u/HotSauceHigh

(updated below)

First of all I am in therapy partly for trust issues and paranoia with women. So keep that in mind.

I have Anthem bronze pathway epo in California. (I just chose the cheapest possible plan. $741🙄)

The insurance only covers in network providers.

I met my out of pocket max and the EOBs say I owe $0 now. I just realized that my credit card has also been getting charged $200 per session by the therapist.

Based on the emails I agreed to her billing plan. I wasn't absorbing it though. I was thinking sure, whatever, I'll meet my OOPM soon and then it will be $0, like everything else.

I chose her because she's in network.

This situation fits what I've read about balance billing. I have a hard time believing that my 50+ yo therapist would do something illegal like this. I can't believe she wouldn't know the laws. I don't trust her but she's smart. Rationally this seems far fetched.

From anthem:

"Dear Valued Member: Thank you for your secure message. We understand how concerning it is to be billed when your Explanation of Benefits (EOB) shows no member responsibility, and we appreciate you bringing this to our attention.

Upon reviewing your 2026 claims submitted by x, most of the claims indicate no member responsibility, which means you should not owe anything for those services.

We found only two claims where a member responsibility was applied: Claim number x (Date of Service: 03/05/2026-03/09/2026) Member responsibility: $180.00 Claim number x (Date of Service: 02/24/2026) - Member responsibility: $60.00

If you have already made payments that correspond to these two claims, then any additional charges from this provider may not be accurate.

For the other claims that show $0.00 member responsibility, we recommend that you share a copy of your EOB with your provider, as it reflects how the claims were processed.

Sincerely, Elaine S.

Customer Service Representative"

What should I do? We are supposed to meet on Tuesday.

**UPDATE:** I cancelled our appointment and asked for a breakdown of charges, in a neutral way, implying anthem must have messed up. Anthem again confirmed she should not be charging me.

Her stated rate is $235. Anthem has been giving her $97.87 per session. So she's taking home $297.87?? she wants me to believe that anthem only gives her $35, and that balance billing is ok? I can't believe this. does she think I'm dumb and rich? is she dumb, or a thief? she was kind of a decent therapist!

My claims history shows that she has submitted 10claims. Each claim shows multiple sessions each day. totaling 19 sessions.

She charged me $198 the first 3 charges and $200 the last 2. 5 total charges to my credit card which aligns with the number of times I remember seeing her. I have not seen her 19times and I've definitely never seen her 3x in one day. I never got any kind of receipt with the charges. I just noticed them. Is it common to not send a receipt?

**UPDATE 2:** a lot of her claims were on dates I was gone on a trip for a month taking care of a dying family member.

The very first claim for a 60 minute therapy session for which Anthem paid her $97.87 was actually our 14m48s introductory phone consult (she had flaked twice. She was 9th on my list and no one else was available. Should I just keep seeing her...?😑)

**UPDATE 3:** I sent Anthem screenshots of texts, emails, and phone history showing her first claim was a lie, and that I was out of the country during a majority of her other claims. I cannot believe I was out of the country with my dying mother, with no return date, and this woman was using my name to make hundreds of dollars. What the flipping fuck. I want to be HER therapist and analyze her pathology. Also, she gave away my time slot while I was gone with no conversation, and I was hurt but I decided to respect that I couldn't expect her to hold a spot for me when I left and stopped communicating. Ha! I wonder if I had never reached back out, how long she would have kept pretending we were having sessions.

**UPDATE 4** Sent by: Anthem Support

"Dear Valued Member:
Thank you for your secured message.

I’m really sorry you’re going through this, it can be very upsetting and confusing to see charges and visit records that don’t match your recollection, especially when it involves multiple charges to your card. We understand your concern, and we appreciate you bringing this to our attention.

Please be advised that we process claims exactly as they are billed and submitted by your provider. Claims are reviewed based on the information received, your plan benefits, and the provider’s network status. Anthem also follows the provider’s contract to determine the allowed amount and how much is applied to your responsibility, such as deductible, copayment, or coinsurance.

For specific details about the billing codes used and the charges submitted, we recommend contacting your provider or facility directly, as they can explain how the claim was filed and the amounts billed for each service.

If you believe your claims were not processed correctly, you have the right to request a review by filing an appeal, and we’ll be happy to guide you through that process.

Appeals must be submitted within 180 calendar days of the last processing date. Please include your member identification number, the claim number in question, the details of your appeal and any additional medical information or documentation supporting your appeal. For a standard appeal, a decision will be made within 30 calendar days after the receipt of the documentation.

You can send appeals by mail to the following address:..."

Sounds like Anthem wants me to do a load of paperwork when I've already submitted evidence of fraud. :( I asked them to forward to their fraud department. TBD.

**UPDATE 6**

From therapist responding to me asking for a breakdown of her charges:

"Hi x,

Thank you for sending this, and thank you for following up with Anthem. Yes, it’s completely fine to skip tomorrow.

I’m going to look into the insurance issue on my end and see what I can find out about why Anthem is showing $0. Once I have more clarity, I’ll get back to you.

Warmly, x"

🤨

me:

"Thanks x. Can you send me a superbill today explaining the details of the $198 and $200 charges?"

I just read her reflections email on our last session and it was so insightful and helpful. Maybe we can both compartmentalize her fraud...🫠