My Therapist Said He Was In-Network. He’s Not. Am I Obliged to Pay Out-of-Network Rates for Past Sessions?

By Health Consumer News Staff
Published July 30, 2025

Imagine booking a therapy session, reassured by your provider that they’re in-network with your insurance, only to later discover they’re not. This frustrating scenario is all too common, leaving patients grappling with unexpected out-of-network bills for sessions they assumed were covered. If you’re wondering whether you’re obligated to pay these higher rates for past sessions, here’s what you need to know.

The Problem: Misrepresentation of In-Network Status

When a therapist or healthcare provider incorrectly claims to be in-network, patients can face significant financial surprises. In-network providers have contracts with insurance companies to offer services at negotiated, lower rates, while out-of-network providers typically charge higher fees, with patients responsible for a larger portion of the cost. A provider’s misrepresentation—whether intentional or accidental—can lead to bills that are hundreds or thousands of dollars more than expected.

For example, Jane Doe, a 34-year-old from Chicago, scheduled therapy sessions after confirming with her therapist’s office that they were in-network with her Blue Cross Blue Shield plan. After six months of weekly sessions, she received a bill for $2,400, reflecting out-of-network rates. “I felt blindsided,” she said. “I trusted their word and now I’m stuck with a bill I can’t afford.”

Are You Obligated to Pay?

The answer depends on several factors, including state laws, your insurance policy, and the specifics of the provider’s misrepresentation. Here’s a breakdown:

1. Provider Misrepresentation: If the therapist explicitly told you they were in-network, you may have grounds to dispute the out-of-network charges. Misrepresentation can be considered a breach of trust or even a violation of consumer protection laws in some states. Document any communication (emails, texts, or notes from phone calls) where the provider confirmed their in-network status.
2. Insurance Company Policies: Most insurance plans require providers to verify their network status. If the provider was mistaken or misled you, your insurance company may intervene. Some insurers will honor in-network rates for past sessions as a goodwill gesture, especially if you can prove the provider’s error.
3. State Laws and Regulations: Some states have laws protecting consumers from “surprise billing” or provider misrepresentation. For instance, New York’s Surprise Medical Bill Law requires insurers to cover out-of-network charges at in-network rates in certain cases where patients were misled. Check your state’s department of insurance website for applicable protections.
4. Your Actions: If you signed a financial agreement acknowledging out-of-network rates, you might be held liable for the charges, even if the provider initially misled you. However, if you relied on their verbal or written assurance of in-network status, you may have a case to negotiate or dispute the bill.

Steps to Take

If you’re facing this situation, act quickly to protect your finances:

• Contact the Provider: Request an explanation in writing for the out-of-network charges. Provide evidence of their in-network claim, such as emails or call records. Ask them to adjust the bill to in-network rates as a resolution for their error.
• Reach Out to Your Insurance Company: File an appeal with your insurer, including documentation of the provider’s misrepresentation. Ask if they can process the claims at in-network rates or offer a one-time exception.
• File a Complaint: If the provider refuses to budge, file a complaint with your state’s insurance department or consumer protection agency. They can investigate potential violations of state law.
• Seek Legal Advice: For large bills, consult a consumer attorney or legal aid organization. Some states allow patients to sue for deceptive practices, potentially recovering damages or voiding the out-of-network charges.

Preventing Future Issues

To avoid similar problems, verify a provider’s network status directly with your insurance company before starting treatment. Ask for confirmation in writing, and double-check any provider’s claims through your insurer’s online portal or customer service line. Keep records of all communications to protect yourself in case of disputes.

The Bigger Picture

This issue highlights a broader problem in the U.S. healthcare system: lack of transparency in provider networks. A 2023 study by the Kaiser Family Foundation found that 1 in 5 insured Americans faced unexpected out-of-network bills due to provider errors or outdated insurance directories. Advocacy groups are pushing for federal legislation to strengthen protections against surprise billing, but for now, patients must navigate this complex landscape themselves.

If you’re caught in this situation, don’t panic. Gather your evidence, contact your insurer and provider, and know your rights. With persistence, you may be able to avoid paying those out-of-network rates for sessions you thought were covered.

Have you faced a similar issue with a healthcare provider? Share your story with us at news@healthconsumer.org.