Employer Plan Changed 7/1; recent surgery, surgeon now not on plan

I have Anthem BCBS in Colorado via my employer. Our plans start over July 1 every year. I had an HMO plan for the last two years that were ok – I could basically go to any doctor I wanted as long as I had a referral. It did cost a bit every time you went to the doc though.

Our plans didn't change much the last few years but starting with our options for 7/1, all the costs went up and doubled in many cases. The plan I had been on was going to be really expensive if I stuck with it. I crunched all the numbers and decided to switch to a different Anthem HMO/PPO plan.

Here's the thing – I had surgery scheduled 6/27 on my old plan. When we make decisions on switching insurance plans, we have little detailed information. There's kind of a search feature you can use to see who is covered in different plans but it's somewhat confusing (mainly plan names are not exactly what my employer calls them). It's not the full anthem website, it's a much more limited view. I had searched for my surgeon on the plan I was switching to, and it said he was covered.

I just discovered tonight, that my surgeon is NOT covered in my plan that started 7/1. Neither are any of the physical therapists in his same practice. His facility is covered but not him. My surgery itself is billed on my previous insurance and is covered. But my follow up was supposed to be 7/10 where I get stitches out, etc. Now I can't go back to him. I also have to go elsewhere for physical therapy.

The other problem is Anthem also parted ways with my primary care practice of 10 years, which I didn't know until after I had surgery on 6/27. So I don't have a primary care right now.

My biggest concern is my surgery follow up and getting my stitches out. I don't know if my case falls under the continuity of care law since Anthem can argue this surgeon wasn't covered under my new plan the whole time (But from what I could see when I had to decide on which plan he was covered, I just can't prove it). I can't wait months for them to decide…I have stitches that need to come out.

I also had 1 physical therapy appointment after 7/1 that was denied because the physical therapist is not covered on my new plan (which I didn't know – I didn't even know their full name so I could check before my appointment). Apparently that could cost me $400 if I have to pay it.

Any advice? Am I just screwed and have to figure out recovery on my own now?

submitted by /u/squatsandthoughts
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