Psychotherapy coverage
I have surest. In their plan it says that there is a 100 dollar copay for out of network psychotherapy. My therapist charges 275. I know that’s a lot and I am not interested in seeing someone else, as I have seen her for almost 10 years, she is extremely qualified, and she has counseled my whole family. When I submitted the claim surest only covered 11.95 of 275. When I reached out to them this was their explanation:
“For this service, the current allowed amount is $111.95 per visit, however copays are reviewed yearly and do sometimes change. It is possible in the future that the allowed amount may increase or your estimated Out-of-Network copay for the service may decrease.
Once your Out-of-Network Out-of-Pocket maximum limit is reached, Surest would cover your copay portion of the claim for the rest of the benefit plan year. Please keep in mind, only the copay portion of the claim applies to this total. Balance billed amounts do not apply to your Out-of-Pocket maximum; for example, on this claim only the $400 copay portion will be considered and the balance billed portion of $652.20 would not apply towards the Out-of-Pocket maximum.
That is correct, your $100 copay per visit would be covered or waived by Surest for the remainder of the plan year once your Out-of-Network Out-of-Pocket Maximum amount of $10,000 is met.”
Do I have any recourse for an appeal? Or is there anything I can do to get a higher amount covered? Also the fact that the allowed amount is 111.95 is ridiculous considering average therapy in my area is minimum 150-175.
Thanks!