3rd party accolade not processing my gap exception and lying to me about it
I have a mastectomy & reconstruction scheduled for breast cancer. For my reconstruction surgeon, they don't take Aetna but before I scheduled their office helped me seek pre-certification to use them for the codes. I've had to go through Accolade which is some 3rd party layer. They seem to be an app and a call center. I have talked to one clinical nurse via them who said while she obviously was just giving an opinion informed by her experience, that based on my chart I should expect to receive pre-certification. I did. My provider and Meritain my claims provider are on the phone every other day. The claims provider is expecting to receive a gap exception to process. My plan sent me the pre-cert letter. This company Accolade has stopped answering my written support thread. Via phone they give a different answer to what is going on each time including lying about things "being submitted". What can I do? What should I ask? Can I demand my call center records from Accolade? Should I hire a lawyer? Asking the company "what do you do?" gets a froofy answer about helping navigate your benefits. Why would submitting my gap exception to my claims processor be something that they have authority over?
submitted by /u/Working_Tomato872
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