How much can my insurance legally push me around?
So my situation is somewhat unique, I have what I would have previously called rather high quality insurance through a parents job. My plan (theoretically) is very generous, with nearly all medical services (Aside from dental and vision) covered at 100%, no copay, regardless of price. For about 3-4 months, everything was fine, I was using the insurance for physiotherapy and registered massage therapy due to two medical conditions, and there was minimal issues with reimbursement. Occasionally the insurance would make a request like a renewed doctor's note/recommendation, but it was generally reasonable and not hard to get in a reasonable time frame. However since the beginning of September, they have gone practically on lockdown, delaying or denying almost all claims until I get a medical report and recommendation from a orthopedist, with claims from providers who I have been seeing for months, getting reimbursed with no issue, being suddenly denied. Seeing an orthopedist is very difficult for me because I live in Canada, and the public orthopedists take weeks to months to see, and there are only a small handful of very expensive private orthopedists, and my insurance is now refusing to pay the full amount for a private orthopedist, despite the fact that this flagrantly is a violation of my schedule of benefits. I'd rather not say the name of the provider (don't know if I can get in trouble), but I can say they are an international provider, legally I believe they are headquartered in Delaware, but mostly I interact with their French office. I'm wondering if anyone with knowledge in this area can tell me how much my insurance provider can delay payments, take ridiculously long to respond to requests, ask for unreasonable and unnecessary specialists who they then refuse to pay for, before this becomes some sort of violation or breach of contract which I can act on?
submitted by /u/JasonBoorneeeee
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