Following the insurance protocol and going in circles

[justTess]

I have had anxiety issues for 10 years.  My health insurance company changes yearly from my employment.  I am noticing this is just the nature of the field I'm in.  Anyway, I see a psychiatrist about 3 times a year for anxiety management.  When I followed the directions from this year's insurance customer service line... I was told to call another company because they took care of all mental health issues.  The other company refered me to the wrong type of counsoling clinic.  I had to call again and wait 10 days to get approval for a psychiatrist.  After the visit, the other company tells me I need to file with the original company because it is an SMI diagnosis for pharm management.  I call back the main insurance carrier who then tells me I need to go back to 2ndary company.  Finally, it gets sorted out and the main insurance company says they will take care of it, however, it is only covered 50% because the psychiatrist is not on their preferred list. >:(

Bottom line... instead of paying $75 for the visit.... It is costing me $300.00

Is there anything I can do to recoup this amount since I followed their directions and ended up with this mess?

[Amir Mostafaie]

Dear justTess,

It sounds like you have had some issues with getting your claims to the right department & now that the claims have landed in the right place, they are higher than what are used to! Also it sounds like your Doctor doesn’t contract with your new Carrier anymore (or he is out of network).
Unfortunately, regardless of going back and forth between your Carrier & a third party administrator, you are likely to pay more if and when you go out of network.
If you are responsible for 50% of the charges & that equals $300, your Psychiatrist is charging you $600 for the visit. If you have had a history with this Doctor, you might want to ask him if he will give you a break or a discount.

Sincerely,

Amir Mostafaie