I have recently left my group practice to go out on my own, and have realized that my former employer billed a particular insurance company (whom I'm out of network with) at $450 and they reimbursed at $241 until the max out of pocket was met, then $402. For the life of me I can't figure out why an insurance would reimburse at that rate. This feels like an ethical issue as I can't justify being paid $402 a session! Has anyone experienced this before? I also learned we were writing off the deductible for these clients, and it was justified because we were out of network and had no contract. Many of these clients with this particular insurance have followed me to my new practice and I'm trying to figure out how to bill. Any thoughts would be appreciated.
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