Posted by mair on January 9, 2007, at 12:22:38
In reply to You've got to be kidding..... Anne, posted by wishingstar on January 9, 2007, at 10:57:54
This stuff is confusing.
Unless, I'm misunderstanding what you're saying the reduced fee arrangement was based upon the fact that your insurer wouldn't cover your sessions. Under the best circumstances for her, she was entitled to receive no more than $70 per session and in fact she received $101 (your $45 plus $56, or one-half of the amount she got from the insurer.) Under the worst of circumstances, she was entitled to receive only what the insurer's "approved amount" was, possibly less than $70.
Since the lower rate was predicated on a lack of coverage, I think she has the right to charge $70 for the 2 sessions that were covered. Thus she would owe you at least $31 for each of the sessions covered by the insurer ($101 received less $70). I don't believe she can, under any circumstances, take the full amount of the check she got from the insurer and apply it against all of the other reduced fee sessions.
I really hate dealing with the insurance company and waiting for them to do anything. You can start there, but I might be inclined to write her a letter requesting that she remit the overpayment to you.
My own T is wonderful in many respects, but her understanding of insurer financial arrangements is, or at least used to be, rather limited. I discovered early on that she was overcharging me, not maliciously, but more because she really didn't understand the deal she had struck with my insurer. She simply did not understand that she wasn't entitled to bill me the full difference between her normal and customary hourly rate, and what the insurer paid her as a network provider. She was really only entitled to the difference between what the company paid her and the company's approved rate.
So maybe Anne thinks that what she's doing is ok.
mair
poster:mair
thread:720755
URL: http://www.dr-bob.org/babble/psycho/20070103/msgs/720775.html