Claim was denied because doc was out of network.

Long story short I needed to see a specialist recently. When I made my appointment I was paired with the OON doc. There’s two docs who work there and the other doc is in network. (I’m new to using private insurance as I recently separated from the service so excuse my ignorance). I’ll call OON doc doc 1 and in network doc doc 2.

Anyway, had my initial appt with doc 1 who didn’t even meet with me. A PA came in and just ordered blood work labs and I was told I’d be called for another appt when the blood work was done. Well several weeks later I was called by the receptionist and told doc 1 saw my blood work and wanted to move me to doc 2 because doc 2 is better informed on my issue.

Then doc 2 orders further and more specialized blood tests.

Here’s my issue. Doc 1’s blood work claim was denied by my insurance because he is OON. $2000 bill

Doc 2’s bloodwork claim was approved because he is in network. Complete coverage

Both tests appear as the same name on my insurance website so the only difference is the doc who ordered the tests.

So, I’m wondering why the specialist receptionist didn’t put me under the care of doc 2 in the first place. I thought this was why they asked for my insurance info when I made the appt.

Am I out of luck getting my insurance to cover this bill? This is my first time dealing with my private insurance and so far the process seems at best uncaring and at worst totally rigged.

submitted by /u/XkommonerX
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