After being part of the "furlough wave" in the airline industry on October 1, I elected for COBRA to continue my health insurance because 1.) I was in the middle of an active medical condition, and 2.) the health insurance was excellent ($15 copay for a $17k procedure in June). However, since health insurance is immediately cancelled on the date of loss of employment (Oct 1), and since I didn't receive paperwork to even make COBRA elections until Oct 19, there is no way for my insurance to be verified in the mean time.
Since I had time on my hands (thanks to the furlough), and was eager to not delay care for my medical condition (especially when I'm paying for health insurance after all), I opted to get a screening procedure out of the way while in the "COBRA gap". Since my insurance showed inactive to the doctor's office, I was told I had to cancel the procedure until it could be verified. Knowing verification could take another few weeks and that I was already paying full priced COBRA premiums for October, I thought I should be able to receive treatment without delay. The doctor's office offered an "uninsured" price for the procedure of $1300. I contacted insurance (Anthem BCBS) and asked if I could file a claim for this procedure once it was retroactively activated. They said yes I could and I went ahead with the procedure.
Fast forward to the first week of November and COBRA "kicks in", now it's evident to everyone I was covered from October 1 to present. I went ahead to file the claim and Anthem said claims were required to be filed by the doctor's office when in network. So I asked the doctor's office to resubmit the claim and they said it's against their policy to submit a claim when a patient opts for the "uninsured" payment, which was not disclosed to me prior to the procedure even after explaining the COBRA situation. So now I'm in limbo between Anthem and the doctor's when I paid $1300 for something that should have been $15 while paying $800/month for COBRA premiums. (The employer paid 75% of the premium, I would have gotten a cheaper option if I wasn't in the middle of a health issue).
Anyone have similar scenarios? I know there is a state insurance board but honestly I don't see what the problem would be for the doctor's office to just resubmit the claim (against their policy) and have Anthem pay their contract rate for it. I've contacted Anthem several times about this, and no one will elevate it to plan administrators/case managers even though I've asked directly for them.
tl;dr got an elective in network procedure during the "COBRA gap", provider won't resubmit the claim, insurance won't let me submit the claim myself, and I'm out $1.3k after paying a ton in premiums.
Submitted January 01, 2021 at 10:48PM by C441_Driver https://ift.tt/2X4DPNg
