What is really going on when insurer stalls review of your claim?

I had a procedure done a couple of months ago where I called my insurer (one of the big ones in the US) to confirm that the procedure and doctor were in-network, to which they confirmed BEFORE the procedure.

I go for the procedure and pay my copay. I come back later and the doctor’s office tells me I owe more because when they submitted the claim to my insurer, it came back as out of network (despite me and the office confirming beforehand it was in network).

I contacted my insurer to fix this. The person I spoke with had me submit documents showing the doctor’s name, etc. they gave me a reference number for the case.

It’s been a couple of months. Every time I call I get someone who says “I see there’s been no activity on this. I’ll put notes in to say you called and to push for this to be processed correct as in-network.” Rinse and repeat.

I started calling twice a week. Called today and got the same line but this time they admit they don’t know why there’s been no activity so they now submitted an appeal but it could take 60 days from today!

What were they doing this whole time when I called the past couple of months and they kept telling me it’s in review but has had no activity?

submitted by /u/DrawingIndividual
[comments]