out-of-network provider listed as in-network due to their old practice being in-network?

As background info: I used to see my therapist before covid at a group practice, but during covid she opened her own private practice and I now see her there. My insurance company changed at the beginning of 2024 and she let me know the new company was out of network for her private practice and that I'd need to do self-pay but can submit to insurance for out-of-network reimbursement. That is what we have been doing for a few months.

So imagine my surprise when my first claim was approved as in-network!?

After some digging I think I figured out why – the old practice I saw her at was in-network with them, and that is the address they put for her, instead of her new private practice address. Her new private practice address was provided to them when I submitted the superbills, so they were given that information already, and just didn't use it I guess? (I assume they just searched her name and selected what was already in their system instead of verifying her address?)

My question is… do I need to say anything to my insurance or my provider about this? They just mailed me a check reimbursing about half of what I paid, because of her being marked as in-network. While of course I am happy about getting reimbursement, my fear is months later them saying they made a mistake and making me pay them back. I see her every week so there will be many more claims submitted to them (one superbill per month).

I have searched this and not found anyone mentioning this situation before and wondering if anyone here has any info or ideas about what I should do. Thanks!

submitted by /u/akwaffle
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