My Doctor Charges Me a Copay When My EOB States My Out of Pocket Cost is $0

Hi forum…

I’ve been seeing a therapist since January based on a recommendation from a friend who also uses the same therapist. I have EmblemGHI insurance through the city of New York. I’m confused about the costs I’m being charged and was hoping for some advice.
Here’s the situation:

  • My therapist claims she is in-network.
  • She initially stated I needed to pay my $200 deductible upfront for the year, which I did.
  • I’ve been attending sessions once a week in person, and she collects a $25 copay per visit.

The confusing part is that my Explanation of Benefits (EOB) statements show that my out-of-pocket cost should be $0. Despite this, my therapist insists on the copay each visit.

When faced with billing confusion, I had a direct conversation with both the therapist’s office and my insurance provider. They were able to clarify why there was a discrepancy between what I was being charged and what my EOB indicated.

Best thing is to double-check with your insurance directly—sometimes they have different info than the therapist does. If your EOB says $0, you shouldn’t be paying. Give them a call, and if needed, bring it up with your therapist again.