I originally posted in r/insurance but realized this was probably the better fit. I regularly see an out-of-network therapist that I pay out of pocket, then submit my own claim each month to Cigna for reimbursement. I’ve been doing this for more than a year, no change in service or provider. They cover up to 80% of their allowed amount, which is too low to begin with for what therapy actually costs in my area, but whatever. Recently they sent me a reimbursement that was lower than what I had been getting; the allowed amount had changed on the EOB. I called to ask why, thinking it was probably a mistake and they could adjust it. I pointed out the difference in reimbursement for the exact same service, and the customer service rep submitted the claim for adjustment, and also sent along the prior month’s EOB as a reference point (or so I was told).
Several weeks later, I got an adjusted EOB for the prior month (the higher amount I had been getting all along) that reduced the the reimbursement amount, and had a note that said “overpayment request to follow.” Apparently they decided the most recent reimbursement amount is what they actually owe me and corrected what they had been paying me. Per the note, I assume that they’re going to try to bill me for the difference between the amount they paid and the adjusted amount, but haven’t received that yet.
This strikes me as absurd. I can understand seeking overpayment if they accidentally paid the same claim twice or gave me more than the service actually cost. But from what I can tell, here they just changed their mind about what therapy should cost in my area and then applied that retroactively to claims they already paid out. I also think it’s incredibly petty to be going after a patient for what will be a few hundred dollars – meaningless to Cigna, but significant for me, especially given how much therapy costs in the first place.
Any advice on what I can do about this? Everything I’ve read online about overpayments is geared towards doctors, and I’m wondering if I have different options as a patient. Appreciate any help.
Jurisdiction is New York, United States.
submitted by /u/attarock
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I originally posted in r/insurance but realized this was probably the better fit. I regularly see an out-of-network therapist that I pay out of pocket, then submit my own claim each month to Cigna for reimbursement. I’ve been doing this for more than a year, no change in service or provider. They cover up to 80% of their allowed amount, which is too low to begin with for what therapy actually costs in my area, but whatever. Recently they sent me a reimbursement that was lower than what I had been getting; the allowed amount had changed on the EOB. I called to ask why, thinking it was probably a mistake and they could adjust it. I pointed out the difference in reimbursement for the exact same service, and the customer service rep submitted the claim for adjustment, and also sent along the prior month’s EOB as a reference point (or so I was told). Several weeks later, I got an adjusted EOB for the prior month (the higher amount I had been getting all along) that reduced the the reimbursement amount, and had a note that said “overpayment request to follow.” Apparently they decided the most recent reimbursement amount is what they actually owe me and corrected what they had been paying me. Per the note, I assume that they’re going to try to bill me for the difference between the amount they paid and the adjusted amount, but haven’t received that yet. This strikes me as absurd. I can understand seeking overpayment if they accidentally paid the same claim twice or gave me more than the service actually cost. But from what I can tell, here they just changed their mind about what therapy should cost in my area and then applied that retroactively to claims they already paid out. I also think it’s incredibly petty to be going after a patient for what will be a few hundred dollars – meaningless to Cigna, but significant for me, especially given how much therapy costs in the first place. Any advice on what I can do about this? Everything I’ve read online about overpayments is geared towards doctors, and I’m wondering if I have different options as a patient. Appreciate any help. Jurisdiction is New York, United States.
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