I live in NY and have a fully-insured PPO plan with Oxford/UHC.
When I started my new job and new insurance in 2020, I naturally looked on the site to see if any of my current providers were in-network. I found that Provider A was, although their website said they weren’t. Provider A offers services under Group A. I sent them an email with the screenshot of the search results letting them know there was conflicting information. They again confirmed that Provider A doesn’t not accept my insurance, I can do self-pay and submit to my carrier, etc.
After one appointment on my new insurance, Provider A goes on parental leave. I saw Provider B while they were out. I would submit OON claims to UHC that would ultimately end up with me getting reimbursed through my company’s HRA.
Provider A returns and I have my appointment. I submit the claim to UHC and it’s processed in-network. I call UHC and learn that Provider A has been in-network since 2019. In fact, when I submitted a previous claim for Provider B, the date of service for my one appointment with Provider A was processed incorrectly as OON.
I go back to Group A to let them know that no matter what they say, my claims are being processed as in-network and something is wrong. Group A keeps telling me they don’t take my insurance. They say that they honor that insurance for a few patients but do not accept my insurance.
I have never heard of in-network providers being able to choose which members they’ll accept. Is this common? If not, what are my best options? It would seem Provider/Group A owes me a refund.
Thanks!
Edit: spelling/grammar
submitted by /u/N9neNine
[link] [comments]I live in NY and have a fully-insured PPO plan with Oxford/UHC. When I started my new job and new insurance in 2020, I naturally looked on the site to see if any of my current providers were in-network. I found that Provider A was, although their website said they weren’t. Provider A offers services under Group A. I sent them an email with the screenshot of the search results letting them know there was conflicting information. They again confirmed that Provider A doesn’t not accept my insurance, I can do self-pay and submit to my carrier, etc. After one appointment on my new insurance, Provider A goes on parental leave. I saw Provider B while they were out. I would submit OON claims to UHC that would ultimately end up with me getting reimbursed through my company’s HRA. Provider A returns and I have my appointment. I submit the claim to UHC and it’s processed in-network. I call UHC and learn that Provider A has been in-network since 2019. In fact, when I submitted a previous claim for Provider B, the date of service for my one appointment with Provider A was processed incorrectly as OON. I go back to Group A to let them know that no matter what they say, my claims are being processed as in-network and something is wrong. Group A keeps telling me they don’t take my insurance. They say that they honor that insurance for a few patients but do not accept my insurance. I have never heard of in-network providers being able to choose which members they’ll accept. Is this common? If not, what are my best options? It would seem Provider/Group A owes me a refund. Thanks! Edit: spelling/grammar submitted by /u/N9neNine [link] [comments]Read Morer/HealthInsurance