Reply to Carefirst out of network benefits suck / allowable charges racket

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[quote=Anonymous][quote=Anonymous]To the people saying "find an in network provider," please know I have spent over a decade looking for an in-network therapist in the DMV and I've only found two in all that time. The first was objectively terrible -- hadn't been in practice for very long, showed up late to every appointment I ever made with him, was unfamiliar with CBT when I mentioned to him it was something that had worked for me in the past, etc.

The other is my current therapist and CareFirst is STILL giving me the runaround on seeing her. She is in-network through the practice she works with and both the practice and I called before I ever saw her to confirm it would be covered and was told yes, it would be covered with my normal co-pay ($30). I get the first bill, it's for $80 (her rate is $145). This is a totally random amount, I've never had an $80 copay, nowhere in any of my plan details is there anything that would explain why this is what they charged me.

I really like this therapist and I'm determined to make it work but they are still not charging my normal copay and there have been multiple weeks where I spent more time on the phone with CF than I did in therapy. In the past I have done short stints of therapy (like 6-8 weeks) with out of network providers who I paid for via an FSA so at least it was paid for with tax-free dollars. But it's ridiculous how much many I spend on a healthcare benefit that is supposedly included in my plan.

I get it, this is what insurers do. But I tell you what, when I take my kid to the pediatrician or see a PT for backpain, I don't have to jump through these hoops -- they charge me the co-pay and we all move on with our lives. It is a problem specifically with mental health services and insurance companies are at the core of the problem because they, for all intents and purposes, run healthcare in the US. We have crap mental healthcare here because that's how insurance companies want it. Think about that next time poor mental health gets blamed for crime, violence, parenting fails, etc. -- we make it as hard and expensive as possible for people to access this care, all so insurance companies can avoid paying a therapist with 20 years of experience who is genuinely great at her job $115 for an hour of her time, at least a third of which will be eaten up by overhead and administration anyway. [b]When's the last time your insurer paid for a $1000 lab test or doctors visit on your plan without a fuss, but apparently a little over $100 for a qualified professional specializing in mental health is too much to bare.

I hate insurance companies. They are making us all sicker[/b].[/quote]

Look, I hate insurance companies with a passion. But that $1000 lab fee isn't going to happen every week for a year. [/quote]

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