Can someone explain the reasoning behind this for me, please?
I am in the process of finding a new therapist. I’ve met with several for initial consultations. I had used my insurance for my previous therapist, and was told that as long as a session was coded as an “office visit” the charge would be subject to co-pay.
What I didn’t realize (and wouldn’t have known to ask) was that if my consultations with potential new therapists are coded as “psychiatric diagnostic interview” then they are subject to my deductible and co-insurance.
This I now discover after having met with several therapists. This is AWESOME. I now have several hundred dollars of responsibility. Which pisses me right OFF. I DID call to see if I was covered. I would have made different decisions if this one very, very important distinction had been pointed out to me! How in the bloody hell am I supposed to be an informed consumer if the information I’m given is not relevant? How am I supposed to know what the different codes are and what they mean? And anticipate when they will be used and when they won’t?
What I want to know is, what is the rationale behind writing a policy this way? The way it looks to me, there is a very strong disincentive to use your mental health benefits if your first meeting is going to cost you $300 even if every visit thereafter is only subject to a co-pay. Why would a policy be written this way? I switched jobs and policies and as sucky as my old insurance was, it didn’t have this issue.
BTW, it’s only the PhD’s that this is true for. The LMHPs all have me coded as an office visit.
Chalk this up to yet another very expensive learning opportunity on how insurance works. My old therapist was covered, I assumed an office visit is an office visit. Why would I think otherwise? When I go to see a new physician, there is no difference between my first visit with them and every visit thereafter.
God, you try to do what you’re supposed to do (verify coverage) and then you get hit with hundreds of dollars in bills because you are neither an insurance worker nor a mental health provider, don’t do that kind of work, and didn’t know to ask “what if my consultation is coded as a psychiatric diagnostic interview? Will that make is subject to my deductible?”
I’m told I can appeal. Appeal what?