TL;DR AT THE BOTTOM
I don't go to doctors whatsoever in the past 7 years I had maybe 3 or 4 urgent care visits. That's all, hence i stay with the cheapest HMO. Changed my insurance to a known company last year, still staying on the cheapest plan [~$40/month]
Last year I had a situation where i lost hearing in my left ear and needed help so i contacted my insurance to provide me a list of urgent cares where i can go to seek help. I was provided with a list and i visited every facility from the list just to be denied, so i contacted my insurance explaining the situation and i received another list but this time with a promise 'those will respect your plan'.
Guess what?
Neither of them did.
At the last facility lost of hope i asked if maybe they knew who takes my insurance and was told a few places and one of them claimed they did. Before going to that location i contacted my insurance to check if i could have a visit there since it wasn't on either list that i was provided. I was told that yes. So i went there and before having the visit I called my insurance once again to check if for sure the visit will be free and I was assured that if it only goes through their system at the urgent care they will cover the visit.
So i had the visit, the issue with my ear was resolved and a month later i got a bill. I called my insurance right away they claimed that it wasn't an urgent care visit hence they denied the claim. We had a 3-way phone call with the urgent care place where they confirmed that indeed it was an urgent care visit, and the doctor's name that appears on the claim is only because it was her shift, and by law, they have to put the doctors name there so they get paid for their work.
They asked for some tweaks in the claim which the urgent care billing supervisor did and sent them and i was told that now i have to wait.
A month passed i got a bill again, I contacted my insurance same story; it wasn't an urgent care visit, a 3-way phone call, the urgent care place was told to send the claim again, but this time my insurance agent just hung up on us after they said they will send the claim again. I was left on a line with the urgent care representant and even she was like what your insurance is doing right now is very sketchy.
Anyway, since I knew now all i had to do was wait for the claim to be processed i just ignored the weird agents behavior and waited for the thing to be resolved.
A month later once again i got a bill, so i contacted my insurance but this time im was told that it's because the place is out of network… I had so many back-and-forths over here so i'll just skip a few phone calls and a few reclaims sent by the urgent care to this year where finally one of the representatives told me "we can't do anything about it really, but their supervisor might help." So i asked to speak to one, and immediately I was that they apologize for everything i had to go through and that they will not only cover the claim, but also set that location as my preference even though it's out of network where in the future i won't have to go through all this again. The only thing i was asked for is to send a simple appeal so they have some documentation for it. So i did, and on the appeal i was told to keep it simple and short. All i did was just write the date of lists provided to me, said that neither of the facilities were respecting it, I mentioned that i was told that i can have a visit at XYZ location by a representative from my insurance, and was ensured about it minutes before the visit by another one agent. And i included the phone call confirmation with the supervisor which ensured me the issue will be resolved.
Guess what?
It got denied. On top of that, i found out that the urgent care forwarded my bill to a debt collector.
I called my insurance twice and both times was told that a supervisor would give me a call back which never happened. Today i finally got a hold of one and was told that whatever other agents and supervisors told me doesn't matter, and I can only request an external review as the only solution.
Now my question is there's no way this is legal; i was literally told by them that i could have a visit at XYZ, which then they decided not to cover.
It's not that much – a couple hundred dollars, but what if this would be a million dollars? Like surely this can't be legal to misinform your members like this
Are there any legal actions i can take against my insurance for putting me through so much stress and mental problems caused by… i don't even know how to call it incompetence, lying, scamming?

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TL;DR
No facilities from the list I was provided with by my insurance were respecting it. Found one that wasn't on the list. Got a green light from them to go there, and also double-confirmed it before the visit. The claim ended up being denied and eventually was assured by the supervisor that they would cover it after sending a formal appeal which was denied and now i need to seek external review.

submitted by /u/Nextraque
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