Anonymous wrote:

Anonymous wrote:Tell him you're sure both of you want to make this right. Then figure out how much you're owed, and let him know you'll take that as a credit to count against future sessions.

Be calm and matter of fact. Emphasize the importance of honesty in a therapeutic relationship. If he cooperates, he might be a keeper. If not, you've had time to find a new doctor.
-Psychologist

I would not trust a mental health professional that uses deceit in this way, I would terminate the relationship as soon as I found a replacement (only because I know it’s very difficult to find a psychiatrist if it was a specialty, that was easy to come by they would be fired and reported right away)

I plan to terminate, but it’s going to take some time to find someone with fertility/perinatal expertise.

Anonymous wrote:Sorry, that seems frustrating by the insurance company if they are processing some as in network, and some as out of network.
It’s still only mid-April, so it may be taking some time for the doctor to be fully set up under the insurance with his own practice if he just started in January. For the first 11 visits, insurance reimbursed you 70% each—so roughly $175 per visit. The last three were processed as in-network, which means you’re only responsible for the coinsurance instead of the full $250. It might be best to contact the office billing department to reconcile the account and request a credit for any overpayment. Also maybe request the insurance company to reprocess the first 11 claims as in network.

OP said It was 70% of the allowed amount, which is probably much lower

Anonymous wrote:Tell him you're sure both of you want to make this right. Then figure out how much you're owed, and let him know you'll take that as a credit to count against future sessions.

Be calm and matter of fact. Emphasize the importance of honesty in a therapeutic relationship. If he cooperates, he might be a keeper. If not, you've had time to find a new doctor.
-Psychologist

I would not trust a mental health professional that uses deceit in this way, I would terminate the relationship as soon as I found a replacement (only because I know it’s very difficult to find a psychiatrist if it was a specialty, that was easy to come by they would be fired and reported right away)

Something adjacent happened to us with a psychologist. We had been going to them because they were in network on our insurance. But, then they informed us that they would no longer be taking the insurance and we would have to pay out of network, but they kept trying to assure us that they cost to us would be the same. It was odd, because I understood that we would have to pay a large out of network deductible first, and then that the UCR on the visit would be lower, thus lowering the percentage insurance rate (which would be like 30% instead of a copay which amounted to 15%), so I knew that they were misrepresenting how much we would get back.

The financial deception made me so uncomfortable that I decided not to keep using that psychologist.

OP here. The odd thing, especially, is that I now know from the in-network EOB that the negotiated rate is $228. So my doctor was engaged in all these shenanigans for an extra $22 per visit. I assumed the in network reimbursement had to have been much lower.

Tell him you're sure both of you want to make this right. Then figure out how much you're owed, and let him know you'll take that as a credit to count against future sessions.

Be calm and matter of fact. Emphasize the importance of honesty in a therapeutic relationship. If he cooperates, he might be a keeper. If not, you've had time to find a new doctor.
-Psychologist

Anonymous wrote:

Anonymous wrote:Sorry, that seems frustrating by the insurance company if they are processing some as in network, and some as out of network.
It’s still only mid-April, so it may be taking some time for the doctor to be fully set up under the insurance with his own practice if he just started in January. For the first 11 visits, insurance reimbursed you 70% each—so roughly $175 per visit. The last three were processed as in-network, which means you’re only responsible for the coinsurance instead of the full $250. It might be best to contact the office billing department to reconcile the account and request a credit for any overpayment. Also maybe request the insurance company to reprocess the first 11 claims as in network.

There’s no office billing department. Hence the awkwardness. Also, like 5 visits I had to pay in full with no reimbursement because of the separate OON deductible.

He owes you this money. You and he need an agreement of how you will be reimbursed. Personally, I would prefer to be paid back in full and would have already created and submitted an accounting of every cent. and I'm not an accountant, just someone who doesn't want anyone messing with my money. If he reimburses you immediately, and he is otherwise a good psychiatrist, then keep seeing him. Get that money back, though!

Anonymous wrote:Sorry, that seems frustrating by the insurance company if they are processing some as in network, and some as out of network.
It’s still only mid-April, so it may be taking some time for the doctor to be fully set up under the insurance with his own practice if he just started in January. For the first 11 visits, insurance reimbursed you 70% each—so roughly $175 per visit. The last three were processed as in-network, which means you’re only responsible for the coinsurance instead of the full $250. It might be best to contact the office billing department to reconcile the account and request a credit for any overpayment. Also maybe request the insurance company to reprocess the first 11 claims as in network.

There’s no office billing department. Hence the awkwardness. Also, like 5 visits I had to pay in full with no reimbursement because of the separate OON deductible.

Sorry, that seems frustrating by the insurance company if they are processing some as in network, and some as out of network.
It’s still only mid-April, so it may be taking some time for the doctor to be fully set up under the insurance with his own practice if he just started in January. For the first 11 visits, insurance reimbursed you 70% each—so roughly $175 per visit. The last three were processed as in-network, which means you’re only responsible for the coinsurance instead of the full $250. It might be best to contact the office billing department to reconcile the account and request a credit for any overpayment. Also maybe request the insurance company to reprocess the first 11 claims as in network.

I am a solo practice therapist and can understand the struggle to make ends meet by accepting insurance. Big companies negotiate to pay less than half the typical cash rate, meaning 100 or so instead of 250, minus all my overhead in licensure fees, continuing education, malpractice insurance, etc. Not to mention I spent years earning multiple advanced degrees. Teens are out here charging $100 for Algebra II tutoring and don't have to deal with any of the headaches therapists do. It's disheartening. Finding and filling one's practice with cash-pay clients outside of insurance is every provider's dream (and there are lots of scammy courses out there on how to do just that.) Having a balance of insurance clients and cash-pay clients is how many of us make ends meet.

HOWEVER

What your therapist did is absolutely unethical and, I suspect, illegal. If they are in-network with your insurance they cannot charge you the cash rate. It's already negotiated when a provider agrees to be paneled with an insurance, we are accepting their lower reimbursement rate. It finally caught up to them, obviously, but this is not a person to be trusted with your emotional well-being. They obviously were more concerned about their own financial well-being than yours.

I'm sorry this happened to you, OP.

Your health is more important than 2K. Find another provider. And then gather the necessary documentation and see what you can claw back.

Once you find a new provider, you can report him to the medical licensing body and also your state insurance board (in DC it's disb; don't know about other places). You can also send him a letter saying if he doesn't refund the money you will take him to small claims court.

Hopefully you used check or card and have record of each payment. This is reprehensible.

I’d report this to the insurance and his licensing board

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 future 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).