No in-network providers specializing in my treatment, what are my options?

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For the past 9 months I’ve been struggling with a severe eating disorder. My job has switched health insurance providers (Aetna to Blue Cross Blue Shield) and my therapist doesn’t accept the new provider. There is a plan where the copay for out of network coverage is affordable, but BCBS will only cover up to the “allowed amount” per session. I’ve contacted them, but they won’t release the “allowed amount” until the claim is filed.

I have a feeling that the “allowed amount” will be an artificially deflated number, like $100 per session, while my therapist charges $300. This therapist is the only one I’ve had where I actually feel like I’m making progress, but I cannot afford to see her out of pocket. I’ve also looked at in-network therapists in my area, and there aren’t any that specialize in the treatment method that’s been working for me.

Is there anything I can do? Aetna doesn’t sell individual plans, but is there some other way to buy an individual plan from Aetna, maybe from a third party? Is there any way BCBS might grant an exception, or increase the “allowed amount” for an eating disorder diagnosis? Please help, I’m feeling quite desperate and hopeless.

submitted by /u/ilovemalts
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For the past 9 months I’ve been struggling with a severe eating disorder. My job has switched health insurance providers (Aetna to Blue Cross Blue Shield) and my therapist doesn’t accept the new provider. There is a plan where the copay for out of network coverage is affordable, but BCBS will only cover up to the “allowed amount” per session. I’ve contacted them, but they won’t release the “allowed amount” until the claim is filed. I have a feeling that the “allowed amount” will be an artificially deflated number, like $100 per session, while my therapist charges $300. This therapist is the only one I’ve had where I actually feel like I’m making progress, but I cannot afford to see her out of pocket. I’ve also looked at in-network therapists in my area, and there aren’t any that specialize in the treatment method that’s been working for me. Is there anything I can do? Aetna doesn’t sell individual plans, but is there some other way to buy an individual plan from Aetna, maybe from a third party? Is there any way BCBS might grant an exception, or increase the “allowed amount” for an eating disorder diagnosis? Please help, I’m feeling quite desperate and hopeless.
submitted by /u/ilovemalts [link] [comments]Read Morer/HealthInsurance

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