Requesting help understanding out of network Behavioral Health Benefits
I have Optum for Behavioral Health under United HealthCare through my employer, which is HCA. I am a single person (no family on the plan). I am in network for my Psychiatrist, no issues, have a 30 dollar copy each visit.
I see a psychologist that does not file insurance (many reasons why) so is obviously not in network, but she is very good. I pay her when I go in, and she provides me with an insurance or FSA reimbursement sheet through the portal. I have maxed out my FSA this year so I thought I’d try to file with Optum just to see if they would pay for anything. Optum chat representative today assured me I had “no limit” for visits (seems odd, but okay) and that filing all these claims for the psychologist would NOT affect coverage of my Psychiatrist.
Ok. I see this psychologist weekly and it is 200 dollars every time. I had 2000 in my FSA and that was gone in 2.5 months. I feel like this means they will pay 25% of the 200 AFTER I pay 6750 for the year out of pocket plus 1250 deductible. This is what it says on the site:
When an out-of-network provider is used: Annual OOP
$6,750.00 Individual / $13,500.00 Family
Annual Deductible
$1,250.00 Individual / $2,500.00 Family
Copayment/Coinsurance
Indv: 75% Per Visit, Deductible Applies, Grp: 75% Per Visit, Deductible Applies
Auth Rule
Confirm by calling the number on the back of your card
If you could help me understand that, I’d appreciate it. I’m still going to enter in all the visits because any little bit of reimbursement will help, but it’s looking to me like it won’t be very much. Also, is the Out of network deductible combined with the in-network deductible, or am I starting over?
If you haven’t already, please edit your post to include your age, state, and estimated gross (pre-tax) income to help the community better serve you.: 51, Florida, 60k.
