I got kind of a hard time sharing my experience about a terrible health insurance company (Molina) and I was really shocked. Perhaps I grew up privileged, but I always thought that purchasing a medical plan through a trusted source, that the company would be mostly truthful. It seemed a lot of people feel differently. I would like to learn more about health insurance laws anyway, so I am curious…
Is it legal to intentionally provide a list of fake providers to prospective and current clients? In this case, I was also told I would not get any help until I went through the list of hundreds in my community, none of which were actually in network providers for what they were supposed to be. Then I was given a list of thousands in the county and told I must go through those. They were represented as all listed of in-network providers for a specific specialty. Again, not a single one of the first hundreds were. Of the county lists of thousands, I only got through 25-26 pages, and gave up at that point.
At that point, after calling and being told I would get a call back with a provider for several weeks, perhaps a couple months, they told me to file an appeal, which could take up to a month. 6 weeks later, they provided me with a provider that did that speciality that was not accepting new clients, nor would see someone with my diagnosis.
I gave up, but I was wondering if this was legal? I begged them to change the list so others wouldn’t have to go through the days of calls since all of the info was false. Many were not doctor’s offices even, some didn’t practice the specialty, and most said they had never and would never take Molina. They refused to change the provider list to update all the numbers that were not providers, not active numbers, or didn’t accept the insurance.
Also curious… is it legal to require someone bring labs to a certain lab? Most doctors will not allow you to take a lab yourself somewhere, so I’m not sure how this could be legal, but it may well be. I’m not certain the lab even existed, but I’m just curious.
One more question: is it legal to require even urgent labs get prior authorization that could take up to 48 hours?
I’m trying to gather what I can for a company that has been fraudulent (with the provider reports and other things) and other behavior designed to save money at the risk of one’s health. I am not at the insurance anymore, but if you see wrong and don’t do anything, aren’t you just as culpable, type of thing. So just curious over the legality of certain things. I expect mostly it’s legal, but if it’s not I would be interested to know.
PS- This is not a dig on Individual Insurance Providers. I have one now that I absolutely LOVE. They have always made sure I have access to everything promised (more in fact) and they are quick to help me with anything. I credit a large part of my health to their thoroughness as an insurance company. It just shows the difference the company culture can make.
submitted by /u/melonchollyrain
[link] [comments]I got kind of a hard time sharing my experience about a terrible health insurance company (Molina) and I was really shocked. Perhaps I grew up privileged, but I always thought that purchasing a medical plan through a trusted source, that the company would be mostly truthful. It seemed a lot of people feel differently. I would like to learn more about health insurance laws anyway, so I am curious… Is it legal to intentionally provide a list of fake providers to prospective and current clients? In this case, I was also told I would not get any help until I went through the list of hundreds in my community, none of which were actually in network providers for what they were supposed to be. Then I was given a list of thousands in the county and told I must go through those. They were represented as all listed of in-network providers for a specific specialty. Again, not a single one of the first hundreds were. Of the county lists of thousands, I only got through 25-26 pages, and gave up at that point. At that point, after calling and being told I would get a call back with a provider for several weeks, perhaps a couple months, they told me to file an appeal, which could take up to a month. 6 weeks later, they provided me with a provider that did that speciality that was not accepting new clients, nor would see someone with my diagnosis. I gave up, but I was wondering if this was legal? I begged them to change the list so others wouldn’t have to go through the days of calls since all of the info was false. Many were not doctor’s offices even, some didn’t practice the specialty, and most said they had never and would never take Molina. They refused to change the provider list to update all the numbers that were not providers, not active numbers, or didn’t accept the insurance. Also curious… is it legal to require someone bring labs to a certain lab? Most doctors will not allow you to take a lab yourself somewhere, so I’m not sure how this could be legal, but it may well be. I’m not certain the lab even existed, but I’m just curious. One more question: is it legal to require even urgent labs get prior authorization that could take up to 48 hours? I’m trying to gather what I can for a company that has been fraudulent (with the provider reports and other things) and other behavior designed to save money at the risk of one’s health. I am not at the insurance anymore, but if you see wrong and don’t do anything, aren’t you just as culpable, type of thing. So just curious over the legality of certain things. I expect mostly it’s legal, but if it’s not I would be interested to know. PS- This is not a dig on Individual Insurance Providers. I have one now that I absolutely LOVE. They have always made sure I have access to everything promised (more in fact) and they are quick to help me with anything. I credit a large part of my health to their thoroughness as an insurance company. It just shows the difference the company culture can make. submitted by /u/melonchollyrain [link] [comments]Read Morer/HealthInsurance