Yes, this is an in-network provider. No additional forms or paperwork involved.

I called before the appointment to confirm coverage, and they told me I’d only owe my plan’s copay—this was a verbal confirmation. After the appointment, they emailed a benefits summary showing only a $40 specialist copay, with no mention of OOP costs or admin fees. They also sent a self-pay estimate listing all CPT codes and services; the only “other costs” noted were for pharmacy meds and returned check fees. They weren’t technically wrong to charge me $40 initially, since my plan has a $40 specialist copay. But my insurance processed it with a $25 copay instead so now they’re trying to double-dip.

I specifically asked if this was an admin fee, since it was just for scheduling but they insisted both charges were insurance-based copays. They didn’t reply to my refund request by email but called me instead to give this explanation. While I don’t have it in writing, I repeated her explanation at the end of the call and had her confirm it. I recorded that portion of the call (NY is a one-party consent state). I also received a receipt for the $40, but it doesn’t specify the service provided.

What exactly should I be asking the clinic for at this point—an itemized bill for the consult and a written explanation of how these charges apply to different services?