I’ve been seeing a therapist for about 2 years, using my out-of-network benefits to offset the steep fee (I’m in NYC where it is not uncommon for therapy to cost $200-$250/session).
In previous years, my health plan used R&C for my area to determine reimbursement. My therapist’s fee was completely in-line with R&C, so every dollar I spent went toward fulfilling my deductible and when my benefits kicked in, every dollar was considered eligible for coverage.
When I started filing 2021 claims, I saw that they had switched to a Medicare benchmark — which cuts my reimbursement in half. I’m now being met at essentially .50 for every dollar, meaning it will take me 2x as long to hit my deductible, and then insurance is only considering half of my bill eligible for coverage. This will end up costing me an additional $4K out of pocket/year.
I’m extremely frustrated with my employer, as this was never called out during enrollment and my per paycheck contribution has not changed despite the benefit I most frequently use becoming significantly worse.
Has anyone else ever encountered this? I assume there’s nothing I can do?
submitted by /u/abc4489
[link] [comments]
I’ve been seeing a therapist for about 2 years, using my out-of-network benefits to offset the steep fee (I’m in NYC where it is not uncommon for therapy to cost $200-$250/session). In previous years, my health plan used R&C for my area to determine reimbursement. My therapist’s fee was completely in-line with R&C, so every dollar I spent went toward fulfilling my deductible and when my benefits kicked in, every dollar was considered eligible for coverage. When I started filing 2021 claims, I saw that they had switched to a Medicare benchmark — which cuts my reimbursement in half. I’m now being met at essentially .50 for every dollar, meaning it will take me 2x as long to hit my deductible, and then insurance is only considering half of my bill eligible for coverage. This will end up costing me an additional $4K out of pocket/year. I’m extremely frustrated with my employer, as this was never called out during enrollment and my per paycheck contribution has not changed despite the benefit I most frequently use becoming significantly worse. Has anyone else ever encountered this? I assume there’s nothing I can do?
submitted by /u/abc4489 [link] [comments]Read Morer/HealthInsurance