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going out of network

greyt00greyt00 member
in Special Needs
My occupational therapy center has gone out-of-network, supposedly.  The center started posting notices about it a few months in advance.  It seemed very certain.  This should have gone into effect as of September.  Well, September claims (3 weeks worth have been processed) are still getting the more favorable co-pay billing.  The directory on the insurance web site says the center is in network.  Does anyone have experience with something going out of network but the billing didn't change accordingly?  The center is charging us according to what is "supposed to be" happening, so they're essentially sitting on our money, waiting for insurance to figure it out and re-process.  I don't trust the people who answer the phones at the insurance company.  I've been through such he** with them, regarding ABA coverage.  Maybe questions about this network thing would be more likely to get accurate answers. Supposedly the insurance company has up to 2 years to go back and fix the charges.  No, I really don't think the OT place is trying to $crew me.  I'm just wondering now if there was some miscommunication.  Anyone been through something like this?  Only reason I haven't called is A) stupidly hoping they won't notice for 2+ years and we get off lucky and B) calling them is like getting teeth pulled without anesthetic.

 
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Re: going out of network

  • greyt00greyt00 member
    The dates of service are September.  It's really pitiful if the directories are so slow to be updated.  And it's really pitiful that information I get from them, in any capacity, is so unreliable.  I don't get why this is so hard.  I will probably call them by the end of October to ask because if they really are out-of-network, and we stay on this insurance next year, we are dropping from twice per week to once per week.  :(   I hate to do it, but this is not the only negative factor.  Thank you for sharing your experience.  

     
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  • greyt00greyt00 member
    edited October 2014
    The whole thing is so stupid.  The reason they are out of network is that Cigna took on a 3rd party to do its contracts for physical and occupational therapy.  That company offered a rate of TWENTY PERCENT of what they used to get.  No one could afford to take that.  I assume they lost many other providers, too, though until they update their stupid directory, I can't see if anyone is left in network.  If no one is left, that's insane, they cannot do that.  But this is the kind of cra* I need to get used to, I suppose.  I can deal as long as we have ABA coverage.  So I hesitate to draw too much attention to my account by whining to my insurance company about less expensive items while ABA Is being paid for.  Maybe I shouldn't be so afraid, but I just am.  I always fear that bringing something to their attention will put me in an even worse position.  I guess right now there is too much to lose.  Currently worrying whether DH's plan will put the ABA provider out of network or drop ABA altogether, and worrying about how much premiums will go up. 

     
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