Location: California
In February of this year, I started therapy. I looked to see what therapy services my insurance offers in network and selected one. Prior to my initial consultation, they ran my insurance to get a quote and I received an email stating that I have $0 patient responsibility for these services. Once I was set up with a therapist, in the online portal, I needed to set up a payment method and was told that I’m not going to get charged for services, but it was needed in the event I cancel a session without a 24 hour notice (late fee). I put a credit card on file and started receiving weekly sessions.
Here’s where the issue came: I maxed out the credit card and this week, I get an email saying that the payment for my session failed. I go in my portal and I am greeted with a balance of $2,400. I check my credit card’s past statements, and found no charges from my therapy provider since starting therapy. I email the billing team, letting them know that I was quoted a $0 patient responsibility and was never notified of any balance due or automatic payment since receiving care. They tell me that the bill is due to my insurance processing claims towards my deductible (for context, my plan’s deductible is $2,000, and is then processed at a 20% coinsurance rate), I am responsible for my bill, and to check with my insurance for policy details. Additionally, they added a blurb that was also included in the initial quote email stating that the company “assumes no liability for any errors in [the] quote, nor is it a guarantee of coverage or payment.” Cool, so I know that they aren’t liable for the misleading quote and I need to watch a video on insurance.
My question is, can I take any action against the company for not notifying me of my bill for each time I received care, which led to a large amount accumulated unknowingly? It was only after this time did I start receiving any communication about my balance due.
Comments
You signed a contract with your provider that you would pay the balances due. You have a $2000 deductible that’s route almost always going to meet before the 20% kicks in and your costs go down. You have an explanation of benefits that is created every time you have treatment and they are usually mailed to you unless you opt to have them emailed. You also have access to the portal, website, or app of your provider and your carrier which also gives you a running total.
You owe this money.
In the future, never rely on your provider to provide insurance information, like the amount due. Always ask your carrier. Always. But if you haven’t met your deductible and max out of pocket, almost every service you have will have an associated cost unless the service is preventive. Labs are not preventive. Few services are preventive. And your benefits book likely also stated the cost of therapy visits for your plan.