Insurance company denying claims for out of network provider when provider is in network.
I am so frustrated. My insurance company requires referrals for everything. Early on in my pregnancy I was referred to a maternal fetal medicine doctor. I was sent to a group with several doctors. It was approved and every single doctor is in network. All claims were being paid. A few months ago the name of the office changed but the providers are the exact same and still showing in network on the website. Since then I have had 8 visits. 4 claims were paid and 4 were denied for being out of network. The total balance I owe according to the provider is around 10k. I have requested on multiple occasions to review the bills. The customer service rep I speak to tells me they were incorrectly denied and they will be reprocessed and paid. I’m then given a reference number. The bills have now been reprocessed 4 different times and denied for the same reason. I recently submitted a written appeal, which was also denied saying the providers are out of network. But they are not. I have reached a point where I don’t even know what to do. I’m tempted to file a civil remedy notice and sue them for bad faith but it’s just such a time consuming process and I’m about to have a baby. I also have used all my holds with the providers office and will have to start paying on these balances that I literally do not owe. Any suggestions or feedback? I’m in Florida if that helps.
submitted by /u/user_of_things
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