Potential issue with pre authorization

Has anyone had a insurance letter that they didn’t receive?

I get a very expensive biologic infusion ($80k per infusion). I recently just got my fourth one at the same place I have gotten the first three, completely in network. During the process, I was told the office would coordinate all the pre authorization. The infusion site is at the doctor’s office (which is part of a larger medical/hospital system but not at the hospital).

I noticed my claim was still pending 1.5 months later and recently learned, I might be able to see the pre authorization online. Well there was a letter attached that said they would cover it at out of network rates. This site is not listed in network on their directory and I have no idea where the office ordered the drug from. If it isn’t at an in network or ordered from the specific specialty pharmacy – my coverage is zero.

I emailed the lady who does the pre authorization and told her about the letter and she said nothing was communicated to them and they were told it is in network. I never received the letter in the mail nor received a call from Cigna.

Has anyone seen where the insurance changed its network designation and did not tell the medical office nor the patient? Trying to be zen about it but also trying to emotionally prepare myself if I see an $80k bill show up at my door.

submitted by /u/Iheartdillpickles
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