Questioning current provider of benefits

So I like to think I have a pretty good understanding of my health benefits and coninsurance, however I am a bit stumped at what happened here in the last half of 2020 with one provider that my 5 year old sees. For the past 3 years she has been in speech therapy and has been seeing a specialist that is covered by our insurance. We have a $3000 deductible that we have to hit before it is partially covered. Once covered I believe we end up paying a portion depending how it is coded.

I didn’t question it too much until recently because we have never had an issue at this provider and it was mostly consistent. We are billed each week for what is a 30 minute session to help with speech. It is listed on my insurance website as: Oral Function Therapy (Billed at $140) or Treatment of Speech (Billed at $140). I don’t see what goes on in these sessions but either one of those two are coded. Before my deductible is met, one costs me $90.78 which is applied to my deductible. The other is $68.40 applied to my deductible.

Once my deductible is hit then each week I pay the coninsurance amount which is normally $18.16 but some weeks I see the other billing code which changes my coinsurance due to $13.68.

To summarize that part I am normally billed the first half of the year $90.78 and the second half of the year (which is about when I hit the deductible) $18.16. This year, however, things changed. I hit my deductible in July and about two weeks after I started seeing both codes getting billed every single week for $280. This resulted in me owing $30.75 every week for the rest of the year. This looks to me like they were double billing for the same service rendered in the past. These are still the same 30 minute sessions and to our understanding nothing has changed at all.

I contacted them to explain the charges and they simply said oh yes we bill for both for her services but as a courtesy we will only bill the one code from now on. This seemed very strange to me and something seems off. Is it possible they are not receiving as much money from the insurance provider so once I hit the deductible they are now billing it twice under two codes in order to recoup how much they were getting when I had to pay the full amount? Anything else I should look into here?

Thanks for any assistance!

submitted by /u/jaelae
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So I like to think I have a pretty good understanding of my health benefits and coninsurance, however I am a bit stumped at what happened here in the last half of 2020 with one provider that my 5 year old sees. For the past 3 years she has been in speech therapy and has been seeing a specialist that is covered by our insurance. We have a $3000 deductible that we have to hit before it is partially covered. Once covered I believe we end up paying a portion depending how it is coded. I didn’t question it too much until recently because we have never had an issue at this provider and it was mostly consistent. We are billed each week for what is a 30 minute session to help with speech. It is listed on my insurance website as: Oral Function Therapy (Billed at $140) or Treatment of Speech (Billed at $140). I don’t see what goes on in these sessions but either one of those two are coded. Before my deductible is met, one costs me $90.78 which is applied to my deductible. The other is $68.40 applied to my deductible. Once my deductible is hit then each week I pay the coninsurance amount which is normally $18.16 but some weeks I see the other billing code which changes my coinsurance due to $13.68. To summarize that part I am normally billed the first half of the year $90.78 and the second half of the year (which is about when I hit the deductible) $18.16. This year, however, things changed. I hit my deductible in July and about two weeks after I started seeing both codes getting billed every single week for $280. This resulted in me owing $30.75 every week for the rest of the year. This looks to me like they were double billing for the same service rendered in the past. These are still the same 30 minute sessions and to our understanding nothing has changed at all. I contacted them to explain the charges and they simply said oh yes we bill for both for her services but as a courtesy we will only bill the one code from now on. This seemed very strange to me and something seems off. Is it possible they are not receiving as much money from the insurance provider so once I hit the deductible they are now billing it twice under two codes in order to recoup how much they were getting when I had to pay the full amount? Anything else I should look into here? ​ Thanks for any assistance!
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