Insurance Covered Some Therapy Visits but Not All

Hey everyone,

I broke my wrist a couple months ago and need physical therapy for it. I went to PAMF as I had my surgeries there and it was covered by my insurance. When making an appointment for the therapy, I asked for a specific therapist that I saw was covered under my plan (blue cross). However, the person I talked to said I should see another therapist that is a hand specialist and that everyone in the PAMF organization would be covered as they "bill as an organization, not as providers". Naively, I said ok and booked an appointment with the hand specialist without checking on the insurance's website.

I've seen the therapist 6 times so far and the first 3 visits were covered and had a $5 copay. I saw this on my account and was reassured that my therapy was covered and I got complacent. However, the latest 3 visits are being rejected by my insurance because apparently my provider is out of network.

I am unsure what to do and I'm honestly confused by the situation. If the provider really is out of network, why were the first 3 visits covered? I'm scared to mention this to the PAMF billing department or my insurance in case they decide to retroactively not cover the first 3 visits.

I now know I should've checked the insurance's website to see if the hand specialist was in network but I am new to this and should be less trusting ig.

What possible courses of action can I take to reduce the out of network charges? I would appreciate any feedback. Thanks!

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submitted by /u/_pratpratprat
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