[PsychTau2]

So here's what little bit I know from working in the psych hospital and having to talk to insurance companies (joy I tell you...sheer joy):

When a doctor is a "participating provider" or "in network", they have a contract with that insurance company that specifies how much they charge for different services and how much payment they are willing to accept from that insurance company (same thing goes for hospitals and labs and such). That's why you'll see an Explanation of Benefits that has some astronomically high fee for an office visit (which is what the doctor would charge someone who isn't using insurance...we had a psychiatrist who would charge $300 for an initial visit), then it will have something that says "allowable charges" which is the maximum amount that doctor can charge those insurance customers (this number can be different between insurance carriers, btw), then it goes into the deductibles and % that your plan covers, and finally leaves you with the amount that you owe (which in theory should be the % of the allowable charges that your policy doesn't cover). Some doctor's offices get their payment from the insurance company, then turn around and bill the patient for the part of the original, cash office fee (the $300) that isn't an allowable charge. So they're still trying to get their $300 from someone.

I've found that insurance companies and doctors are resending bills and statements over and over again, hoping to catch someone who isn't paying close enough attention (or doesn't have the time or brain power to sit down and ask 10,000 questions to get it straightened out), and who will simply write a check and send it away. The more you get copies of bills and statements (from both companies) and ask questions, the less chance you have of actually paying.

I would also get a copy of your policy (the small print document that talks about exclusions, etc) and see what it says about allowable charges. Some insurance networks specifically state that the doctor CANNOT bill their patients/customers for more money in order to get more than the allowable amount. Meaning if the psychiatrist who charges a non-insurance person $300 has signed a contract with QCA Insurance to only bill QCA patients $150 for an office visit, they can't get more than $150 from ANYBODY for that office visit (they can't try to rebill the patient for the extra $150).

Ask lots and lots of questions, and ask them repeatedly. And don't let those CSRs on the phone back you down. Good luck!!!

PsychTau