United Health Care marketplace insurance showing specialist is in network, but hospital says otherwise.
TLDR: Signed up for affordable health insurance through marketplace. Plan claims specialist is in network, but the hospital called and said the appointment won't be covered and United Health Care is not in network. I called UHC and they said some things that didn't really make sense and hung up. What Should I do? This is in Alabama btw.
I was fired form my job in February and lost my insurance which was BCBS FEP. Before I lost that insurance, I had some imaging work done for a medical issue that I am dealing with. That imaging work was done in March under BCBS. I officially lost the insurance in April. During this time I had an appointment with a specialist scheduled in May and I figured that would give me enough time to sign up for marketplace insurance. I managed to get signed up with United Health Care Silver Plan at the end of April so I would have insurance ready for my appointment in May. When I was looking for the insurance, I filtered the results to show the specific specialist that I had the appointment for and the hospital/medical center that the specialist works at. Marketplace (Healthcare gov) showed that the doctor and facility were in the network for this plan. I bought the plan and was happy thinking that everything should go smoothly for my upcoming appointment. This is where things start getting confusing. I got a call from the hospital (I believe it was the department of the specialist that I needed to see) saying that the insurance that I have (UHC) will not cover anything at all including initial visit, imaging, surgeries etc. I broke out in an instant sweat. I told her that the marketplace website said that this doctor and facility were in the network. I ended up rescheduling to late June. I keep having to push this appointment back due to the insurance issues. I called UHC to confirm whether the hospital/specialist was showing if they were in the network in their system. They did not really help much. The rep said something along the lines of "A primary care physician needs to send a referral to the specialist and they don't have it in the UHC system. The thing is I had a referral sent which is why I had an appointment to begin with, it was just sent when I was enrolled in Blue Cross Blue Shield FEP. Basically my question is: WHERE DO I GO FROM HERE? Should I file some type of complaint to get the money that I have paid for the plan? What's the point of having a plan that doesen't cover anything. I only went with this plan because of the affordability and the benefits. It has an $1800 deductible and I was pretty sure I will need some surgery. It said on the website that the facility and doctor were in the network. Should I cancel the plan and look for another plan through marketplace? I am currently unemployed and living off savings for now. I really am trying to see a doc soon because my medical issue wont allow me to exercise or exert myself. I know this may sound like I am all over the place but I am needing some advice. Also this is taking place in the state of Alabama. Just looking for some advice on what to do next. If more details are needed then let me know. Thanks.
submitted by /u/Classic-Sympathy-224
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