Posted by fallsfall on August 30, 2003, at 13:38:00
My company is changing health insurance companies on September 1. My company alway buys top of the line coverage.
I was thrilled to see my new therapist's name in the book. But when I told him who the new company was he said that he was not a provider for them (and then said something about a lawsuit that he had with them). Not encouraging.
A couple of weeks ago I called the new company to find out what their "Usual and Customary" fee was for therapy. When I read the literature it looked like they would pay 80% of anything up to their Usual and Customary fee (and if my therapist charges more, which he does, then I pay the difference). Insurance companies don't like to tell you what their Usual and Customary fees are - they tell you to submit a bill and find out that way (but that seems a little late to me - you've already incurred the charge or 6 weeks of charges before you get their answer). So being the pushy lady I am, I ended up talking to a supervisor for the Doctor's phone service line (they don't talk to patients...). She gave me a hard time for a while but then looked at the details of my policy and told me that there were no Usual and Customary charges for my policy - that the company would pay 80% of whatever my doctor charged. I asked her 3 ways to make sure I understood it right. This was too good to be true.
I told my doctor that my paperwork said that (for biological illnesses, i.e. Depression) there was no limit on the number of sessions. He didn't believe it, so I called to confirm. I was told that there was no limit as long as they were "medically necessary". They couldn't tell me how they determined this, but did say that I didn't have to pre-certify. So if I don't precertify, and there's no limit, how do they determine this?
But this time I was told that for my Out of Network therapist to submit a bill that he would have to have a "contract" with the insurance company. I asked if they could send me a copy of the contract - No. I asked if they could send him a copy of the contract - no. HE would have to personally pick up the phone to ask for this. He hates this company. He's not going to sign a contract, and he certainly isn't going to call them. So it looks like they will not pay 80% - they will pay 0. And that would mean that I would need to change therapists. (I just CHANGED therapists).
So I called a third time. This time I was told that I could submit a bill from him and the insurance company would pay 80% and he didn't have to have a contract.
Just tell me what is true!!!
So this morning I started trying to figure out what I would do if I really do have to change therapists. I just went through a therapist search, so I actually have 2 other candidates. They are both listed in the provider directory (but so is my current therapist...). So I went online to find out if they were currently registered with this company. Reading the instructions on my card and on the site in (what I thought were) reasonable ways, I found 3 different lists of providers. Unfortunately, these two therapists weren't on ANY of the lists (but my old therapist was, so I know I was searching the right way). This does not bode well.
Of course, since it is Saturday there is noone to answer the phone. But you don't know that until you have pressed "2", "1", "4", "6".
I am so frustrated that this is so hard. I am finding it impossible to do anything except search through the web site hoping I can find a morsel of information that will put my mind at ease.
Any ideas on how I can put this on a back burner until Tuesday? I'm terrified that I'll be without therapy. So I feel like I have to DO something to resolve the problem. But there isn't anything I can do!!!
ARGH.
poster:fallsfall
thread:255647
URL: http://www.dr-bob.org/babble/social/20030829/msgs/255647.html