Appealing denial of out-of-network telemedicine therapy?

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I’ve been seeing a therapist since before the pandemic started. She’s out of network and my insurance is high deductible, so my insurance typically pays very little (50% of their allowable cost after the deductible is reached, so about 25% of what I pay *after* the deductible is reached). That being said, I think my therapist is very good and it’s at least some reimbursement.

I finally got around to submitting my claims for most of the year (I usually batch them and send them all at once) and was blindsided by learning that UnitedHealthCare denied all of the telemedicine visits. Speaking with them, they say they support telemedicine in-network, but not out-of-network–it doesn’t matter if our state was under a stay at home order or any other circumstances, I should have found an in network therapist. I had heard about all the changes insurance and others had made to support telemedicine, but didn’t realize that out of network providers were being completely excluded from these changes. In practice during current times, this basically means they don’t cover out of network therapy at all.

I have some responsibility for not realizing this earlier, and I certainly agreed to take on paying the majority of the cost myself by seeing an out of network therapist. But, I didn’t expect my insurance to say “well, we know there’s a pandemic, but if you want us to keep paying anything like we have in the past, you have to see your provider in person or find a new one”

Is there any chance that I’ll have success appealing the claim denials? If so, what should I be saying in my appeal? Additional information: I’m located in New York, and my spouse is an essential medical worker (doctor). It’s a high deductible UnitedHealthCare plan self-funded by the employer.

submitted by /u/travis-42
[link] [comments]
I’ve been seeing a therapist since before the pandemic started. She’s out of network and my insurance is high deductible, so my insurance typically pays very little (50% of their allowable cost after the deductible is reached, so about 25% of what I pay *after* the deductible is reached). That being said, I think my therapist is very good and it’s at least some reimbursement. I finally got around to submitting my claims for most of the year (I usually batch them and send them all at once) and was blindsided by learning that UnitedHealthCare denied all of the telemedicine visits. Speaking with them, they say they support telemedicine in-network, but not out-of-network–it doesn’t matter if our state was under a stay at home order or any other circumstances, I should have found an in network therapist. I had heard about all the changes insurance and others had made to support telemedicine, but didn’t realize that out of network providers were being completely excluded from these changes. In practice during current times, this basically means they don’t cover out of network therapy at all. I have some responsibility for not realizing this earlier, and I certainly agreed to take on paying the majority of the cost myself by seeing an out of network therapist. But, I didn’t expect my insurance to say “well, we know there’s a pandemic, but if you want us to keep paying anything like we have in the past, you have to see your provider in person or find a new one” Is there any chance that I’ll have success appealing the claim denials? If so, what should I be saying in my appeal? Additional information: I’m located in New York, and my spouse is an essential medical worker (doctor). It’s a high deductible UnitedHealthCare plan self-funded by the employer.
submitted by /u/travis-42 [link] [comments]Read Morer/HealthInsurance

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