I needed a recurring medical treatment and was very thorough verifying the provider I chose was in-network. I checked on the insurance website before each visit and I have notes where I verified the provider was in-network on at least 2 phone calls with the insurance member services during my treatment.
My claims are now being denied and are a VERY significant amount. My provider did a benefits investigation before treatment and they have verification of that and are 100% certain they are in network.
I knew how important it was to go in network for this so I did my due diligence. When I spoke to my insurer (supervisor) they said it was ultimately my responsibility to know if my provider was in network and don’t seem concerned I have screen shots of the in network status on the insurance website and phone calls confirming the status.
My provider is fighting these denials since they have proof of their in network status. I’m awaiting that outcome before I file an appeal. I was told my phone calls could be pulled up in an appeal to prove I was told the provider was in network multiple times. If it comes to an appeal, is it helpful to hire an attorney or advocate to help? It’s a self-insured medical plan so I don’t think any State law is relevant here.
submitted by /u/arwenthenoble
[link] [comments]I needed a recurring medical treatment and was very thorough verifying the provider I chose was in-network. I checked on the insurance website before each visit and I have notes where I verified the provider was in-network on at least 2 phone calls with the insurance member services during my treatment. My claims are now being denied and are a VERY significant amount. My provider did a benefits investigation before treatment and they have verification of that and are 100% certain they are in network. I knew how important it was to go in network for this so I did my due diligence. When I spoke to my insurer (supervisor) they said it was ultimately my responsibility to know if my provider was in network and don’t seem concerned I have screen shots of the in network status on the insurance website and phone calls confirming the status. My provider is fighting these denials since they have proof of their in network status. I’m awaiting that outcome before I file an appeal. I was told my phone calls could be pulled up in an appeal to prove I was told the provider was in network multiple times. If it comes to an appeal, is it helpful to hire an attorney or advocate to help? It’s a self-insured medical plan so I don’t think any State law is relevant here. submitted by /u/arwenthenoble [link] [comments]Read Morer/HealthInsurance