Its been a month and a half since my first of four doctors visits with a referred out of network doctor. I was told by the doctors office when I called to make an appointment that they would call me back once my referral came through and my insurance approved it. They called me back a week later saying it was approved, I went to four appointments and had imaging done.
On my fourth appointment they suddenly “caught” that my insurance wasn’t ever approved so if I wanted to see the doctor I would need to pay out of pocket. I cannot afford this out of pocket and had I known it was not covered, I would have never gone let alone gotten imaging done.
I have now been fighting with the doctor and insurance as to why this happened. Its been a month and a half and I cannot get to anyone who has an answer. I have talked numerous times to Anthem Blue Cross Blue Sheild Claims, Resolutions, and Utilization Management departments and all are giving me different information: my first referral was accepted and the doctors office rejected it, my first referral was accepted and then the insurance rejected it, my first referral was never accepted, my retroactive referal (if submitted) is garaunteed to go through, my retroactive referral was immediately rejected within 24 hours (though I was told it would take 30-40 days). People I’ve talked to have said they would have their supervisors contact me and no one has. I have made more calls and more people are giving me new stories and cant get ahold of the previous claims agent.
At this point, it says my claim has gone through (via an email) but when you go online to anthem.com, it says that my authorization has not been approved yet. The doctors office is of no help and while they claim to have people looking into this, I have only talked to them when I’ve called.
I am a complex patient with several layers of pain/issues who is slowly losing the ability to walk and need to see this doctor because they are one of the best in my state. Even if I don’t see this one and see one in-network, I am stuck with thousands of dollars of costs that the doctors office says I now have and doesn’t see their part in it. I am feeling so overwhelmed, my stress levels are through the roof, and obviously I’m physically struggling… and honestly I am wasting work time getting this done which is only adding to this really stressful situation.
Do I hire a patient advocate? How do I even do that? Does anyone have a direct number to someone at Anthem? How do I stop getting the run around?
What do I do?
Signed,
Lost and starting to feel hopeless
submitted by /u/somebunnysketching
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Its been a month and a half since my first of four doctors visits with a referred out of network doctor. I was told by the doctors office when I called to make an appointment that they would call me back once my referral came through and my insurance approved it. They called me back a week later saying it was approved, I went to four appointments and had imaging done. On my fourth appointment they suddenly “caught” that my insurance wasn’t ever approved so if I wanted to see the doctor I would need to pay out of pocket. I cannot afford this out of pocket and had I known it was not covered, I would have never gone let alone gotten imaging done. I have now been fighting with the doctor and insurance as to why this happened. Its been a month and a half and I cannot get to anyone who has an answer. I have talked numerous times to Anthem Blue Cross Blue Sheild Claims, Resolutions, and Utilization Management departments and all are giving me different information: my first referral was accepted and the doctors office rejected it, my first referral was accepted and then the insurance rejected it, my first referral was never accepted, my retroactive referal (if submitted) is garaunteed to go through, my retroactive referral was immediately rejected within 24 hours (though I was told it would take 30-40 days). People I’ve talked to have said they would have their supervisors contact me and no one has. I have made more calls and more people are giving me new stories and cant get ahold of the previous claims agent. At this point, it says my claim has gone through (via an email) but when you go online to anthem.com, it says that my authorization has not been approved yet. The doctors office is of no help and while they claim to have people looking into this, I have only talked to them when I’ve called. I am a complex patient with several layers of pain/issues who is slowly losing the ability to walk and need to see this doctor because they are one of the best in my state. Even if I don’t see this one and see one in-network, I am stuck with thousands of dollars of costs that the doctors office says I now have and doesn’t see their part in it. I am feeling so overwhelmed, my stress levels are through the roof, and obviously I’m physically struggling… and honestly I am wasting work time getting this done which is only adding to this really stressful situation. Do I hire a patient advocate? How do I even do that? Does anyone have a direct number to someone at Anthem? How do I stop getting the run around? What do I do? Signed, Lost and starting to feel hopeless
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