Can your health insurance change how much they’re going to cover six months after you’ve already paid the bill in full?
I hope this is the right place to ask this but Google was not helpful in the slightest and I'm very confused/frustrated. I'm in the state of Michigan if that changes any guidelines or laws. My doctor recommended I get a colonscopy done just as a preventative procedure to make sure everything with my meds is still going right. My Summary of Benefits and Coverage from my insurance provider said no charge for preventive care/screening and deductible does not apply, my healthcare provider was in-network, and an estimated cost I was sent by my doctor said I'd only pay estimated $114 out of pocket, so I was down.
Long story short, I've paid $2k over the last six months for this procedure so far. I tried calling my insurance provider after the first bills and arguing my case that it should have been no charge according to my Summary, but they said that since my doctor found a polyp during the colonscopy and ran a diagnostic test on it, that it was no longer preventative. I told them that diagnostic tests were also listed as no charge on my Summary and they told me that it still was not covered. So I cut my losses and paid the bills to get it over with.
Except now, six months after I've paid these bills, I'm getting new ones. Where insurance said in January that they would cover $750, they're now saying they will only cover $400 and that my payment (that I'd paid in full back when I received the bill) is more than 120 days overdue. Is this something they can legally do or are they bound to the amount they originally agreed to cover? (And for that matter, is not covering things listed in the Summary when I carefully selected this plan for these benefits knowing I had this procedure coming up just something they can legally do?) I hate the idea of threatening legal action but I also don't have the extra $3/400 lying around every month to keep paying these surprise medical bills for the foreseeable future.
Thanks in advance!
submitted by /u/perpetually-done7
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