Not sure if I should move this to the health sub or not...leaving it here for now.
Question 1:
On my "Schedule of benefits", something is listed as covered. I made an appointment with a provider, but he advised me to call ahead to the insurance company because he's had problems before. So I did. But according to their "system" it isn't covered, regardless of what my "schedule of benefits" says.
Note: I downloaded the SoB (ha!) directly from their website yesterday before i called.
The csr told me that it would be denied if they got a claim for it despite the contradiction. So I'm now communicating with my HR asking them to contact their representative at the insurer to clarify.
Here's the question: what would have happened if I didn't call and they denied? Is there an appeal's process? Don't I have a good faith (not sure if that's the correct phrase) argument to get them to pay for the claim?
Question 2:
My plan is a calendar year plan. The out of pocket max for my plan was listed on the documentation I received last year (November 2013) when I re-enrolled. They increased it mid year retroactive to jan 1, saying it was an error. I would have picked the plan I did regardless, but some others picked the plan due to the lower OOP max.
Questions: Are they allowed to do this? The paperwork that stated the lower max was provided by them, not by our HR.
Sorry for the length.
Question 1:
On my "Schedule of benefits", something is listed as covered. I made an appointment with a provider, but he advised me to call ahead to the insurance company because he's had problems before. So I did. But according to their "system" it isn't covered, regardless of what my "schedule of benefits" says.
Note: I downloaded the SoB (ha!) directly from their website yesterday before i called.
The csr told me that it would be denied if they got a claim for it despite the contradiction. So I'm now communicating with my HR asking them to contact their representative at the insurer to clarify.
Here's the question: what would have happened if I didn't call and they denied? Is there an appeal's process? Don't I have a good faith (not sure if that's the correct phrase) argument to get them to pay for the claim?
Question 2:
My plan is a calendar year plan. The out of pocket max for my plan was listed on the documentation I received last year (November 2013) when I re-enrolled. They increased it mid year retroactive to jan 1, saying it was an error. I would have picked the plan I did regardless, but some others picked the plan due to the lower OOP max.
Questions: Are they allowed to do this? The paperwork that stated the lower max was provided by them, not by our HR.
Sorry for the length.
health insurance questions
