Provider got credentialed with insurance
So I am seeing a doctor for some IV medication treatments. Originally, they were out-of-network and I was paying out of pocket and submitting superbills to my insurance. My most recent superbill was processed as in-network, with a lower rate paid, and that is being sent to the provider rather than me. I asked the provider and they confirmed that they were trying to get credentialed with my insurance company but hadn’t heard, and will check next week.
So I guess my question is: what should I be expecting? Is the provider required to reimburse me the full amount that I paid them minus the copay? Or are they allowed to just repay me what insurance will pay?
I’m very confused why they decided to get credentialed in the first place – this is a treatment that health insurance companies usually will not cover and when they do, they will probably make like $50-$100 per hour instead of the $300-$500 they make now.
submitted by /u/skkipper0
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