Reply to DC Psychiatrist Falsely Represented That He Is Cash-Only OON

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[quote=Anonymous]I was seeing a psychiatrist through a large practice. He left the practice in December and opened a new, cash-only, concierge practice. He represented to me in writing that he was not in-network with either of my two health insurances. I moved over to his new practice and started seeing him on an out-of-network basis since January.

Each week, I've paid $250 up front and submitted out-of-network claims to my insurance. Up until this week--after 11 successful claims--each claim was processed as out-of-network. My insurance company reimbursed me 70% of the allowed amount after I met the higher out-of-network deductible. Then my last three claims were all processed as in-network, and payment was remitted directly to the psychiatrist instead of to me. I called the insurance company to get the claim reprocessed and they insisted there was no mistake. My provider is actually in-network. I was sure they were wrong.

I contacted my provider and asked if he was actually in-network with my insurance. I was shocked that he confirmed that he is despite representations to the contrary. He said in writing that while he was "trying to start a cash-only practice, it isn't exactly working out." He has been in-network with my insurance since I began seeing him in January and just lied to me. He said he will bill [I]future[/I] claims as in-network. But he now owes me like $2,000 for the past 14 visits.

I'm mad. This isn't some large hospital system. This is a one-man shop of a person doing psychiatry and psychotherapy. I don't feel like I can fight with him because I need the ongoing care until I can lock down a new provider. I strongly suspect I'll never see this $2,000 I'm owed, and my insurance is taking zero responsibility for missing its own error for months (he does NOT appear in the in-network provider directory, for what it's worth). [/quote]

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