What Do I Do When Health Provider Doesn’t Honor Contract?
I have joined one of the Health Care Insurance Group. As a member they gave me a Members Kit, which has the Exclusive provider Organization Contract. In that contract under Section 6.1.8.Screening for Prostrate Cancer; it states that the Insurance Company covers an Annual standard Diagnostic Examination not subjected to Co-payments or Deductibles when provided Participating Provider. I had my prostrate checked and when the bill came ; I not only have to pay half of the bill but also the Copayment also, which is over $11,000.00. I protested it but the review committee said I must pay. Ignoring, not honoring their very own rules.
Who can I go to, other than this insurance committee to look into this matter? Its like the fox watching the hen house. I pay my monthly dues, all of my prescriptions, and doctors visit fee $150.00 for every time I visited this year.
You have the right to an appeal. So we suggest appealing the charges. Even under the worst ACA protected plan, covered services are covered in-network. So unless we are missing something you shouldn't owe more than your out-of-pocket maximum for covered charges. Whatever you do, don't pay the bill without appealing.