In my experience, just about the only thing that seems to work with these rockheads is public humiliation.
I would take my story to a local reporter or talk radio host. If doing so would not infringe on your wife’s privacy too much.
This information might come in handy in the event of a billing dispute. If the insurance company continues to give you a hard time, you should look to pursue this through your state insurance commission.
Print the screen of it showing the provider in network. Write to the insurance company and cc to the state insurance commissioner.
Tell them that you (or the insured) called to verify and was told it was in network. Tell them you expect to have the charges covered as “in network”, in accordance with the terms of the insurance policy. Wait a few weeks....
Put all communications in writing. Saves headaches later and $$$
Keep calling. Also, jot down the date/time/name of CS agents you talk with.
If the current CS agent can’t give you an answer, ask to speak to the supervisor. Take it up the chain of command.
If their website says they are in the network, make a screencap for reference later.
If necessary, contact your state Insurance board.
When bad goes to worse the best path might be to hire a specialist. Start with ‘free information’...
Claims specialists tend to charge between $50 and $100 an hour... Consultation is usually free.
free information: www.medicalclaimshelp.org
Alliance of Claims Assistance Professionals - www.claims.org
Above links from Kiplinger Retirement Report
Take SCREEN SHOTS of EVERYTHING and PRINT All of it, then go down to the US Post Office and FILE a Formal Criminal Complaint of MAIL FRAUD, documenting the FRAUDULENT use of the US Post Office to willfully and knowingly send FRAUDULENT BILLING NOTICES, it is a FELONY to do so.
Get a hold of your STATE dept of Consumer Affairs and File another FORMAL CRIMINAL COMPLAINT for Deceptive and Fraudulent Advertising and Fraudulent or Deceptive Billing Practices.
THIS WILL GET THEIR ATTENTION.
Having the name of the person at the company will not help you. If the company says you are wrong, you are wrong even if they said previously you were right.
They are like the government. You have to pound them into submission. You call until you get someone who agrees with you and then escalate from there.
Use the following chart to deal with your insurance company. This chart compares what they say to what they really mean
What they say What they mean
In Network Pay up
Out of Network Pay up
Co-Insurance Pay up
We’ll look into that Pay up
We have to check Pay up
You get the idea. They make it supremely complex and impossible for the normal person to understand.
Last December, my son was disgnozed with a chronic disease. He spent four days in the hospital and has an $11,000 treatment every two months. We figured we hit our deductible by January. In February, he broke his elbow and we figured the surgery would be 100% covered. Using whatever corny math these people have, I think we finally hit our out of pocket deductible in October.
My wife, with an accounting degree and about 100 hours of research has discovered thousands of dollars in errors, surprisingly all in their favor.
I even asked my company why they don’t have an ombudsman to help employees navigate this morass.
Plus, every time we catch a mistake, they credit us and then recalculate every bill since the mistake was made, resulting in even more errors.
Good luck. Never give up. Question and fight every dollar.
There are several good suggestions but to be formal and uphold your appeal rights it does have to be in writing and via certified mail for your appeal.
Depending on your state the insurance commissioners are coming down hard on the plans for bad data on the provider websites and directories.
The plan can pay an out of network provider as in network so you can request that.
You can also contact your legislators for help. The insurance companies hate legislative complaints.
There is a difference here to make everyone aware so you know to ask the questions in the future.
The people who perform tests/x-rays etc and the people who read and interpret them can and often are separate. Both contract separately and charge separately.
Looks like more and more doctors are playing both sides of the aisle, and since the insurance companies are only looking out for themselves, the consumer gets burned.
i will follow the advice above and keep pushing.
We work with several doctors and consistently receive calls from patients who are requesting that we verify benefits and coverage for them before they make an appointment for services. Have heard the statement “But you’re listed as in their network” more times then I can count after I tell them the doctor is not in their network.
Insurance carriers combine and expand networks all the time and allow employers or third party administrators to use their networks without the provider agreeing to be in a specific part of their network.
Best bet is always have the doctor or service provider confirm your benefits before you are ever seen. Keep a record of the verifier’s name, date and time they gave you the benefits. You might even wish to have them email you the benefits they are quoting. You simply should never believe anything you read on the internet when it comes to insurance companies.