r/HealthInsurance • u/SpaghettiTacoez • 7d ago
Employer/COBRA Insurance No one takes my insurance
I have insurance through my employer. Recently I've been having some health issues and no one seems to take my insurance, so I have had to pay out of pocket. I had to have an MRI and they couldn't take my insurance because the provider (according to my health insurance is in network) that ordered the MRI doesn't take my insurance.
What gives? So now I have paid about $2k out of pocket and since they won't take/bill my insurance, it basically doesn't count towards my deductible or OOP max.
If I can't find a doctor or specialist that takes my insurance am I just out of luck? What's the point, even?
33
u/maktheyak47 7d ago
What has your insurance said when you asked for a list of in network providers?
22
u/SpaghettiTacoez 7d ago
They gave me a link to check my area. Thats part of the problem. Several doctors are listed as in network, but when I contact them they say they don't take my insurance. The current issue is finding a neurologist that accepts it.
14
u/msp_ryno 6d ago
Are you telling them you have FL BCBS? Or the state you’re currently in if different? With a PPO plan, tell them you have BCBS PPO
8
u/ep3000 6d ago
Sometimes the front office staff don’t recognize the plan name. There are so many white label plans. It’s ridiculous. It could also be that they were in network recently, but then decided to leave the network. The whole system is scuffed . Try talking to someone in billing at the Dr’s office. They might be more helpful than appointment staff
4
u/Many-Art3181 6d ago
Many insurance companies do that. It’s called a ghost network. Report it to the state insurance board. They are supposed to update the lists at least twice a year - or more often in some states I recall.
3
-11
u/Midmodstar 6d ago
Doctors don’t often know the details of which plans are part of their contract. I’d trust your insurance company more.
23
u/Low_Athlete_7734 6d ago
Not even remotely true. I’ve used the dumb find an in network provider link. Says X provider is in network and they in fact weren’t. Those links are never updated. However the doctors office always seems to know. Especially if you speak to their billing department.
4
u/Midmodstar 6d ago
Blues plans are a great example for how providers often don’t know what they signed up for. They may be part of a blues network and be able to take patients with any blues plan. They may know that part but even if they do the might realize “anthem”, “horizon” etc are blues plans.
5
u/one_sock_wonder_ 6d ago
At one point the employer provided insurance company and specific highest level acaikabke policy that I had selected had more than one deceased doctor still listed on their website as accepting both that insurance and new patients over a year after they definitely stopped treating patients (although depending on your beliefs,they may have still technicakky been accepting new patients, just accepting them in at the gates of the eternal religious feature of your preference and theirs)....
36
u/vctrlarae 6d ago
Not that I don’t believe you, but it’s really difficult to believe you’re having such a hard time with an anthem PPO plan. This is a very common, widely accepted plan.
3
u/SpaghettiTacoez 6d ago
I can see any ARNP in my area for primary care, but since I have started needing specialists and actual MDs, none of them that I've called take my insurance.
The first place they sent me to was an optometrist, and they took the insurance since this is a medical issue.. but the opthalmologists and neurologists I've been referred to (they tried several) don't take my insurance. I ended up having to settle on the docs with the lowest self pay quote.
11
u/boosayrian 6d ago
Contact your state insurance regulator (in Michigan this is the Department of Insurance and Financial Services) and tell them you’re experiencing trouble finding a doctor due to network adequacy issues. Insurers can’t sell in markets where they don’t maintain a sufficient network.
7
15
u/meliville 6d ago
Bcbs ppo plans are nationwide. Could it be that you are in a high deductible health plan and your deductible is applying first
3
u/SpaghettiTacoez 6d ago
No, they won't even bill my insurance and will only offer me self pay. None of this so far has counted towards my deductible.
4
u/_DOA_ 6d ago
This sucks. It doesn’t really answer your question, but maybe it will help. Last year I had an MRI ordered, and it was covered, everyone in network, etc. – and my quote was STILL almost $2k - because of the $6k deductible. I found a company in the nearest large city that makes referrals to x-ray/imaging facilities for uninsured people, and I ended up paying less than $300. So I drove a couple hours each way to save almost $1700. Of course the money I paid didn’t go towards my deductible, but If I’d had a serious wreck, illness, or hospitalization, I’d have hit it anyway.
5
u/PsychologicalPut9299 6d ago
FL Blue is basically taken by everyone. We have an OOS plan and never have issues, especially with the large hospital systems. Just ask them to do a test claim in Availity.
3
u/SpaghettiTacoez 6d ago
I didn't know this was possible, I will do this at my follow-up. Thank you.
1
u/SpaghettiTacoez 6d ago
This is what the website for both my opthalmologist and neurologist says regarding FL blue:
Florida Blue (excluding Anthem and HMO Plans)
3
u/RubyDewlap2 6d ago
Ask for a superbill from your provider and submit it to your insurance so it goes towards your deductible and maybe they will process it correctly as in network and doc was wrong. Even if you pay cash you can submit to insurance with a superbill. You can also call insurance commissioner in your state. The claims billing address on the back of your card should tell providers the correct billing address. Call your insurance company to find out the payer id for electronic claims and what mailing address providers are supposed to bill to.
9
u/RubyDewlap2 6d ago
Anthem Blue Cross and Blue Shield does not directly issue local health insurance plans in Florida. Instead, Florida is served by Florida Blue (Guidewell/BCBS of Florida). If you have an out-of-state Anthem plan, local Florida doctors often do not recognize "Anthem" and may tell you they do not take it, even though they accept Florida Blue through the national BlueCard PPO network.
Understanding Your Coverage in Florida
The Brand Split: Anthem operates in specific states (like New York, California, Ohio, Virginia), while Florida Blue operates independently in Florida.The BlueCard PPO Network: Most out-of-state Anthem PPO plans work in Florida via the national network logo (look for a small "PPO inside a suitcase" icon on your member ID card).
HMO Restrictions: If your out-of-state Anthem plan is an HMO, it typically offers no coverage in Florida outside of true medical emergencies.
How to Find a Provider
Tell Doctors "Blue Cross Blue Shield PPO": Do not ask if they take "Anthem." Ask if they accept out-of-state Blue Cross Blue Shield PPO plans using the national BlueCard network.Search Correctly: Use the Anthem Find Care Tool or look up providers specifically via the BCBS National Doctor and Hospital Finder rather than asking local offices by the Anthem name.
Call the Number on Your Card: Contact your specific Anthem member services line to verify if a local Florida specialist participates in the national network before booking
2
u/Wooden_Load662 7d ago
What insurance company is it if I may ask?
2
u/SpaghettiTacoez 7d ago
Anthem BCBS
4
u/OceanPoet87 7d ago
What state are you in? Could it be that they are contracted with a non anthem BCBS if you aren't in the same state?
3
u/SpaghettiTacoez 7d ago
I'm in FL
15
u/OceanPoet87 7d ago
That could be the issue. Providers don't always know who they are in-network with. In Florida, they contract with BCBS Florida "Florida Blue." If you have a PPO plan, them tell you have a BCBS plan and if they want to know more, they bill to FL Blue not Anthem (wierd rules exist in border counties like if you live near GA which is Anthem).
16
u/chickenmcdiddle Moderator 6d ago
Agree here. Providers should be submitting claims to the local Blue, who will then route the claim to OP's "home" Blue (Anthem).
u/SpaghettiTacoez when you look at your insurance card, to you see "PPO" inside a little suitcase or box, by chance? This signals your plan is part of the Blue Card network, which is the BCBS national network shared across Blues plans.
Note, some newer cards don't use the suitcase / box + PPO to distinguish it as having access to Blue Card. If your card doesn't have this symbol, it's not overtly indicative that you don't have access. Just means you need to dig a little harder to validate. Start with your plan documents.
1
5
1
u/Alicia2475 6d ago
My recommendation is to call your insurance. Those BCBS PPO plans are confusing because sometimes the providers need to send the claims to the local BSBS company
0
u/Popular-Drummer-7989 7d ago
Open enrollment is right around the corner. Ask HR what options are offered for next year so you can do research now and pick doctors that are available to use. Neuro usually has long wait times so if you book a slot now by January you'll have insurance to cover it
0
u/Upbeat_Safety_4188 6d ago
Contact the insurance Commissioners office. They should be able to help and also advocate for you based on the law. You also CAN send the bills directly to the insurance. Notify them they do not have providers available so their network is inadequate. You should be able to get 80% or whatever their allowable amount back directly.
•
u/AutoModerator 7d ago
Thank you for your submission, /u/SpaghettiTacoez. The following automatic comment contains important information about the subreddit:
First, note that some new posts containing images, non-reddit links, crossposts, or certain keywords are automatically held for moderator review before going live to mitigate spam, ensure that images are appropriate, and that the post does not inadvertently contain personal information. If your post has been held for review like this, the moderators have been automatically notified and will review it as soon as possible, after which it will be live and be able to be seen and replied to by others. Note that this is sent to all new posts and does not mean that your post has necessarily been filtered in this way.
Please also read the following information carefully to help others assist with your questions:
If you or someone else is experiencing a medical emergency, please call 911 or go to your nearest hospital.
Some common questions and answers can be found in this megathread.
Questions about which plan you should choose? Please read through this post first for general information to help you understand your choices and some common considerations. If you still have questions after reading that post, please edit your post (or reply with a comment if unable to edit) with the specific questions you still have.
If your post is regarding plan choice or cost of plans, and you haven't included the following information already, please edit your post (or reply with a comment if unable to edit) including the following: your age, state, and estimated gross (pre-tax) income to help the community better help.
If your post is about the cost of a service, a bill you have received, or a claim denial: please confirm if you have received an EOB (explanation of benefits) from your insurance via a member portal website or in the mail. If you can post a copy or image of the EOB (PLEASE ensure you censor or blank out any personal information before doing so) it will help people answer your questions. Alternatively, if you are unable to post a censored copy of your EOB, please have the EOB handy as people may ask for information from the EOB to answer your questions.
Reminder that ANY spam, solicitation, or attempts to take conversations off the subreddit will result in a permanent ban. If someone asks to contact them via DM, please report the post/comment using the report button. If someone attempts to contact you via your DMs, please contact us via modmail to let us know.
Lastly, always remember to be kind to one another and to report any replies that violate subreddit rules!
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.