[lostwonder]

My insurance carrier is changing and my T is out of network. Last time I had this carrier he tried to get in network, but after four months had no luck. I can't afford even his discounted rate more then once every two weeks without sacrificing my daughter's private education, and we are on twice a week sessions now. Once every two weeks is simply not going to be effective for progress. Six years of work, building trust, and now I'm going to have to ask for a referral. I'm heartbroken.

[HazelGirl]

You can apply for continuity of care, where your insurance company treats him like "in-network" instead of out of network.

[lostwonder]

Originally Posted by HazelGirl

You can apply for continuity of care, where your insurance company treats him like "in-network" instead of out of network.

Does this type of thing get approved often?

[HazelGirl]

Originally Posted by lostwonder

Does this type of thing get approved often?

It depends on the insurance company. You might have to do paperwork and fight a little, but if you fight enough, you should be able to do it.

[lostwonder]

I thought for some reason the countunarty of care is for when a previously in network provider goes out of network?

[HazelGirl]

Originally Posted by lostwonder

I thought for some reason the countunarty of care is for when a previously in network provider goes out of network?

I don't have first-hand experience, so maybe that's the case, but you can look into it and see.

[InRealLife45]

I have first hand experience. They said no several times , they gave ten conditional sessions once, I kept saying I need more sessions and ultimately they caved and I see my non Medi-care provider T same as I always did no Interruptions. You need to file a grievance and ignore their denials. Hire a lawyer (legal aid is fine) they don't even have to do anything except put their name on your paperwork to scare them. Go to a board meeting of your insurance and talk to them. They will not want to but if you refuse to accept a referral and cite continuity of care, they really don't have a choice. Good luck.

[InRealLife45]

Is the new network related to your old one? Like under the same parent company? If so they may be able to fast track adding him to the network so you can see him without having to fight them over it.

[lostwonder]

No not remotely related. My husband's company had a merger with a larger company. We are going from BCBS to UHC. I'm ok. I'm not sure if it is the same network he couldn't get on last time and I may be jumping the gun in getting so upset. Good cry and large vent. Suppose it is a passive that I now realize that I am quite attached, and oddly do even trust. I didn't quite realize it before. No matter what happens, even if it hurts, it will be ok.

[rainbow8]

Don't discount seeing your T every 2 weeks, especially after 6 years with the same T. I had to do that for insurance reasons too. I went fro 90 minute weekly sessions to every 2 week 60 minute sessions. At first it was difficult but I got used to the change. We email and that helps. I wish I didn't have to reduce my sessions but it was better for me than getting a new T! It IS an option.

Good luck, whatever you do!

[AncientMelody]

I understand the frustration.....despite being a medical practitioner myself I do not receive very good medical coverage. No vision or dental and high deductible medical. I essentially have to pay out of pocket for mental health care. Since my psychiatrist is my therapist, I pay more for a session than I might otherwise, but I prefer to continue with her rather than see someone else. So I am seeing her less frequently than I like.

On the upside it's still going reasonably well so far, so you may continue to make more progress than you realized good luck and keep us posted

[lostwonder]

My T is also a Pdoc. I don't see going from 2x a week sessions to once every two weeks really being feasible for continued progress. My husband and I sat down last night and crunched some numbers. We bothed failed to notice that coverage will be about $100 a week cheaper, so no matter what we should be able to swing once a week. I panicked, and I learned. No more pussyfooting around and taking the connection for granted.

What is your new plan's policy on out of network care? I know many plans will reimburse at 50%, sometimes more. Sometimes there is also a deductible.

Where I live in Cali the really good T's are all OON. My T files the OON claims on my behalf.

[lostwonder]

Originally Posted by Clementine K

What is your new plan's policy on out of network care? I know many plans will reimburse at 50%, sometimes more. Sometimes there is also a deductible.

I don't know. I really don't have enough information to be as upset as I was.