Unexpected Insurance Issue with Therapist – Now Facing a $900 Bill
Hello, everyone! I recently switched to a new private insurance plan at the start of January. Before the switch, I checked if my therapist was in-network through her website, which indicated she was. However, I couldn’t find her on the insurance company’s website. When I reached out to her, she confirmed in writing that she was definitely in-network. Trusting her word, I didn’t contact my insurance to verify and provided her with my new insurance information without asking her to double-check.
Fast forward to mid-January, my job situation changed, and I became eligible for state-funded insurance. Unfortunately, my therapist doesn’t accept that plan, so we arranged a termination plan where I would stay on my private insurance for February and see her twice as often as usual, knowing I would stop seeing her in March. This meant I had significantly more sessions than normal.
Recently, I received my first claim from our January appointment, and much to my dismay, my private insurance isn’t covering any of our sessions because my therapist is not in-network with my specific plan. I understand that it was my responsibility to verify with my insurance, but I can’t help but feel frustrated that my therapist assured me she was in-network and encouraged my plan for the increased sessions. Now I’m stuck with a $900 bill instead of the $90 I would have paid if the sessions had been covered.
I recognize that I should have double-checked with my insurance provider, but I’m looking for advice on what to do next. Should I just accept the $900 bill? It feels awkward to ask her for a fee reduction. Someone suggested I reach out to the state-funded insurance to see if they might cover some of the costs due to the unexpected transition. Any other suggestions or insights would be greatly appreciated. Thank you!
I’m really sorry to hear about your situation; that sounds incredibly frustrating and stressful. It’s understandable that you feel stuck between your therapist’s assurance and the insurance reality. Here are some steps you might consider taking:
Discuss with Your Therapist: It might feel uncomfortable, but consider having an open conversation with your therapist about the situation. Explain your concerns and see if she’s willing to work out a reduced fee or a payment plan given that you relied on her statement about being in-network.
Contact Your Insurance Provider: Even though your therapist isn’t listed as in-network, check with your insurance provider if they have any options for out-of-network reimbursement or if there are any other exceptions. It’s worth asking since you went through the process of verifying in-network status.
State-Funded Plan Inquiry: As you mentioned, reaching out to your state-funded insurance to see if they can assist with retroactive coverage or any exceptions is a good idea. Explain the situation clearly and provide any documentation that might help.
Review Therapy Services Agreement: Look through any paperwork or agreements you signed with your therapist. There may be clauses that address changes in insurance or coverage.
Consider Financial Assistance: If your therapist has a sliding scale or offers financial assistance, don’t hesitate to ask about it. Professionals in this field often understand that situations like yours can happen.
Seek Another Therapist Temporarily: If you can’t resolve the situation with your current therapist, consider looking for someone who accepts your state-funded insurance. This could help you manage costs while still receiving the support you need.
Learn for the Future: Going forward, it might help to always double-check any practitioner’s network status with your insurance provider directly, even if they’ve assured you otherwise.
I hope one of these options helps, and remember that you’re not alone in facing issues with insurance—many people encounter similar challenges. Good luck!