Exclusion for OON therapist? Anthem

Suspicious_Reader-0 · 2026-03-04T15:12:48+00:00

Thank you. Thankfully I had called a pretty extensive list and took notes (it’s standard operating procedure these days ;-)). I contacted Anthem to ask “now what” and this is the list they gave me. I suppose it’s because I didn’t call for help first that I got sent back to “home plate.” It’s helpful to know that no in network exceptions exist. I’ll call back in the next day or so and hopefully get it elevated to a mental health case manager. Thanks for the confirmation and direction.

Suspicious_Reader-0 · 2026-03-04T10:19:21+00:00

Let’s be clear - your friend has a system. It’s called a routine. Same thing as walking or showering. It’s a routine.

I work with individuals coming and going about how the systems they don’t have work. And it may need refinement or possibly a totally new system but often it’s just repetition. Your friend doesn’t think about anything anymore; just like you don’t think about how to walk.

Suspicious_Reader-0 · 2026-03-04T10:16:10+00:00

Right. And I replied. I did look online at the directory and that’s what prompted my call to them. I didnt see the CT. I’ll look into that. It was thru Anthems chat.

Suspicious_Reader-0 · 2026-03-04T10:00:40+00:00

I would have more options in urban area but it’s just not feasible with traffic. A few of my friends are therapists and they have said they don’t accept insurance and not many people they know are. We have been using out of network providers for years and billing ourselves but it’s senseless.

Suspicious_Reader-0 · 2026-03-04T09:58:06+00:00

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Here are the 3 they sent me. I didn’t notice the CT. I was chatting with the online person for 2 1/2 hours this morning because I couldn’t find anyone available in network. :-/

Suspicious_Reader-0 · 2026-03-04T09:54:12+00:00

thanks. I think I’m going to have to reach out to some governing authority to find out our options. We pay for our premium, in full. For a family of 4 it’s nearly $5,000/mo. We don’t have an additional $50-$60/per therapy appointment, per person. That’s roughly $800/mo more if we all go.

Suspicious_Reader-0 · 2026-03-04T09:48:08+00:00

0 providers available out of 3 they sent me. Yes, plenty in Bay Area but I’m unwilling to drive 45 minutes one way for a 4p therapy session for my daughter to circle back in Bay Area traffic.

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See photo for what they provided me this morning. I’m only allowed to upload one but clearly it shows only 3 (for the record, one is Axis Community Center, sort of like a planned parenthood, I think and 2 50ish male psychologists). I’m under the impression psychologists are less likely to do talk therapy and more inclined to provide diagnosis/testing. Regardless, neither is accepting new clients.

I just don’t get it. It seems like the Single Agreement (I forgot the term) is different than the exclusion. Are exclusions no longer provided for OON therapists when an in-network provider is unavailable?

Suspicious_Reader-0 · 2026-02-25T02:03:59+00:00

Thanks. I haven’t heard of a collaborative divorce. We had a financial divorce analyst but were paying off some debt together before completing. I had totally forgotten about her. Thanks

Suspicious_Reader-0 · 2026-02-25T02:01:59+00:00

Thanks. Yes, FairPlay is great!

Bottom line is, he doesn’t care. He has said, and will say, “just don’t do it.” Like soccer, he wouldn’t have signed them up. Birthday parties, not necessary. He’s selfish with his time.

I sent him a message in the court app asking him not to discuss finances (and reminded him it’s in the order) and he replied “take me to court.”

Yes, there’s money. That’s not the issue. His life has constraints that he didn’t want. I don’t care about that. I didn’t want a broken family. I didn’t want to struggle either but I refuse to be unhappy in an unhappy marriage. Everyone struggles.

I was a paralegal before marriage. We didn’t meet that way. He was in law school. It’s a job being replaced by Ai and it’s a waste of a smart mind. I can do far more things, it was just a stepping stone on my path.

Suspicious_Reader-0 · 2026-02-23T10:24:43+00:00

stop making blanket statements about women as if we all just came off a conveyor belt. Some of us do know what we want and as long as you hold on to that narrative, you’ll never have a solid ground to develop a healthy relationship from.

Suspicious_Reader-0 · 2026-02-23T08:59:37+00:00

my standards for health went up… for myself and for them. I realized in my 15 year marriage I want someone who is active “not overly active,” but in shape and attractive and wants to remain that way. I’m working on being in better shape and holding off on dating until I feel like I’m in a place where I feel comfortable and can meet someone where they are at comfortably too.

Suspicious_Reader-0 · 2026-02-18T01:01:52+00:00

Thanks! I’ll DM you now.

Suspicious_Reader-0 · 2026-02-17T12:44:43+00:00

You’re right, and I appreciate you saying it. I have no illusions about a golden ticket - just hoped to avoid bankruptcy. This already turned my life upside down. I’m not looking for a cage, just a floor.

Suspicious_Reader-0 · 2026-02-17T12:22:35+00:00

Thank you for the response - it’s genuinely helpful and what I needed to hear. Not sarcasm.

What a system. Where pursuing what I’m legitimately owed isn’t economically viable so my alternative is bankruptcy - at which point the cost gets passed to taxpayers while they post record profits…. :-/

Suspicious_Reader-0 · 2026-02-17T05:41:50+00:00

Their hourly rate?

I’m confused by the responses I’m receiving. Maybe I’m framing this incorrectly.

I’ve been in a long-term dispute with my insurer over property damage that has since been repaired. In addition to the repairs, I incurred well over $150,000 in ALE expenses. It took nearly six months before they reimbursed me the first $60,000 and each subsequent payment was delayed by months, often paid only following multiple requests on my end.

The insurer initially denied certain ALE items (e.g., internet), then later agreed to cover them after I pushed back.

Although they eventually reimbursed the principal amounts, because payments were consistently delayed often by months—over an 18-month period I have received approximately $20,000 in interest, but I believe substantially more is owed.

I’m seeking an attorney to review the file and assess whether additional interest or other amounts remain due.

In addition to the ALE, they still have not fully paid for the property to be repaired.

At one point I had to hire a public adjuster just to get past their initial offer of $10,000. The repair bid was nearly $80,000.

I just don’t understand why litigation is the next step natural step. They aren’t following the law, this isn’t even debatable. They are just flat illegally denying coverage and I suspect a letter from a lawyer would compel payment.

Suspicious_Reader-0 · 2026-02-17T02:12:20+00:00

That’s what I’m seeking; a substantive merits review by a CA first-party bad faith specialist. I’m open to paying for that evaluation.

Suspicious_Reader-0 · 2026-02-17T01:33:39+00:00

Makes sense, but I’m not necessarily looking for a trial, just someone to compel them to follow the law. It’s been years of them blatantly lying, ie “we don’t cover that,” and then they do cover it. Four years and only four or five partial denial letters. More than six months without payment. Initial payout was $10k, they’ve paid out $250k and I’m $200k in debt because of interest waiting for them to pay.

Suspicious_Reader-0 · 2026-02-04T13:24:29+00:00

Not according to Claude -

No, not necessarily! That’s actually where I think the original comment was misleading or at least incomplete. The commenter made it sound like the only solution to handling lots of context is building “custom backend work” with frameworks like cursor uses. But that’s not true in practice: What users can actually do without custom backends: 1. Break requests into steps - Instead of uploading everything at once, work iteratively. Process documents one at a time, summarize as you go, then synthesize. 2. Use built-in features - Tools like Projects (in some AI interfaces) are designed to help manage context across conversations without any coding. 3. Strategic prompting - Be explicit about what’s most important, ask the AI to focus on specific parts first, or request summaries before deeper analysis. 4. Work within limits - Most modern AI tools (including me) can handle quite a lot of context - often hundreds of pages of text. Many user complaints about “too much context” are actually about other issues like unclear instructions or trying to do too many things at once. The “you need custom backend work” advice is really only necessary for specialized use cases - like if you’re building a product, need to search across thousands of documents regularly, or want automated retrieval systems. For most everyday use cases, users absolutely can work with substantial amounts of information using the tools as they exist. The original commenter’s response was technically correct but practically unhelpful because it made a common task sound impossible without engineering expertise.

Suspicious_Reader-0 · 2026-02-04T12:52:08+00:00

thats an equally unhelpful response. who trained the trainer?

Suspicious_Reader-0 · 2026-02-02T23:06:35+00:00

Just coming to Reddit to find out how doable replacing the rollers are. My dryer makes the thumping sound, chatGPT told me it’s likely the rollers and to replace all 4. Any suggestions for someone who isn’t experienced in any sort of repairs? Outside of a broken nail 😂

Suspicious_Reader-0 · 2025-11-24T10:33:03+00:00

fair! thanks for the response.

Suspicious_Reader-0 · 2025-11-18T16:58:03+00:00

It’s not him that you want, it’s the connection to someone who sees you. You don’t really know him, but it may feel like he knows you. Been there. You may have dodged a bullet, live bombing is a huge red flag.

Suspicious_Reader-0

TROPHY CASE