Age: 30. Income: none, I’m a student. Location: Boston, MA.
Massachusetts requires trans care be covered by law, and my plan explicitly covers the procedure I’m having in-network regardless of network status of the doctor typically. I received written confirmation that this procedure would be billed in-network and successfully got prior authorization for the surgery with this specific provider.
My claim was billed out of network anyway, and at rates other than what my plan outlined. The claim judgement says the ‘maximum allowable’ expense for the procedure is ~2k. The surgery is 20k. My plan benefit explicitly says there is no maximum allowable for this category of procedure, and for out of network coverage I should pay only a $250 deductible and 30% coinsurance after.
The amount cheque they sent me doesn’t even align with what they say they owe me on the messed up claim.
Five hours on the phone later and they say there’s nothing they can do except submit it for a claim review as if it was a simple dispute where I think something should be covered and isn’t. It took two hours of pushing for me to get the info that claim reviews are allowed 15 days to process. They spent hours refusing to give me any timeline at all.
I contacted the DOI and they said I should file a grievance with the BCBS MA, and then with them. The grievance process takes up to 30 days. Is there anything I can do to pressure them? They owe me over 10k according to their own documents, and I can’t wait a month or more to see it.
submitted by /u/IsItInkOrIsItBlood
[link] [comments]Age: 30. Income: none, I’m a student. Location: Boston, MA. Massachusetts requires trans care be covered by law, and my plan explicitly covers the procedure I’m having in-network regardless of network status of the doctor typically. I received written confirmation that this procedure would be billed in-network and successfully got prior authorization for the surgery with this specific provider. My claim was billed out of network anyway, and at rates other than what my plan outlined. The claim judgement says the ‘maximum allowable’ expense for the procedure is ~2k. The surgery is 20k. My plan benefit explicitly says there is no maximum allowable for this category of procedure, and for out of network coverage I should pay only a $250 deductible and 30% coinsurance after. The amount cheque they sent me doesn’t even align with what they say they owe me on the messed up claim. Five hours on the phone later and they say there’s nothing they can do except submit it for a claim review as if it was a simple dispute where I think something should be covered and isn’t. It took two hours of pushing for me to get the info that claim reviews are allowed 15 days to process. They spent hours refusing to give me any timeline at all. I contacted the DOI and they said I should file a grievance with the BCBS MA, and then with them. The grievance process takes up to 30 days. Is there anything I can do to pressure them? They owe me over 10k according to their own documents, and I can’t wait a month or more to see it. submitted by /u/IsItInkOrIsItBlood [link] [comments]Read Morer/HealthInsurance