I’ve been feeling pretty depressed recently. After some helpful prodding by my spouse, I decided to reconnect with a psychiatrist that I have worked with in the past.
Since I last worked with her, she has moved from being in-network to out-of-network with Blue Cross Blue Shield of MA, where I have a PPO plan with a $500 deductible. I also have some money in an HSA. Because of this, going out-of-network is a potential option for me, but I still wanted to know how much these sessions would cost.
I called BCBS and that’s where things got hazy…
I gave the rep two specific billing codes (90791 for the first-time evaluation session and 90834 for psychotherapy sessions) and shared that my psychiatrist’s hourly rate for these was $240 and $190 specifically.
The BCBS member services team informed me that after meeting a $500 deductible, they would reimburse me 70% of the Allowed Rate of the psychiatrist’s rate. The representative told me that the Allowed Rate is based on the Medicare Rate, but they can’t access the Medicare Rate until the charge is rendered.
I was surprised – I thought I was mishearing them so gave them another opportunity to tell me how much it would cost to see this doctor. I wasn’t interested in a ballpark number. They were going to reimburse me for something…so how much?
The rep reiterated that he wasn’t able to tell me how much they would reimburse me for until I submitted a claim.
The representative was actually super nice and actually genuinely expressed empathy for my confusion. He said that at one time he was allowed to access and share the Medicare Rate and give accurate estimates.
I can read between the lines here and estimate that it is going to cost me roughly $50 or $60 per session. But the conversation and lack of transparency really irked me, especially since I paid this company nearly 8 grand in premiums last year.
So my questions are:
- In Massachusetts do I have a right to know exactly how much I will be reimbursed by my healthcare plan for standard appointments like this? (I.E not a complex surgery where other costs may crop up unexpectedly and make it hard to determine in advance)
- Does the insurer have some financial motivation for pushing their subscribers away from out-of-network benefits and into in-network benefits? I have a hunch, that is what is going on here.
submitted by /u/Unable-Rain7843
[link] [comments]
I’ve been feeling pretty depressed recently. After some helpful prodding by my spouse, I decided to reconnect with a psychiatrist that I have worked with in the past. Since I last worked with her, she has moved from being in-network to out-of-network with Blue Cross Blue Shield of MA, where I have a PPO plan with a $500 deductible. I also have some money in an HSA. Because of this, going out-of-network is a potential option for me, but I still wanted to know how much these sessions would cost. I called BCBS and that’s where things got hazy… I gave the rep two specific billing codes (90791 for the first-time evaluation session and 90834 for psychotherapy sessions) and shared that my psychiatrist’s hourly rate for these was $240 and $190 specifically. The BCBS member services team informed me that after meeting a $500 deductible, they would reimburse me 70% of the Allowed Rate of the psychiatrist’s rate. The representative told me that the Allowed Rate is based on the Medicare Rate, but they can’t access the Medicare Rate until the charge is rendered. I was surprised – I thought I was mishearing them so gave them another opportunity to tell me how much it would cost to see this doctor. I wasn’t interested in a ballpark number. They were going to reimburse me for something…so how much? The rep reiterated that he wasn’t able to tell me how much they would reimburse me for until I submitted a claim. The representative was actually super nice and actually genuinely expressed empathy for my confusion. He said that at one time he was allowed to access and share the Medicare Rate and give accurate estimates. I can read between the lines here and estimate that it is going to cost me roughly $50 or $60 per session. But the conversation and lack of transparency really irked me, especially since I paid this company nearly 8 grand in premiums last year. So my questions are:
In Massachusetts do I have a right to know exactly how much I will be reimbursed by my healthcare plan for standard appointments like this? (I.E not a complex surgery where other costs may crop up unexpectedly and make it hard to determine in advance) Does the insurer have some financial motivation for pushing their subscribers away from out-of-network benefits and into in-network benefits? I have a hunch, that is what is going on here.
submitted by /u/Unable-Rain7843 [link] [comments]Read Morer/HealthInsurance