Health Insurance Appeal – Out of Network
Let me start by saying I appreciate any advice you can give me. I moved over to my husbands insurance because we had infertility issues that his insurance covered and mine did not. I went to an in network provider in my area, who was awful and decided to go to a reputable doctor in a different state. The doctor is covered in network, however, I was told that the reproductive lab was out of network. My husband and I were required to pay 11,000 dollars out of pocket and assured we would be reimbursed by our insurance. Knowing that talk is cheap (;)) I called our insurance 2-3 times to verify that this was true, I even shared billing codes from the doctors office. I was told that after we met our max out of office expense of $2200 everything would be covered. Having this knowledge, we moved forward with the treatment and submitted out of Pocket to insurance. Insurance came back and said that they will only reimburse us 1500 dollars. I don’t even begin to know how to appeal or where to go from here. 11000 dollars is a big difference From 1500. Does anyone have any advice? I am in Pennsylvania and my doctor is in Ohio. Thank you!
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Health Insurance Appeal – Out of Network Let me start by saying I appreciate any advice you can give me. I moved over to my husbands insurance because we had infertility issues that his insurance covered and mine did not. I went to an in network provider in my area, who was awful and decided to go to a reputable doctor in a different state. The doctor is covered in network, however, I was told that the reproductive lab was out of network. My husband and I were required to pay 11,000 dollars out of pocket and assured we would be reimbursed by our insurance. Knowing that talk is cheap (;)) I called our insurance 2-3 times to verify that this was true, I even shared billing codes from the doctors office. I was told that after we met our max out of office expense of $2200 everything would be covered. Having this knowledge, we moved forward with the treatment and submitted out of Pocket to insurance. Insurance came back and said that they will only reimburse us 1500 dollars. I don’t even begin to know how to appeal or where to go from here. 11000 dollars is a big difference From 1500. Does anyone have any advice? I am in Pennsylvania and my doctor is in Ohio. Thank you!
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