Anthem is saying my procedure is out-of-network but it’s not?

I am supposed to get a follow up procedure for a digestive health issue tomorrow but my doctor's office called yesterday saying that I may be responsible for the full amount of the procedure because Anthem denied Prior Authorization. The reasoning for the denial was that part of the claim is processing as out of network.

When I look on Anthem Find Care it shows that both the Hospital / Service and doctor (all at the same address) are in network. I also spoke with a rep at Anthem yesterday and she saw the same thing and that I "should be covered" but she said that Blue Cross actually does that claim processing and in their system they can't verify the network status because part of the claim is processing as in network and part is out of network. She could not tell me what was triggering the out of network status as it appeared it should be in network on her end.

How do I get the Prior Authorization approved or otherwise prove that there seems to be an error and that this procedure should be in network? I've offered to do a 3 way chat with the clinic and Anthem but it's like pulling teeth. I'd rather not have to reschedule as this clinic books many months out.

Location = Minnesota

submitted by /u/PMmeWoolSocks
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