[Depletion]

So I'm seeing a T who is out of network, and I'm trying to get coverage. My plan allows 50 percent coverage for out of network for 20 visits. I called the insurance and they say that all she had to do is submit a DX. So I told her, and she said she would do that. But now she wants me to file all the insurance claims myself, and pay her the full amount up front and wait for the insurance to reimburse me. I really don't want to do all of that, and never expected that I would be have such dealings with the insurance. She says that she wants me to do that because she has had a hard time getting the insurance to pay her back in a timely manner when she is out of network. But isn't this her problem to figure out? Is it normal for her to ask me to file the claims. I'm really scared that if they don't pay her back in a timely manner it could be ages before I see any money. And I'm worried that could really hurt my finances. What am I supposed to do about all this??

[stopdog]

I see one who does it like you describe. I pay in cash and if I want to be reimbursed, she will get me what I would need to submit to the insurance company.

[Leah123]

I did that once myself too, for a couple years long ago. It was quite a headache. How attached are you to her? I think what she's suggesting is quite reasonable, but not easy for you, and I'd consider switching unless you're particularly enamored.

As far as reimbursement, you might ask your insurance agent about the details, worst case scenario, reimbursement can take a few months, but some companies are able to do it, in some situations, as quickly as a couple weeks. However, if it's a financial hardship, I would again suggest trying to find someone in-network unless you can't bear to leave her.

[Polibeth]

When I saw an out-of-network therapist I had to submit to the insurance myself. Like stopdog, he gave me what I needed to do so. It did seem to take some time to get reimbursed if I recall correctly (It was like 7 years ago).

Not unusual for out of network providers to do things this way.

[elliemay]

This is what my therapist did as well. You can find out what the average time is for a claim to be paid to you. It might not be as long as you think.

However, I know I had to stay on top of things at my insurance company.

And yes it put a significant dent in my wallet.

[guilloche]

Yup, that's my experience with out of network too. Out of network means that they don't have any relationship with your insurance company, so you have to take care of all that yourself. It is a pain.

[Wysteria]

Sorry Depletion,

I know it is very hard and frustrating...just stay on top of it...often nowadays there is a way to file them online...just have to have the back up and diagnosis codes and signed by the T...

Remember to pull a statement from the insurance company at the end of the year....may be possible to take a good deduction at the end of the year if you file long form for those monies paid out and not reimbursed. Put in everything if you go this way as you will have to meet your annual deductibles as well.

Soon, Obamacare will do away with that 20 visit cap...with what's called 'mental parity'. It means that you get the treatments you need to get healed. Not just some arbitrary 20 visits like insurance companies have done in many states up until now. If you have diabetes, you get all the care you need to get better. Even if you have a serious mental condition, up until now, you were always limited by the insurance company as to how much treatment you could get and then have to go out of pocket.

Be patient and best wishes.
Wysteria

[Depletion]

Unfortunately I am very attached. And now very annoyed. I have set up an FSA which I expected would last a particular amount of time, and this whole reimbursement thing seems like it might mess that all up. I will look into how the whole reimbursement thing works with the insurance. Thanks everyone.

[rainboots87]

Seems reasonable of her to request that as an out-of-network provider, though I understand the extra work on your part. My former T who had a heck of a time getting paid even though she was in-network. From the claims listing I could see online, she had her last claim denied and it looks like she didn't even bother to resubmit it. Insurance is a big pain.

[sunrise]

What you describe is how I have experienced that out of network is done. You pay the therapist, and you submit paperwork to your insurance so they can reimburse you for the 50%. My insurance used to let me submit multiple claims at once for the same provider on one form. So that cut down on my paperwork. You could save them up and do a half dozen at a time. Then you get one big check. It's really not that bad once you get into the routine and develop a system for filling out the paperwork. Usually you can download the out of network claim form from your insurer's website.

[OneWorld]

Mine does the same thing. Also, insurance will pay 50% of their 'approved rate' for that service. So if your T charges $200 but they approve a $100 charge, they would send you a check for $50 not $100. I didn't realize that before so I thought I'd share.

Sent from my iPhone using Tapatalk

What your therapist is asking is pretty standard for out-of-network payment. I did this with my previous therapist. And like someone else mentioned, I'd save up a number of session payments and submit them on an insurance form. After doing payment this way I learned to really appreciate what doctors and therapists have to go through to get their money. Sometimes the payments would come through in 6 to 8 weeks, but I've had some that took THREE MONTHS. And worse of all, I'd have none show up for months and months and when I'd check they'd have some excuse or glitch. I always got my money because I'm pretty persistent, but after it happened about five times over the years, I began to wonder if the insurance company with actually sitting on the payments to see if I'd actually follow up.

[elliemay]

Originally Posted by Jaybird57

What your therapist is asking is pretty standard for out-of-network payment. I did this with my previous therapist. And like someone else mentioned, I'd save up a number of session payments and submit them on an insurance form. After doing payment this way I learned to really appreciate what doctors and therapists have to go through to get their money. Sometimes the payments would come through in 6 to 8 weeks, but I've had some that took THREE MONTHS. And worse of all, I'd have none show up for months and months and when I'd check they'd have some excuse or glitch. I always got my money because I'm pretty persistent, but after it happened about five times over the years, I began to wonder if the insurance company with actually sitting on the payments to see if I'd actually follow up.

This is EXACTLY my experience as well. I suspect we have the same insurance provider...

There was one claim that took 3 months to pay. Another where "we mailed it..."

Overall though, the average turnaround was about a month or so.

Of course, when I was having a bad day, I would just call the insurance company and take it out on them. Not necessarily the nicest thing to do, but it made me feel better (sort of). I think they assigned me a case manager or something.

I pay strictly out of pocket now. More money in the long run, less stress.

I envy those with co-pays.

[skeksi]

When I submit the claim, I think I get reimbursed faster than when they provider does it. I submit the claim for my psychiatrist visits and get reimbursed within about a month. My T submits his visits and my insurance company is still processing claims for him from January!

[Depletion]

Originally Posted by Jaybird57

What your therapist is asking is pretty standard for out-of-network payment. I did this with my previous therapist. And like someone else mentioned, I'd save up a number of session payments and submit them on an insurance form. After doing payment this way I learned to really appreciate what doctors and therapists have to go through to get their money. Sometimes the payments would come through in 6 to 8 weeks, but I've had some that took THREE MONTHS. And worse of all, I'd have none show up for months and months and when I'd check they'd have some excuse or glitch. I always got my money because I'm pretty persistent, but after it happened about five times over the years, I began to wonder if the insurance company with actually sitting on the payments to see if I'd actually follow up.

This is what I'm afraid of, and I hate calling people on the phone to ask for things I'm terrible at it. What an awful system I hate to hear that this is the norm I wish I didn't like this T so much.

Originally Posted by Depletion

This is what I'm afraid of, and I hate calling people on the phone to ask for things I'm terrible at it. What an awful system I hate to hear that this is the norm I wish I didn't like this T so much.

Well, the really good thing, Depletion, is that you like this therapist "so much."
Liking the person you're working with might be an incentive to do something you don't like doing--talking on the phone. I can totally relate. I hate talking on the phone with my best friends. The thought of dealing with insurance people on the phone makes my skin crawl. But, like you, I really liked my out-of-network therapist so I sucked it up and made the calls.

You might be luckier than some of us and find that your insurance company doesn't give you the run around and you'll get your money in a timely manner. If that happens, let me know what company you're working with and I'll switch!!

[Depletion]

Originally Posted by Jaybird57

Well, the really good thing, Depletion, is that you like this therapist "so much."
Liking the person you're working with might be an incentive to do something you don't like doing--talking on the phone. I can totally relate. I hate talking on the phone with my best friends. The thought of dealing with insurance people on the phone makes my skin crawl. But, like you, I really liked my out-of-network therapist so I sucked it up and made the calls.

You might be luckier than some of us and find that your insurance company doesn't give you the run around and you'll get your money in a timely manner. If that happens, let me know what company you're working with and I'll switch!!

My mental health is actually a contracted EAP, so I doubt you could switch to them. But I guess I'm going to have to be an adult and figure this all out. I really, really, really hate it when that happens. I wish T could just take care of it for me, its more nurturing that way *Sigh*

[UnderRugSwept]

I have had to submit claim forms for out-of-network providers before, and as long as I filled out the info on the form correctly (the ones I have done were not too difficult at all), I never have had to call. I was able to track (somewhat) the processing of the claim online...if it was shown as "processing," for example, I could verify that it had been received. The only annoying part really was waiting while each claim processed so that I could get reimbursed, and some insurance companies are faster than others.