Insurance Billing

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.

Can you do a single case agreement with your insurance? That's what L did for me and she doesn't accept insurances. It works as if she is in network: I just pay my copay and the insurance pays the rest. The only difference is that she has to get re-approved every 3-4 months. But my insurance has approved every time. I'm actually worried about when she comes back because I don't think she submitted for pre-approval during her leave and that might cause a problem.

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.

Convo with T about insurance went better than I expected, mostly I think because I detached myself from the ‘she only sees me because she gets paid to’!

Anyway, she explained her billing and how insurance works. Prior to my benefits changing, I was the only person she took insurance from. I also talked to my insurance company about what the bottom line was for using an out of network therapist, which is next to nothing.

So having slept on it and feeling much calmer I am just gonna pay the $130 out of pocket and go every other week. I have been toying with going to every other week for awhile cause I’m doing pretty well, so this just forced my decision..

Thank you both for your help!