Typo in the title — *Have you been able
I have always mostly lurked on reddit and never really posted, but I would appreciate any thoughts and anecdotes of similar situations.
Here is some background: one of my parents gets their insurance through marketplace and they do not qualify for Medicaid or Medicare. Having said that they also work a minimum wage job. The insurance plan they had in 2021 also doubled in price this year because of premium increase and around 1k-2k increase in pay. I help them with their doctors and insurance since they have a hard time doing that themselves. After receiving the bill, I called the marketplace. During this conversation a cheaper plan was mentioned. I asked the representative if my parent would still be able to see the same doctors. I went as far as giving them individual names besides the medical group name. I was reassured that yes they would be able to see the same doctors (which was very important since they see doctors a few times a year for chronic illnesses). So I went ahead and changed their plan to the less expensive one.
Last night, we received the new insurance card and the PCP group had completely changed. I called the insurance customer service and was told that the group my parent was with before is now out of network!! So I called the marketplace again and told them about the situation. The representative informed me that my request has to be escalated through a claim and they submitted an appeal for me. I will hear back sometime in the next 30 days.
This is a very stressful situation and I’m concerned the marketplace may just reject the appeal. Has anyone been in a similar situation? Do you have any advice on what I can do to increase the chance of changing the plan back?
submitted by /u/ConfusedState22
[link] [comments]Typo in the title — *Have you been able I have always mostly lurked on reddit and never really posted, but I would appreciate any thoughts and anecdotes of similar situations. Here is some background: one of my parents gets their insurance through marketplace and they do not qualify for Medicaid or Medicare. Having said that they also work a minimum wage job. The insurance plan they had in 2021 also doubled in price this year because of premium increase and around 1k-2k increase in pay. I help them with their doctors and insurance since they have a hard time doing that themselves. After receiving the bill, I called the marketplace. During this conversation a cheaper plan was mentioned. I asked the representative if my parent would still be able to see the same doctors. I went as far as giving them individual names besides the medical group name. I was reassured that yes they would be able to see the same doctors (which was very important since they see doctors a few times a year for chronic illnesses). So I went ahead and changed their plan to the less expensive one. Last night, we received the new insurance card and the PCP group had completely changed. I called the insurance customer service and was told that the group my parent was with before is now out of network!! So I called the marketplace again and told them about the situation. The representative informed me that my request has to be escalated through a claim and they submitted an appeal for me. I will hear back sometime in the next 30 days. This is a very stressful situation and I’m concerned the marketplace may just reject the appeal. Has anyone been in a similar situation? Do you have any advice on what I can do to increase the chance of changing the plan back? submitted by /u/ConfusedState22 [link] [comments]Read Morer/HealthInsurance