fortunately our current insurance has been pretty good with a few rare exceptions.

[WikidPissah]

I keep on the insurance company...like white on rice...lol. They are sneaky and will try to get by paying as little as possible. Best to keep a close eye on them.

I am sure it will work out now that they know you are paying attention.

[Squirrel1983]

Originally Posted by Crescent Moon

Claims processors do make mistakes. I've had to deal with my share of it.

You can go to the insurance company's website and find their current list of in-network providers, to see if your therapist is still on there.

In the meantime, hang in there! It will probably work out fine.

The first thing I did was check the online directory and she was still in it, then I made the call to them and they claimed she was not. Hopefully it will all work out.

[Squirrel1983]

Originally Posted by farmergirl

Definitely a typical insurance ploy. They really do rely on the majority of people who don't really know what their benefits are and who will accept whatever they say without question. I've literally had to take days off from work in the past so I could stay on the phone with insurance people to get things taken care of. So incredibly aggravating. Fortunately our current insurance has been pretty good with a few rare exceptions.

A few months ago they sent my T a letter that stated I was about to exceed my visit limit when the infomation online and from my work says I have unlimited mental health visits. I called about it, they denied ever sending the letter (I know they did, as T showed me the letter). Then T called and they claimed after 10 more visits she would need preapproval to see me more, but I don't think we are there yet. Stupid insurance.

[Squirrel1983]

Originally Posted by WikidPissah

I keep on the insurance company...like white on rice...lol. They are sneaky and will try to get by paying as little as possible. Best to keep a close eye on them.

I am sure it will work out now that they know you are paying attention.

Hopefully it will work out. They said the reprocessing can take up to 15 business days, so I think they are hoping I will forget. I won't though as I would rather keep seeing my current T.

[Squirrel1983]

Another UPDATE:

So I just looked at my benefits online and I was confusing my out-of-pocket maximum with my out-of-network deductible. My out-of-pocket max. is what is 5000, my out-of-network deductible is only 500 before insurance will start paying some of it. Not as bad.

After 4 visits with T (if she truly is out-of-network now) would cover it, then insurance would pay 60% (I would pay 40%) of the visits. Maybe T would allow me to work out a payment plan for the 4 full price visits. She says she thinks she is still in-network though, so maybe Cigna just made a mistake.

Ah! It's Cigna. Ours too. I know with our plan, T has to talk to someone at Cigna every so often so visits can continue. I think it is a lot less frequent than every 10 visits though. More like around twice a year. It is really never an issue. Just a hoop T has to jump through with them. One of the pleasures of being an in-network provider. Otherwise, they've been very good about coverage for mental health.

[Squirrel1983]

Originally Posted by farmergirl

Ah! It's Cigna. Ours too. I know with our plan, T has to talk to someone at Cigna every so often so visits can continue. I think it is a lot less frequent than every 10 visits though. More like around twice a year. It is really never an issue. Just a hoop T has to jump through with them. One of the pleasures of being an in-network provider. Otherwise, they've been very good about coverage for mental health.

Well, T was told that she would need pre-approval after 10 more visits after Cigna swore I had reached 15 with her. But it still doesn't make sense, since my coverage says I have unlimited. T said it was just a hoop to jump through and sje would do it when the time came. Maybe they decided to do it earlier than they said they were.

[googley]

Unlimited treatments mean that if it is considered medically necessary. Because of that, then your T has to check in with them every so often (depends on the policy/insurance) to let them know that it is still medically necessary. It isn't just you get them without having to prove anything. She will probably have to give them your diagnosis (again) and say that you are getting treatment for it.

[Crescent Moon]

Originally Posted by Squirrel1983

The first thing I did was check the online directory and she was still in it, then I made the call to them and they claimed she was not. Hopefully it will all work out.

I have had various problems like this over the years. When you call, you get the lowest level of "customer service." If they tell you she's not on it, ask to speak to a supervisor. Supervisors have more access to things. Coding could have gotten screwed up by the original processor. Anyway, the main thing is to get to a supervisor.

[Squirrel1983]

Just tried calling Cigna again to see if I would be told something different by someone else. I was. This time they blamed T saying she filed under an expired tax id number and that they have her listed under a different number and she needs to refile under the new number. ???? What the heck? Sent T an email about what they said this time in case it is something she did by mistake. I doubt it though.

Only time will tell.

[Crescent Moon]

Originally Posted by Squirrel1983

Just tried calling Cigna again to see if I would be told something different by someone else. I was. This time they blamed T saying she filed under an expired tax id number and that they have her listed under a different number and she needs to refile under the new number. ???? What the heck? Sent T an email about what they said this time in case it is something she did by mistake. I doubt it though.

Only time will tell.

They are probably talking about the "Provider ID #" It's different than her tax ID number. All health care providers are supposed to register to get this number, which must be used for all electronic claims and payments by insurance companies to a provider. It started with medicare. My therapist is a one-person operation, and she doesn't file claims. I pay her, and get reimbursed by my insurance company. It became a big problem about a year ago.. they wanted a "Provider ID #" even though she wasn't filing electronic claims.

Anyway, that's probably what the deal is.