Post # 1
So, this is my first bad experience with health insurance, though I know it is not uncommon. DH and I finally got insurance and we were excited, so we deliberated over which plan to choose. There were three options.
We had a couple of months to decide, and we finally went with what we thought was the best plan. It was also the most expensive, but I wanted to be able to chose my providers and pay less out of pocket, even if it costs more per month. Sigh. So I thought.
The plan we went with was chosen because hundreds of Docs were covered in-network, so the site told us, while we were logged in and later on their site as well, when we went under our option to search. We picked out Docs off the list, and went for our included yearly physical.
Then we got the bills. The claims were denied, and the company is claiming both of our Docs, that we got off THEIR list provided for us, were out of network. What is worse, they will not let us cancel the plan until January 1st. They told him he was supposed to set up a “special account” to see who was in network. This information was never provided, so it was impossible to know this, especially when we were logged in from his work site while searching and deciding and under our plan on their site-
They cover 1 OB in the entire city and she only has part-time hours because she is the DIRECTOR of residency at the largest hospital! They cover NO Family Practice docs in the entire city! I would have to drive 30 miles!
I am freaking out. The only Urgent Care they cover is this terrible place where a doc told DH he had -not one but two- problems he never had. Homeless people are all over there- nothing against them, but it is NOT a good facility!
🙁 Anyone out there with experience or advice?
Post # 3
I worked in health insurance for 5 1/2 years, and I’m stumped on this one. I recommend calling your state’s department of insurance and filing a complaint. The place I worked for took DoI complaints very seriously.
Was this one of the big insurance companies, or a fly-by-night thing? Sometimes doctors do drop off from those networks because they don’t need the extra business, or because the companies are such a hassle to deal with. But they should have updated their network website to reflect that.
It’s kind of weird that the doctors’ offices didn’t say anything when you handed them your insurance cards and it was for something they didn’t participate in.
Post # 4
Are you in an HMO or managed by a Physician’s Group? If the doctors are in the list that the insurance company provided you, then I would appeal the decision. You have no idea how many times the claims department gets these things wrong. Also, if you really want to see a certain doctor, and the doctor’s office has competent front of office staff, they can request for an “out of network referral” since there aren’t any providers within your area.
Post # 5
Ouch! I don’t have any advice 🙁 My insurance denied my doctor prescribed mammogram (she FLINCHED at my breast exam) because I’m under 35 and therefore have no “right” to have breast cancer. I was supposed to have an ultrasound exam of my breasts, since I’m young and they’re dense. Hospital tech opted for the mammo, though I don’t think that’d made a difference on the coverage.
My roomie is in the insurance biz and basically says, “It’s not in their business interest to cover you. They’ll find every excuse possible.” ugh!
Post # 6
Thank you, you three. I have been appealing again and again and again. They did decide to cover DH’s physical, (he went to the same group of Doctors I did, the local provider that was listen on their website as covered.) For mine, I am still battling. They come up with every excuse, they said in the first denied appeal that the tax code for those providers is one they do not cover, then they said the could not find evidence on their website (though we provided screen shots and it is all there plain as day.) It will be interesting to see what excuse they come up with next. So far, I have just been doing my best to pay the bills on a payment plan. It is “UnitedHealthCare.” Steer clear!