I have a marketplace health plan which I’m currently eligible to switch due to a change in income. While researching new plans, I found my PCP is no longer listed on my insurance company’s website (not listed as out of network, he simply no longer pops up in the search at all). My broker reached out to my insurance co, and they told her he was “termed from the network at this location” as of March 4. To verify (because this meant I would switch plans to a crappier option to keep this PCP), I emailed the insurer myself. The rep who wrote back said the MD is in network at the location I need and was assigned as my PCP as of March 5. Those dates seemed too close to be a coincidence, but I am at a loss to explain this. I called the MD’s two offices (one is primary care, the other sports med) and they both seemed confused but thought he should be in network (per the broker’s contact at the insurer, only sports med is in network). I called the MD’s billing office who told me to go with whatever the insurer is telling me, and had no interest in hearing the details. I’m not sure who to believe here, and I have an appointment coming up. If this guy truly is not in network, I would choose a different plan. How do I get this resolved, definitively? I know from experience that being told the wrong thing by a rep usually does not get you off the hook when it’s time for a bill.
submitted by /u/aterriblesurfer
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I have a marketplace health plan which I’m currently eligible to switch due to a change in income. While researching new plans, I found my PCP is no longer listed on my insurance company’s website (not listed as out of network, he simply no longer pops up in the search at all). My broker reached out to my insurance co, and they told her he was “termed from the network at this location” as of March 4. To verify (because this meant I would switch plans to a crappier option to keep this PCP), I emailed the insurer myself. The rep who wrote back said the MD is in network at the location I need and was assigned as my PCP as of March 5. Those dates seemed too close to be a coincidence, but I am at a loss to explain this. I called the MD’s two offices (one is primary care, the other sports med) and they both seemed confused but thought he should be in network (per the broker’s contact at the insurer, only sports med is in network). I called the MD’s billing office who told me to go with whatever the insurer is telling me, and had no interest in hearing the details. I’m not sure who to believe here, and I have an appointment coming up. If this guy truly is not in network, I would choose a different plan. How do I get this resolved, definitively? I know from experience that being told the wrong thing by a rep usually does not get you off the hook when it’s time for a bill.
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