PCP changed practice locations, shows up as in network on Anthem BCBS website at new location but billing office says otherwise due to how they bill
My PCP (Dr. A) left a practice (lets call it X) and is now part of a completely different practice now (Y medical group). I have Anthem BCBS, and Anthem's website says Dr. A is in network, and the company that is affiliated with her "Privia" is also in network. However, my insurance called the billing office for Y and they said they bill under the name Y medical group ( even though Privia is their admin's name), and Y medical group is not listed as in network, so if I were to see Dr. A, it would be out of network, for which I have no coverage. I am very frustated because it sounds like if I didn't' take the time to ask about billing, I would have had a surprise bill. And of course, anthem's website is still listing Privia Medical Group Llc as Dr. A's affiliation. To add to that, a new doctor (Dr. K) joined the old practice X, to replace my PCP. And while that practice (X) no longer shows up in network (even though it was in network a few months ago before Dr. A quit), my insurance claims to have called X's billing and verified that they would bill my office visit with Dr.K under a NPI associated with Dr. K old practice (a completely different system that also in network), that office visit will be covered, even though she is now located at X. I then asked my insurance if that's true, why not look up what the NPI is Dr. A, and if that NPI is associated with an in network provider, rather than relying on the whether the billing name Y medical group is listed as in network. Insurance agents response:
"The practice and the provider would need to be In Network for the claim to process as In Network .If your provider Dr. A has a location that is showing In Network and they have her listed as In Network under their number she would be In Network. If they do not have her listed as In Network at their location she would not be or if the new location is not In Network she would be Out of Network as well."
Am I over complicating this? I feel like she missed the point. I really do not want to have to find a new PCP when it turns out it would have been fine staying with her. I have spent way too much time chatting with insurance about this, I am exhausted and just want to avoid all doctors whose coverage is ambiguous just to be safe. I feel like its now not enough to check if a doctor is in network, I have to find out how they bill and check that too. Does anyone else have to do this?
It's a self funded employer sponsored plan if that makes a difference.
submitted by /u/ToyotaCorollaFail
[comments]
