Need help. Case from Oct 2018. Out of network provider, there is no one in the area who can provide the same service as this provider does.
Reached out to insurance company for pre authorization. Got that, saw the doctor, doctor sent the bill, insurance company denied saying you need ‘gap exception’ along with pre authorization. There is no requirement for gap exception on the contract of coverage which I signed with the insurance company.
Going in circles with insurance company and Dept of Insurance since. Total damage little over $3000.
Please help.
Edited to add location: California.
Edited to add: your age: This was for my daughter, then 1 year old, now 3.
Zip code: 95035
Income: $140K (in SF bay area, family of 3)
submitted by /u/Entire_History_7336
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Need help. Case from Oct 2018. Out of network provider, there is no one in the area who can provide the same service as this provider does. Reached out to insurance company for pre authorization. Got that, saw the doctor, doctor sent the bill, insurance company denied saying you need ‘gap exception’ along with pre authorization. There is no requirement for gap exception on the contract of coverage which I signed with the insurance company. Going in circles with insurance company and Dept of Insurance since. Total damage little over $3000. Please help. Edited to add location: California. Edited to add: your age: This was for my daughter, then 1 year old, now 3. Zip code: 95035 Income: $140K (in SF bay area, family of 3)
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