Reply to Therapy and insurance... how much are you paying?

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Reply to "Therapy and insurance... how much are you paying?"

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[quote=Anonymous][quote=Anonymous]I knew that most providers were out of network and went in realizing I'd have to pay 50%.  Months in and I just got my explanation of benefits that says it's not actually 50% of what I'm paying, it's 50% of what they think therapy is worth (roughly $70 vs. $200).  So, once I hit a completely separate deductible because the out of network deductible is completely separate and higher than my normal deductible, I'll start getting roughly $35 out of every $200 reimbursed.  Is that typical?  We could not find a provider in network with the right specialty and DS was reluctant so I wanted to go with a provider that came highly recommended.[/quote]

One thing you can try doing is appealing the situation to the insurance company and ask them to treat the OON provider is in network because their in network doesn’t have the right specialty.  It may raise your reimbursement a tiny bit, although you will still be responsible for the balance bill from your OON provider.  It may also enable you to hit an in network deductible or cap. (although you will likely have to track that and argue for it as well.)[/quote]

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