Anonymous
Anonymous asked in Business & FinanceInsurance · 1 month ago

Not covered for therapist payment?

I had been seeing a therapist for nearly a year, during this time I switched insurance to a provider the therapist does not accept. Now around 9 months later and she is only telling me that I owe her over $4000 because none of the appointments since switching insurance were covered.

I’ve since found out that the onus is on the consumer to check with insurance if the provider they are seeing is in a network or contracted with the insurance company.

The therapist who runs the private business with her mother who is also a therapist now says that if I am not willing to pay, she will sue me through the small claims court for full payment. I have asked her if she would accept half payment but she is not willing to negotiate. It is known in our area that her business does very well so it is not as if she is in desperate need of money but for me, having to pay her $4000 out of pocket is going to put me in big financial trouble.

Colleague has little sympathy with me and says it was my responsibility to check with the insurance. He says:

1. Even if she is not in great need of the money it is completely irrelevant.

2. Whatever financial difficulty I’m going to be in is not her issue and she should give no consideration to that at all.

3. He would have no hesitation in suing me for the full cost.

Do you agree with the points colleague has stated, just seems very harsh to me. I would appreciate any opinions anyone has.

11 Answers

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  • B
    Lv 7
    2 weeks ago

    seems very harsh, ask for some type of payment process which they would go for

  • 4 weeks ago

    You pay for the services you received yourself.

  • DON W
    Lv 7
    1 month ago

    While she may not negotiate in terms of accepting a half payment, she may be willing to work out a payment schedule, such as $1000 a month for four months. That way she gets everything she is owed without the expense and bother of taking you to court.

  • car253
    Lv 7
    1 month ago

    Ask if you can make payments or put it on a credit card. This is a learning experience. See if your old provider may still pay for it.

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  • 1 month ago

    Your problem not the provider, YOU should have made sure you were covered, and my insurance company sends me a notice when a procedure I have is not covered and I am sure the provider sent you invoices as well.

    She does not have to accept a payment arrangement, the fact the practice is doing well is of no interest to the court. She will win if she sues you

  • 1 month ago

    His points are accurate. She is entitled to full payment if she wishes.

  • Judy
    Lv 7
    1 month ago

    Sorry you don't agree, but yes, I agree with him. on all the points.

  • lucy
    Lv 7
    1 month ago

    What most people do when they change insurance is to (verify) that their PCP, or any specialists are "in network" or (not).

    Are they telling you that insurance (won't) cover (any) appointments, or that this therapist is "out of network"? If they are out of network, then insurance would have paid them the (in network) price, which would leave you responsible for the balance of each treatment.

    You should have gotten an EOB from your insurance each month of your treatments. With the EOB, then it would show how much your insurance paid and the amount you would owe each month to be billed. Now there are (some) providers who will (not) bill insurance, but bill only the patient.

    Now during these past (9) months, you should have gotten EOB'S, or billings every month of the (recurring) charges and balance owed (each) month. If they (never) billed you or your insurance, then tell you owe $4,000, then that is a problem that you (might) dispute. But if I had to guess, is that you got the bills, ignored them, "thinking" insurance was going to pay?

    Yes, some providers can negotiate bills, but they are (not) required to do so. And yes they can sue you for the balance owed. My suggestion is to set up a payment plan of 6 months to pay them back.

    You just learned a very expensive lesson. Good luck

  • 1 month ago

    I agree with your colleague. Your failure to get the right insurance is not the therapist's problem. It is your problem.

    Everyone should live within their means and pay their debts, even if it means personal hardship. You may have to take out as loan to cover the debt.

    I think the therapist was negligent for not telling you about the unpaid bills sooner but they are within the law to sue you.

  • audrey
    Lv 7
    1 month ago

    Sorry. It was your responsibility to check. She provided you with a service. Now you have to pay.

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