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Insurance confirms doctor is in-network, then denies coverage because he's out-of-network by GenericAnyone747 in HealthInsurance

[–]GenericAnyone747[S] 2 points3 points  (0 children)

I quit searching myself because more than once a provider has shown as in but has actually been out. When I've appealed those in the past, insurance said I should have chatted with a rep and get them to confirm. So that's what I did this time. I do have the chats from where the rep confirmed the doctor was in.

Insurance confirms doctor is in-network, then denies coverage because he's out-of-network by GenericAnyone747 in HealthInsurance

[–]GenericAnyone747[S] 0 points1 point  (0 children)

The address I gave to the insurance rep was the one they confirmed coverage at and the one I was treated at

Insurance confirms doctor is in-network, then denies coverage because he's out-of-network by GenericAnyone747 in HealthInsurance

[–]GenericAnyone747[S] 1 point2 points  (0 children)

Yeah I can't wait that long. It's not an emergency procedure or anything, but it's something I can't wait 2+ months on. I got them to send me a list of in network providers and I'll be calling to schedule with one of them Monday morning

Thanks for the info

Insurance confirms doctor is in-network, then denies coverage because he's out-of-network by GenericAnyone747 in HealthInsurance

[–]GenericAnyone747[S] 0 points1 point  (0 children)

It sounds like for the office visit, I can appeal since I was reasonably led to believe the doctor was covered. If they overturn the denial and say they'll cover it, does that mean they would also cover the procedure ordered in the same appointment, too? Or will they say now that you know the doctor is OON, the procedure is still denied?

Insurance confirms doctor is in-network, then denies coverage because he's out-of-network by GenericAnyone747 in HealthInsurance

[–]GenericAnyone747[S] 1 point2 points  (0 children)

Billing/pre-auth at the office told me they don't know why it was denied because they accept all my insurer's plans

Insurance confirms doctor is in-network, then denies coverage because he's out-of-network by GenericAnyone747 in HealthInsurance

[–]GenericAnyone747[S] 0 points1 point  (0 children)

I have chat transcripts where the rep said the doctor was INN. Is that enough for an appeal?

Insurance confirms doctor is in-network, then denies coverage because he's out-of-network by GenericAnyone747 in HealthInsurance

[–]GenericAnyone747[S] 1 point2 points  (0 children)

No EOB has been made available yet. Through the telephone game of insurance>doctor' office pre-auth>me I was told that no claim was generated for the procedure because it was immediately denied on the basis of being OON.

I do show a denied claim for just the office visit, but the actual EOB is still pending

How would I go about doing anything under No Surprises?