My insurance covers lasik eye surgery 100% for in network providers. Provider gave me two tax IDs – one is in network and other one is not. So confused here
My insurance covers lasik eye surgery 100% for in network providers (I have UMR insurance). In my benefits, it says that I may need to pay upfront for the surgery. I went to this lasik center who stated that they do lasik for people who have my type of insurance. However, they stated that I am responsible for submitting the claim and that they do not deal with insurance.
I found the lasik center and the provider on UMR that says they are in network. So I get the surgery and fill out all the necessary documentation including their tax ID that I was given by the receptionist.
My claim was approved and I received an EOB that the negotiated rate is $2000. I paid $5000 upfront. The insurance sent me a $2000 check and tells me to get a refund from the lasik center for the remaining $3000. I call the lasik center and they state they do not deal with insurance and will not refund me the remaining $3000. From what I understand, this is part of the no surprise act in Florida (where I am) and is illegal – balance billing.
Finally after a lot of back and forth, I get the insurance and lasik center on the phone together and apparently the tax ID I initially filled out the claim with is the wrong one. They use a different one for lasik. Now the tax ID that they gave me is coming up at out of network and therefore the surgery is no longer covered.
What do I do here? I did cash the $2000 check. Is there really such thing as multiple tax IDs that this provider is now all of the sudden out of network? They clearly show in network for both the facility and provider on my insurance website and I also got a list of in network providers from the insurance as well.
This is really stressing me out and I’m just unsure of how to proceed because I got the surgery with it in mind that it would be covered 100%.