I got new insurance this year through my state's insurance marketplace. They said my existing therapist was in-network. This was news to her. I called and spoke to them. They insisted. She called and spoke to them. They insisted.
So they've been paying her $150 a week for me instead this year. She doesn't know how she ended up being considered in their network as she practices solo, but here we are.
The system is vastly more convoluted than I think anybody on any side actually realizes it is.
I'll be honest, I've been really pleasantly surprised with mine. They cover mental health visits without a limit. They cover consultation with a dietitian without limit. They cover physical therapy at 60 sessions, no other questions asked.
They even have a number you can call when your doctor is recommending you have a procedure to find out where you can have it done at the lowest cost. It's staffed by "nurse navigators" whose job is to dig through their data and find what the average cost has been with in-network providers for other people with your plan and find out which one saves you (and the company) the most money. If you decide to go with one of their recommendations of your doctor's original one, they'll call both providers and arrange to have the relevant documents and approvals moved for you, and then they'll send you a gift card because you saved them money too!
It hasn't been flawless by any means, but it has really seemed like they're on my side and helping me through all this confusing stuff.
And I'm on a marketplace plan with cost-sharing reduction because I'm making sure my income ends up being just high enough not to be on Medicaid, but to get full subsidy plus CSR, so I'm paying <$50 a month for it with $0 deductible and <$2k OOP max.
I've decided they're what I wish all health insurance companies were like.
So they've been paying her $150 a week for me instead this year. She doesn't know how she ended up being considered in their network as she practices solo, but here we are.
The system is vastly more convoluted than I think anybody on any side actually realizes it is.