Insurance co-pay more expensive than paying out of pocket?
Context: I’m insured through my parent’s employer who uses the Cigna network, however Cigna doesn’t provide information to providers, my employer does bc the employer recently switched to be self insured and uses a company called “Group Administrators” to manage the plans. I used to be covered under Aetna, but employer has since moved to be completely self insured and uses a third party insurance administrator.
20, Maryland
Dentist told me I need to get my wisdom teeth out so I called around to a few places. First place couldn’t verify my insurance, I thought it was just their staff, so I said ok no worries and moved on to another clinic. This second clinic was also having a hard time verifying my coverage despite calling the number on my card that directs you to my employer’s insurance admin.
I called the insurance administrator to ensure I was still on a health insurance plan and they said yes, and I asked if wisdom teeth removals were covered and they said yes at 100% for the removal and 75% for anesthesia. Not bad, so I told the 2nd clinic and they called a second time to verify eligibility and they were still claiming I wasn’t on the plan.
I called the insurance number myself again and the lady told me that “no one has called them,” I said oh ok interesting, is there any way you could call them and verify eligibility. She said “we don’t do outgoing calls.” I was annoyed but understood (I’m assuming HIPAA or whatever other law makes this a hassle for them).
The second clinic tried calling one more time and were finally able to confirm coverage. The clinic called me back and told me that my insurance is estimating my copay to be between $2.3k-2.6k while the out of pocket cost for removing all 4 wisdom teeth is only $1900 with this clinic. I’m just so confused as to why my insurance plan would charge me MORE than what the procedure is worth.
Looking at financing options through a meeical loan or right now. I’m also going to try one more clinic but it’s looking like my insurance is shit.
submitted by /u/NumerousSir7
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