I have been seeing this therapist for about 6 months, and recently there has been an issue with said therapist failing to bill my insurance (CA Anthem Blue Cross)- she is within network and she would be submitting claims with the bills for our sessions. When the new year started, my insurance (Anthem) started denying her sessions with an explanation of “looks like you have another health plan that covers this care, the doctor/facility needs to provide us the other plan’s explanation of payment so we can apply your benefits to this claim…”
To clarify, I have my name on two different insurance plans. I had been on my parent’s insurance(Anthem) before the new year, and I had recently started a new job with full benefits that started after the new year.
The insurance (Blue Shield) through my new job is not accepted by my therapist, as it is out her network. This, however, shouldn’t be a problem, as an am still on my parent’s plan(Anthem).
I had clarified with my therapist that this is what the insurance is inquiring about- she needs to resubmit the claims and explain to the insurance (Anthem) why we have chosen to continue on with sessions into the new year, and that I do not in fact have another insurance that will cover her service.
She gets back to me and says that she’s only been “submitting claims to client’s insurance as a courtesy”, and me asking her to resubmit is beyond her bandwidth or responsibility, and that this has become complicated (despite me having laid out exactly what she needs to do and say to the insurance). At this point I had already decided to not continue with any more sessions- she then proceeded to send me a super bill of all the sessions that she’s billed over the past two months- the ones that insurance has denied. Alongside the bill was an agreement for me to sign, saying that I am acknowledging that I am paying out of pocket and opting out of using insurance to assist. I don’t feel comfortable signing that because it’s not true- I do have insurance that will cover the service. The only solutions I can see at this point, with her resistance to deal with insurance/claims, is that I pay the bill out of pocket, or I call my insurance and deal with it myself. Is this negligence on her part? I’m confused, is this normal practice for providers? I’ve had therapy before and have never had this issue before where there has just been outright refusal to work with my insurance to get paid. I have spoken to others about this and they all say she’s not doing her part as a competent provider. Am I just being difficult? I obviously would rather not pay out of pocket if there is an obvious solution via insurance. Any advice and insight is greatly appreciated.
submitted by /u/SnooCauliflowers6347
[link] [comments]I have been seeing this therapist for about 6 months, and recently there has been an issue with said therapist failing to bill my insurance (CA Anthem Blue Cross)- she is within network and she would be submitting claims with the bills for our sessions. When the new year started, my insurance (Anthem) started denying her sessions with an explanation of “looks like you have another health plan that covers this care, the doctor/facility needs to provide us the other plan’s explanation of payment so we can apply your benefits to this claim…” To clarify, I have my name on two different insurance plans. I had been on my parent’s insurance(Anthem) before the new year, and I had recently started a new job with full benefits that started after the new year. The insurance (Blue Shield) through my new job is not accepted by my therapist, as it is out her network. This, however, shouldn’t be a problem, as an am still on my parent’s plan(Anthem). I had clarified with my therapist that this is what the insurance is inquiring about- she needs to resubmit the claims and explain to the insurance (Anthem) why we have chosen to continue on with sessions into the new year, and that I do not in fact have another insurance that will cover her service. She gets back to me and says that she’s only been “submitting claims to client’s insurance as a courtesy”, and me asking her to resubmit is beyond her bandwidth or responsibility, and that this has become complicated (despite me having laid out exactly what she needs to do and say to the insurance). At this point I had already decided to not continue with any more sessions- she then proceeded to send me a super bill of all the sessions that she’s billed over the past two months- the ones that insurance has denied. Alongside the bill was an agreement for me to sign, saying that I am acknowledging that I am paying out of pocket and opting out of using insurance to assist. I don’t feel comfortable signing that because it’s not true- I do have insurance that will cover the service. The only solutions I can see at this point, with her resistance to deal with insurance/claims, is that I pay the bill out of pocket, or I call my insurance and deal with it myself. Is this negligence on her part? I’m confused, is this normal practice for providers? I’ve had therapy before and have never had this issue before where there has just been outright refusal to work with my insurance to get paid. I have spoken to others about this and they all say she’s not doing her part as a competent provider. Am I just being difficult? I obviously would rather not pay out of pocket if there is an obvious solution via insurance. Any advice and insight is greatly appreciated. submitted by /u/SnooCauliflowers6347 [link] [comments]Read Morer/HealthInsurance