Therapist wrongly categorized as in-network
I’m two year into being on an Aetna HDHP in Massachusetts. It’s an employer-based plan and has decent out-of-network coverage, and we’ve hit the deductible/out-of-pocket max in the past. I have a therapist who is not in-network with any insurance, but eventually some of that would be covered under out-of-network coverage.
Last year their handling of my family’s claims got to be a total mess. There was an elaborate spreadsheet and many hours spent. In the midst of that, partway through the year, they suddenly started listing my therapist as in-network (even though she totally still doesn’t show up in their provider search) and started covering that seemingly at the lower ded/oop. But it was a mess, so I wasn’t 100% sure.
New year. I’m on top of things, getting claims submitted on time and jumping through all the right hoops. And….they still have her as in-network. I hit my deductible and they started covering 90%. So…
Tbh, with the mess of dealing with them, the idea of getting to correct even this seems daunting. But, if it’s a certainly they’ll do an audit at some point and catch this, then I should probably deal sooner rather than later, or at least account for the difference so I don’t get surprised by a huge bill. How does this usually play out. (How the heck did they even manage to screw up like this?)