Provider Insisting on Payment for Incorrect Claim
Hi all, hoping to get some help. To make a long story short I began seeing a new therapist and we have done two sessions. The first session my insurance processed the claim as her being out of network (which is incorrect) and the second session the claim covered as in network but apparently got attributed to a random place in a neighboring town (the provider on the claim just says “x Town location”). According to the current and incorrect EOB for the first session I am responsible for paying for the entire service ($190) and my insurance is reimbursing me for $125 of it. I talked to two agents who said that the first session claim was incorrect and is submitted for revision as my therapist is indeed in network. One of the agents told me to not cash the check as I would most likely have to send it back and not pay my therapist while this is being handled. The second session claim came back as fully covered by my insurance (I owe $0) with them paying my therapist $97, but as I said this was not attributed to my therapist and instead to a random place. My therapist says the check from the insurance company was sent to a random address in X town that she is not affiliated with.
My therapist is insisting that I pay her $125 for the first session (which isn’t even accurate based on my EOB) and $97 for the second session. We had verbally agreed that we would wait to see what insurance came back with but now she is requesting payment and says this is between me and my insurance. She says she has spoken to my insurance and both claims are finalized (despite me being told the opposite). I don’t know what will happen if I pay her for the first session and my insurance corrects the claim. Should I/do I need to pay her for the first session? Do I need to pay her for the second session? My insurance has said that I do not owe anything for the second session so if there is a mistake, in her words, it seems like an issue between her and my insurance. I’ll try to respond to comments if clarity is needed.
