CA: Mental Health provider is "in network" but not submitting bills to my MHSA

I love my current therapist, except for one thing. She works remote from Europe and while she is still very good during the sessions I can tell she has 0 interest in doing things outside of the session… including proper billing.

She gave my my favorite quote I have ever heard from a medical provider “This whole insurance thing is a mystery to me”. And I am sure it's just as frustrating to her as it is to me. And some of the reimbursement rates I have heard are a pittance but with respect it is her JOB to bill her clients insurance if she says she takes my insurance.

She has also said one mental health provider only reimburses like 40$ per appointment or something which I agree feels ridiculous.

I have heard many a complaint from her about how difficult it is to submit bills, reimbursement rates, so on and so fourth. Many times she promises to investigate or figure out how to submit something and these seem to be false promises.

The situation is this. I pay her and set up sessions with her through Alma. She "doesnt know how to bill" my insurance so she makes me submit them myself from a monthly superbill, fine.

However I just got my first claim back. My insurance is BlueShield of CA and when I started with her I did confirm on a phone call she was in network. Indeed she is in network.

Indeed the bill came back, it confirmed she was in network, but then says "this claim is not subject to deductible." with the reason being "Our records show that the Health Plan Mental Health Service Administrator (MHSA) authorized related services. The MHSA is responsible for processing all claims related to this authorization. The provider of services has been notified that they are responsible for submitting these claims to the MHSA."

Now Magellan health ive heard many complaints from her about. "My clients have experienced difficulty getting reimbursed by Magellan and so I wanted to be sure that we clear this up ahead of time." but my confusion is this bit I have read "If you are in-network with Magellan, you are in-network with Blue Shield MHSA" so what is going on here? Is there a separate deductible for Magellan? Is Blue Shield allowed to tell me she's in network and not answer questions about subcontracting? Has something actually went wrong here?

Is there some way I can submit these bills so they will be put against my deductible? If I cant submit them through Blue Shield is there somewhere else to send them?

What should I do?

submitted by /u/WiseImagination7998
[comments]