Gravie-So Bad

I'm at a loss.

Up until this new job, I had been on MA my whole life. They paid for everything, never got a bill, never had to worry about where I could go and who I could see. This job pays enough that I no longer qualify for MA and can actually afford insurance, but I obviously knew nothing about insurance so I just got what my employer offered: Gravie. It's the Comfort $7,900 OOPM.

I needed to go to the doctor back in January, so I used Gravies "find a provider feature". I wanted to make sure as my primary care has just recently moved to a different clinic. Well, she was listed as in network at the new clinic, as well as the clinic itself being listed as in network.

Then I get notified by Gravie that I had an out of network claim and owe $326.

I send them an email (I prefer to have paper trails), and they tell me that it's because the claim has the individual NPI and not the group NPI. No clue what that means. So I call Gravie for an explanation and to find out what I need to do. Then I'm told that it's not the NPI, it was processed wrong and just needs to be reprocessed. Okay.

The claim gets reprocessed and then they tell me that the doctors out of network for Gravie, but that she's in network for the back up network. Okay, whatever just get it taken care of.

In the meantime, it's time for my psychiatrist appointment. I didn't trust the "find a provider" feature anymore, so I call them to ask if my psychiatrist is in network, as well as a therapist I would like to see (I know it's irrelevant, but these two providers are employed by the company I work for, who offers this insurance. Kinda dumb that the therapist is out of network ". For the psychiatrist, the representative just said "I don't know ". And that's all she would say (turns out my psychiatrist IS in network).

Now I just heard from Gravie again. Apparently they talked to "Raquel" in billing at the clinic I went to. Both my parents work there now. There's only one employee in billing, and their name definitely isn't Raquel. This isn't like Essentia where there's multiple locations and a corporate office, this is literally the only billing employee.

Apparently the issue was something with the TIN, so they talked to "Raquel" and "Raquel" said that they only use one TIN number. So Gravie said it's out of network and my responsibility.

In my head this makes no sense as they confirmed that the clinic itself is in network, so if they only use one TIN wouldn't it be the clinics?

I called Gravie to ask for an explanation. The representative told me that the TIN on the claim is different than the TIN "Raquel" says belongs to clinic. She said she'll try to get it sorted, but that at this point Aetna probably won't pay a claim for an appointment that took place January 17th because it's "too long ago".

Gravie received the claim January 19th. I was notified January 25th and contacted them the same day. So the only reason it's been so long is Gravie.

I submitted an appeal, but is there anything else I can do? How do I make sure that this gets paid? My mom worked in registration at the other clinic before she got a job at this clinic, and she said this happens a lot with Gravie.

submitted by /u/Objective-Stress-369
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