I feel like my insurance company is committing some sort of fraud to avoid paying for my medical treatments (or they are just incompetent)

TLDR: my insurance company keeps saying my policy is inactive despite me paying my monthly premiums and my employer saying I should be active. Care is being delayed because I have to reschedule and cancel appointments while they sort this out

I switched to COBRA a few months ago on my previous employer’s plan and for a month and a half the insurance company was telling my healthcare facilities I didn’t have active insurance despite my employer’s COBRA group administrator saying I should. I spent hours on the phone with various people though never once could I speak to anyone directly employed by the insurance company because they “don’t speak to members”. After many cancelled and rescheduled appointments because I “didn’t have active coverage” we FINALLY figured out the problem and it was fixed a month later

Now, one month later, two days before a very important procedure for my child, the medical facilities are telling me my insurance company won’t give prior authorization because they are saying I haven’t had active coverage since August. It’s the exact same problem I had a couple months ago except this time my employer cobra group administrator said she can no longer assist me because she’s just as lost as I am and gave me a number for the third party customer service team with the insurance company. I had already spoken to both of them multiple times previously for this same issue and the customer service team couldn’t help and sure enough when I called them, they said they needed to speak to my employer’s cobra group administrator (who literally just told me to speak to them).

We are going in circles and getting no where. Basically I’m being told if they can’t figure this out by the appointment in a couple days that I should cancel and reschedule because they can’t get prior authorization and can’t guarantee the service will be covered.

This procedure is both time sensitive and important. I can’t afford to reschedule. Not to mention this feels like a delay of care due to my insurance company’s negligence.

I have met my deductible and it feels like all of this is an attempt to delay treatment until the new year in order to not have to cover my healthcare expenses which seems like fraud. I pay over $1,000 a month in premiums for this insurance and at least 2 of the last 3 months I have had to battle them to acknowledge I have an active policy. I have already had to cancel and reschedule many appointments which has slowed down my ability to be seen and get subsequent appointments scheduled. My deductible resets in January and wanted to have everything resolved before then but it’s impossible due to my health insurance plan playing dumb. I’m so angry.

What resources are there out there to help me? Everyone I talk to just keeps pushing me in circles and no one has the answers. I just feel stuck and it’s so unfair because I’m doing everything right. But what can I even do? I’m just at their liberty.

submitted by /u/anonymous8151
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