TLDR:
Clinic quoted $10 per Spravato treatment after doing a Benefits Investigation with our new Anthem insurance. We continued treatment based on that. Months later we got bills for thousands for Spravato. They’ve ignored most follow-ups and refiled claims with different codes, leading to same or higher totals spread out differently. Has anyone successfully gotten a provider to waive or reduce charges in a similar “misquoted costs” situation, especially with Spravato? Did escalation with insurance help? Did filing complaints with any agencies help, like the state attorney general’s office, state department of insurance, or by filing a grievance with your insurance?
The whole deal:
I'm hoping to hear from anyone who's tried to push back on unexpected medical bills after a provider quoted low costs but later billed thousands. Esp. if you got them to waive the costs or successfully filed complaints with some organization. This is especially for Spravato (esketamine) treatments under the Buy and Bill program, though any experience would help. I think this would fall under informed consent, and they took that from us by telling us incorrect pricing.
My husband had been on Spravato for a year under old insurance. When we switched to Anthem in 2025, I specifically asked the clinic about cost changes. They performed a Benefits Investigation with our new insurer and quoted abt $10 per Spravato treatment and $30 office visit. We continued based on that.
Six months later, bills arrived for thousands on the first few visits after we changed insurance, and it looked like it was going toward our deductible before insurance kicked in. We weren't told of this, and the Spravato coordinator who did the benefits investigation told me she hadn't known about it. This contradicted what they told us about the Spravato program "paying down the deductible" for us. I sent emails to the clinic requesting them to look into it and consider waiving charges (at the recommendation of a billing rep who says they often do waive fees in these situations), and I also noted they'd changed billing systems the same month as our insurance switch and were using different codes than before (in case there had been a billing error).
I probably shouldn't have mentioned the codes, because instead of just waiving fees, they refiled claims (possibly with codes I suggested), but it just rearranged charges: now hundreds per visit spread across deductible and coinsurance. There had also been charges for some much older fees that we weren’t billed for until more than a year later, from the time of our prior insurance. I did get a manager to waive these old charges. But that frankly was the smallest part of the bill. I can’t get them to respond on waiving the Spravato charges from the last half of 2025. Those charges don’t even include a lot more that I saw in EOBs on the Anthem website that we haven’t been billed for yet, so more costs will be coming.
We're now requesting they waive these charges due to the incorrect upfront quote and lack of proper disclosure before treatment.
Questions for those with experience (with any treatment or medical provider):
Has anyone gotten a provider to waive/reduce charges in a similar “misquoted costs” situation?
Did it resolve directly with the clinic, or did you need to escalate (perhaps with a formal grievance with insurance, state agency, etc.)?
3. If you escalated, did it actually help, or just create more delays?
4. Any specific experiences with Spravato billing issues?
Any advice on what actually works (good or bad outcomes) would be great. Thank you!