need some advice – birth control question

hey guys,

looking for some help here to navigate my mom and sister through this situation. im trying to figure it out myself and not sure what next step to take. any advice is appreciated!

my sister is under my mom’s health insurance as she is sixteen. medical benefits are blue cross blue shield, but her employer is a religious-based organization so they do not cover birth control. pharmacy benefits are via optumrx, we also have a separate contraceptive coverage card.

my little sister recently got nexplanon (the implant.) the hospital assured my mom it was covered on 3 occasions before getting it, even though they only had the bcbs card on file – not the optum card. lo and behold, my mom gets a bill for $4200 because it was obviously not covered under the BCBS plan.

i am trying to look into whether optum covers this. i just called their customer service line and was redirected to their medical claims department (not open right now) but this doesn’t make sense to me – our medical benefits are not through optum, only bcbs. can anyone explain to me what’s going on here and if i have any options moving forward?

See also  Have to pay estimate up front?