In-Network Confusion: Now I’m Stuck with a $900 Bill
Hi everyone! I recently switched my private insurance at the start of the new year and checked if my therapist was in-network using the insurance website. Although her personal site claimed she was in-network, the insurance site didn’t list her. She assured me in writing that she was definitely in-network, so I didn’t feel the need to double-check with my insurance provider when I shared my new insurance details with her.
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 agreed that I would continue with my private insurance for February and see her twice as often as usual, planning to stop in March. This led to me attending significantly more sessions than normal.
Now, I’ve received the first claim for our January appointment, and it turns out my private insurance won’t cover any of my sessions at all—I’m on a specific plan that my therapist isn’t actually in-network with. I recognize I should have confirmed with my insurance when switching plans, but I can’t help but feel frustrated that my therapist assured me she was in-network and went along with my plan to increase our sessions.
Now, I’m facing a $900 bill instead of the $90 I would have owed if the sessions were covered by insurance. While I take responsibility for not following up with my insurance, I’m looking for advice on what to do next. Should I just pay off the $900 invoice? It feels awkward to ask her for a cost reduction. Someone mentioned reaching out to the state-funded insurance to see if they could cover any of these unexpected costs due to the transition. Any other suggestions out there? Thanks so much in advance!
I’m really sorry to hear about your situation—dealing with unexpected medical costs can be incredibly frustrating. Here are a few things you might consider:
Communicate with Your Therapist: It might feel uncomfortable, but consider having an open conversation with your therapist about the situation. Explain the misunderstanding and how it has impacted you financially. She may be willing to offer a discount or work out a payment plan to make it more manageable for you.
Check Your Insurance Policy: Review your private insurance policy carefully to see if there are any provisions for out-of-network coverage or if they can provide any exceptions, especially since you were assured she was in network.
Appeal to Insurance: You can appeal the insurance company’s decision. Sometimes, if you can demonstrate that you relied on their network information and the provider’s assurance, they might reconsider their stance.
Explore the State Funded Insurance Option: As you mentioned, reach out to your state-funded insurance plan to see if they can cover any of the costs related to the transition or provide any retroactive coverage for those sessions.
Financial Assistance Programs: Look into whether your therapist’s office has any financial assistance programs for patients in difficult situations. They might be able to help you find a more affordable way to access care.
Budgeting & Payment Plans: If you end up needing to pay the $900, see if the provider can offer a payment plan that allows you to break it down into smaller, more manageable payments.
Ultimately, it’s understandable that you feel frustrated, but addressing it directly with your therapist and exploring your options with both insurance plans could potentially lead to a resolution. Good luck, and I hope this situation works out for you!