I was told by a representative of my insurance company in writing that a provider would be in network. After many visits to this provider, all of the claims were processed as out-of-network. When I contacted someone via phone, I was told that the previous agent was incorrect and that they would begin a case to have these claims reprocessed given the chat conversation where I was told the provider was in-network.
Today, 35 days later, I called for an update as these were supposed to be reviewed within 30 days. Only then, I was informed their decision was upheld and my only recourse would be to appeal the decision. I still have received zero written or electronic correspondence of this adverse determination.
What documents am I entitled to in order to appeal this decision further? Are they obligated in any way to provide me with the recordings of our phone conversations? What about internal notes made by representatives following these communications?
submitted by /u/indytriesart
[link] [comments]I was told by a representative of my insurance company in writing that a provider would be in network. After many visits to this provider, all of the claims were processed as out-of-network. When I contacted someone via phone, I was told that the previous agent was incorrect and that they would begin a case to have these claims reprocessed given the chat conversation where I was told the provider was in-network. Today, 35 days later, I called for an update as these were supposed to be reviewed within 30 days. Only then, I was informed their decision was upheld and my only recourse would be to appeal the decision. I still have received zero written or electronic correspondence of this adverse determination. What documents am I entitled to in order to appeal this decision further? Are they obligated in any way to provide me with the recordings of our phone conversations? What about internal notes made by representatives following these communications? submitted by /u/indytriesart [link] [comments]Read Morer/HealthInsurance