In-network doctor’s visit billed as out-of-network

To clarify, I didn’t look up the specific doctor’s name on Humana’s Find A Doctor Tool before I visited her, because she is an Urgent Care physician and I had 0 way of knowing who would be treating me the day of my visit.

I did, however, ensure that the Urgent Care I visited – and the physical location of the clinic – was in network before dropping by with ear infection symptoms.

I’m being billed by my hospital for the visit because she is out of network. The thing is, I called Humana and they told me that yes, York Hospital is in network, therefore that gave them reason to resubmit the claim intending a correction on their end.

I’m mentally preparing for Humana to come back with a classic “the hospital you visited is in-network, but the doctor isn’t” scenario. But the rep acknowledge verbally that he resubmitted the claims for correction based on his findings on his own search of in-network facilities.

The thing that is making me really weirded out is that I visited a PCP there as well, and she was billed as out of network, too. How many times can I visit this one hospital, and see providers that are 100% FT hospital employees, before Humana starts processing the claims as in network!?

Any ideas on outcome here?

submitted by /u/leoxvirgo
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To clarify, I didn’t look up the specific doctor’s name on Humana’s Find A Doctor Tool before I visited her, because she is an Urgent Care physician and I had 0 way of knowing who would be treating me the day of my visit. I did, however, ensure that the Urgent Care I visited – and the physical location of the clinic – was in network before dropping by with ear infection symptoms. I’m being billed by my hospital for the visit because she is out of network. The thing is, I called Humana and they told me that yes, York Hospital is in network, therefore that gave them reason to resubmit the claim intending a correction on their end. I’m mentally preparing for Humana to come back with a classic “the hospital you visited is in-network, but the doctor isn’t” scenario. But the rep acknowledge verbally that he resubmitted the claims for correction based on his findings on his own search of in-network facilities. The thing that is making me really weirded out is that I visited a PCP there as well, and she was billed as out of network, too. How many times can I visit this one hospital, and see providers that are 100% FT hospital employees, before Humana starts processing the claims as in network!? Any ideas on outcome here?
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