Insurance incorrectly sent reimbursement of self-pay claims to my therapist instead of me.

I had been seeing a therapist for about year who has her own private practice and does not take insurance. I would pay for her services every week out of pocket, and each month she would send me a super bill. The super bill along with a self-pay claim form would be submitted to HMC HealthWorks, the company listed on my insurance card for behavioral services. Apparently, HMC HealthWorks only determines the amount to be reimbursed based off of negotiated rates for the specific service codes. This information is forwarded to Southwest Service Administrators, the company that ultimately determines if the funds are to be distributed from my unions health and wellness trust fund.

I received an email from my former therapist that she received a check in the mail payable to her from my insurance company. Since the funds don't belong to her because she has already been paid in full for her services, she shredded the check and told me I should contact my insurance company to resolve the issue. My insurance company says the information they received from HMC HealthWorks indicates that my former provider is the one that submitted the claims for reimbursement, but that's not true, I did. Their suggestion was to seek reimbursement from my provider; however, she shredded the check, and she also mentioned potential tax implications and ethical issues, which I don't know much about. Interestingly enough, when I look at the EOB of my claims submitted online, some of them say paid to provider, and others show paid to participant and I have received one reimbursement check. I'm not sure what the discrepancy is that is leading to some of the reimbursement checks being sent to me, but most of them going to my provider. Any ideas of what I can do?

See also  Health insurance marks 'surplus' as Covid-19 cuts other medical costs - Korea Biomedical Review

submitted by /u/NoRiskItNoBiscuit
[comments]