Regular doctor visit denied (in network, no deductible). Provider is now billing me $720 for 5 min visit
Had a doctor visit to inquiry about Wegovy and she said it was a good option for me and started the process. It was a five minutes visit max just asking about my weight and gym time. She sent Wegovy Rx to pharmacy.
Insurance denied coverage for the visit as "not covered diagnosis" because it was related to weight management. Doctor office (one medical) now is billing me $720.
RX insurance (CVS caremark) COVERED the Wegovy RX no problem ($1600/month). $0 with copay card.
One Medidal says that tough luck, sometimes insurance doesn't cover for stuff, here pay our bloated rate for a five min visit. I say BS: at what moment was I supposed to know this absolutely run of the mill visit would not be covered? Was it before I mentioned my weight loss request to the doctor, during, after?
Do I have any chance to invoke the No Surprise Act here? At no moment in my five minutes visit or before it was informed to me that visit would not be covered.
Extra info:
I have no deductible. Previous and posterior visits with OM have been paid at the regular copay of $15. Insurance has doled out thousands for OM no problem. Even their adjusted rates are eye watering… But I don't have to pay those.
submitted by /u/reddlvr
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