Group specific policies
Hello. I have health insurance through my employer. My employer got a new provider last year and now I instead of communicating directly with my insurance company i have to rely on information from a third party called Quantum Health. This has been a nightmare for me as I have the most difficult time getting straight or even consistent answers about my coverage. I have access to my summary plan document but when I inquired about providing me with group specific plan policies for a condition I have they keep telling me they don’t have it and that my doctor needs to put a request in for a treatment and they will let me know. Problem is I plan to choose a provider based off of my coverage and if the Dr. offers a treatment covered by my insurance. The treatments I’m interested in aren’t typically covered but if they are I will seek out a provider that offers it and will bill my insurance if it is covered. I would really like physical documentation of specific coverage because based on things they have told me in the past I don’t believe they know wth they’re talking about.
My question is am I entitled to these documents legally? They tell me there isn’t a way to send me all coverage polices for treatments by condition. I was able to find these myself from my insurance company’s website however they are not specific to my “group” policy.
I don’t know what my rights are and am wondering if I should call the DOL to find out. This has been such a headache.
submitted by /u/WaveringxFaith
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