Can anyone please please help me understand this? I’m 21F, never taught anything, don’t know who to ask

Claims/Providers Forum
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21F - Utah, U.S. - Gross Annual $38k - Family Deductible Plan

I made an appointment in June at an in-network psychiatrist office. The first appointment was an hour long general “psych assessment” and when I called the office to ask how much the appointment costs, the woman told me it’s about $250. The monthly follow up appointments are only 30 minutes, but I didn’t ask about cost for those assuming it’s cheaper than the first appointment.

This psych office requires payment of $120 at check-in of each appointment for patients on a deductible plan, which I am. My deductible is not yet met, not even close actually so my insurance shouldn’t be covering anything yet.

My insurance claim for my first appointment and second follow up appointment were processed together at the same time. On my EOB for the first appointment, it shows the billed amount as $269, provider discount $179.55, patient responsibility $89.45.

For the second appointment on that same EOB, billed amount is $137, provider discount is $78.34, patient responsibility $58.66.

So what i’m wondering is, since I paid $120 at each appointment, ($240 total) is that included in the “billed amount” section? Was my entire appointment $269 + the $120 I paid? Or just $269 total? If it doesn’t include the $120 that I paid, does this mean that I overpaid because of the provider discount amount shown?

The total billed amount for both appointments shows as $406, total provider discount $257.89, remaining patient responsibility $148.11. But if I paid $240 at the appointments, did I overpay by $91.89?

Or is it that the $120 is excluded from the “billed amount” on the EOB and the actual total including it is $646, minus provider discount $257.89, minus $240 paid at app. making the remainder $148.11 and that is the rest that i’m responsible for?

If I did overpay, do I get reimbursed by the psych office? I have not yet received a bill from them. I also don’t know if this is something I should be asking my insurance or the psych office to get clarity on.

Thanks in advance for anyone willing to help. This stuff is so confusing and stressful.

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Based on what you’ve written, it seems that the insurance didn’t pay anything. You should get a refund from the psychiatrist’s office since you paid more than your responsibility.

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Yes, nothing was paid by insurance. Is a refund something I will have to ask for from the psychiatrist office or is it something they have to automatically to send me?

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If you think you haven’t met your deductible, call the insurance company to check your claims and benefits. Then, contact the provider’s office. Some plans don’t apply the deductible to outpatient mental health, but it sounds like you think it does.

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Yes I double checked before I made any appointments, under my plan it’s 80% after the deductible

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You probably overpaid. Ask them for a refund, or if you plan to keep seeing the same provider, ask them to credit it to your account. If they have a different interpretation of the EOB, contact the insurance company.

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I went through a similar situation a few times.

Honestly, I eventually stopped going. If I couldn’t trust them with money, I couldn’t trust them at all. The insurance statement clearly shows what they can charge you. They made an agreement with the insurance company, but they charged more.

Ask them to explain and refund the overpayment. It shouldn’t take long.

If you need the treatment, you might have to pay the higher prices, but I doubt you’ll get any money back. I decided I could manage without their help.

On my last visit, they asked me to schedule more appointments to “talk about it.” I declined because I felt they weren’t being ethical. They gave the impression that any excess would be refunded or credited, but that didn’t happen.