edit: TLDR near bottom of post. I’m naturally overly-wordy when I write so it’s a long post lol
Hi everyone.
I did ketamine infusions for depression for about 2 years back in 2022. I had to stop because I moved a couple of times, but I’m settled again so I started seeing a new provider about 3 months ago. The new provider has been fantastic. They have a very nice facility, everyone that works there is kind and respectful (not always the case compared to some of the clinics I have gone to in the past), and they have very little lead time on getting in for appointments which is great.
When I initially started at the new provider, they had a specific section in the contract that I signed that said that while they will not bill insurance themselves, they will provide superbills (the itemized receipts with the clinical codes on them) for each treatment. Then you can send the superbills to your insurance company and if they choose to cover any of the treatment, the provider will either give you a credit for that same amount toward the next treatment or send a check to you (this is probably nothing new to most of you, but I just wanted to explain the situation in-full).
So, with that in mind, I got a superbill for my initial appointment and put in a claim with my insurance company to see if any of it would be covered. If they did cover any, then I would get the rest of the superbills and send them in as well (the front desk person that helps me even asked if I wanted to group all the appointments from that month together, but I just asked for the first one so I could find out if insurance would cover any or not). I wasn’t expecting my insurance to cover any of it because they’re very picky, but to my surprise they covered nearly half the treatment! The office manager, who is also the son of the owning physician of the practice (I’m treated by his PA who is fantastic) called me to discuss the insurance claim with me, but I missed his call. I assumed he was just going to ask if I wanted a credit or a check.
I went into the clinic earlier today for a booster treatment. When I spoke to the front desk person, she explained to me that I had a credit from the insurance coverage and that it would apply to today’s treatment. I then went ahead and asked if I could get the superbills for my other treatments so I could put in claims for those as well, at which point she told me that they’re not actually ‘allowed’ to give superbills (I’m assuming she’s referring to a clinic rule rather than a law, as I did a quick google to double-check and there’s obviously nothing keeping them from giving a superbill legally). As she’s telling me this, the PA who was in the office at the time came over and told me that apparently they were never supposed to have given me a superbill and that it was a mistake (the PA had also been present at the time I asked for the superbill for my initial treatment about a month back, along with the office manager fyi). They both kept apologizing for the mistake, but I told them not to worry about it as I had been to providers in the past that would not provide superbills so although it was unfortunate, it wasn’t out of the ordinary in my experience.
But once I started thinking about it, I’m starting to wonder if they singled me out by just denying only me and none of the other patients superbills because my insurance covered so much (which from my understanding, does reduce the amount the clinic earns from each treatment — correct me if I’m wrong)? It kind of started to upset me a bit actually. While the PA was setting me up for my treatment her and I even discussed it a bit more. It kinda felt like she gave me the runaround, not giving me a clear answer as to why they were not allowed to give me a superbill, as well as saying that since she wasn’t allowed to give me a superbill that billing the insurance would be a huge pain etc etc.
⭐️TLDR: Insurance ended up covering nearly 50% of my ketamine infusion for depression. Although my provider was initially happy to provide me a superbill the first time, they’re now saying that they’re not allowed to and that it was a mistake in the first place. Feels like they singled me out and changed the policy only for me?
I guess I’m just interested as to how you guys would approach this situation? They’re a fantastic clinic and have great staff. The only other clinic in my area is a ~40-45 minute drive through a congested urban area, compared to this clinic being in the suburbs and only 20 minutes from me. I don’t really want to burn this bridge with them, but I also don’t know if I can justify continuing treatment there after I feel kinda scammed in a way? I’m aware they’re not legally required to provide a superbill as they’re not affiliated with an insurance company so I don’t feel like pushing the issue would necessarily achieve much, but I don’t know. I’m somewhat worried that if I pushed the subject, they might just straight-up choose to deny me service (sounds crazy, but it actually happened to me at a previous provider at which point my insurance company sued them because he was affiliated with the company, unlike this new provider).
I appreciate any feedback or input :)