Burned by a previous experience, unsure how to use medical benefits with confidence…

Hi there,

My question is: Can you/ how might you obtain confirmation from your health insurance provider (mine is a PPO plan with BCBS through my job) that an upcoming service/treatment/appointment/whatever you plan on receiving soon will actually be covered? I'm talking beyond the EOB. I'm talking about a letter that confirms that a treatment of code X for me specifically, charged by Dr. Soandso, has been confirmed to be covered to Y degree, as outlined by my benefits.

My reasoning: back in Feb, I attended a telehealth group therapy session w/ a psychiatrist through Mayo Clinic. It was a requirement of Mayo in order to be eligible for a surgery I no longer even want to pursue. I checked with BCBS via a chat agent on our plan website that a telehealth group therapy session would be covered completely minus a $40 copay. I took that to the bank and attended the session. Next thing you know, I'm getting a $300+ bill for the session – citing not a therapy session but a "physician service". Many calls with Mayo (someone in Billing glanced at the issue once and decided the coding was fine; haven't been able to refute anything on Mayo's end since) and BCBS, a BCBS agent identified that the issue was that BCBS was expecting a "Location of Service" modifier that Mayo failed to fill out appropriately/as expected for the type of care I received. With some help from the agent, I appealed the claim with BCBS but just got a letter in the mail saying that my appeal was denied. I felt like I did everything right (knew what type of service I would be receiving from what type of provider, checking my EOB, and confirmed my understanding of my benefit with a plan representative). Only for Mayo to code it some "wonky way" (BCBS phone agent's phrasing) and for me having to pay over 7.5x the expected amount.

A different physician at Mayo wants me to take an appointment with her before continuing to provide prescriptions for me; I'm afraid of an encore of this mess. Hoping there's a way some people confirm with their insurance of a specific service *before* receiving it beyond checking their EOB & just hoping its coded the way they expect it to be. Something like "we are expecting these codes from this hospital/doctor and confirm coverage at this rate." Maybe this is silly, idk. I don't think this would be a prior-auth but rather something I would initiate.

I'm feeling lost, dejected, and scared to use my benefits. I'm 26, have been on company BCBS PPOs for several years, and this is my first year actually using my benefits in a way outside of urgent care/emergency room visits and seeing my regular therapist (fully covered minus a copay).

Thanks and apologies for the length

Edit: I live and work in Minnesota.

submitted by /u/sweetcc333
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