I had a very similar experience with Cigna and a US healthcare provider. The provider was not getting reimbursed from Cigna and Cigna was saying the provider was not accepting the reimbursement.
I got nowhere talking to the provider’s billing department. I finally got it fixed when I called the provider’s corporate office.
I’m not sure if that applies to your situation, but see if you can talk to someone outside of the billing department.
There are also businesses called Healthcare Advocates. You can hire one of those, but I can’t speak to it.
If it matters, hiring a lawyer might get their attention.
But while it is probably an injustice and $3k feels like real money to most people, how much are your time, and emotional energy worth?
You are up against an extractive institution with teams of professionals who spend all day, five days a week, fifty weeks a year figuring out what can be gotten away with. And their compensation correlates to how much is gotten away with.
Their phone tree can be programmed to route your call to the bit bucket when wearing you down by the runaround isn’t working. None of this is a misunderstanding, it is all by design. Good luck.
It can matter and you can get similar results through your attorney general without spending your own money. If it doesn't matter, then you wouldn't do anything.
Because anything else would be unprofessional, you can safely assume the getting-away-with-it calculation considers the applicable attorney general and that there is a budget for political contributions as well.
The calculation also includes the probability you contest denial with a lawyer drawn from accurate data across many denials. Because anything else would be unprofessional.
You greatly overestimate the planning and ability of most companies. Most of these companies assume that most people won't contact the AG or an attorney. Most of these companies correct the issue once the AG or regulator gets involved because it's cheaper than fighting. They only fight the really expensive stuff. This is how it works as I've seen it happen.
The EBSA will investigate the claim and may contact your employer or insurance provider for more information. You may be contacted for additional details or documents. If the EBSA finds that your rights under ERISA (Employee Retirement Income Security Act) were violated, they may take corrective action on your behalf. Keep copies of all documents and correspondence. You can follow up on the status of your complaint by contacting the EBSA at the phone number above.
I had a very similar experience with Cigna and a US healthcare provider. The provider was not getting reimbursed from Cigna and Cigna was saying the provider was not accepting the reimbursement.
I got nowhere talking to the provider’s billing department. I finally got it fixed when I called the provider’s corporate office.
I’m not sure if that applies to your situation, but see if you can talk to someone outside of the billing department.
There are also businesses called Healthcare Advocates. You can hire one of those, but I can’t speak to it.
Your state attorney general should be able to help.
[random advice from the internet]
If it matters, hiring a lawyer might get their attention.
But while it is probably an injustice and $3k feels like real money to most people, how much are your time, and emotional energy worth?
You are up against an extractive institution with teams of professionals who spend all day, five days a week, fifty weeks a year figuring out what can be gotten away with. And their compensation correlates to how much is gotten away with.
Their phone tree can be programmed to route your call to the bit bucket when wearing you down by the runaround isn’t working. None of this is a misunderstanding, it is all by design. Good luck.
I wouldn't spend money on lawyer for consumer protection issues. I'd submit a complaint to the state attorney general consumer protection department.
Like I said “if it matters.”
That's not the same.
It can matter and you can get similar results through your attorney general without spending your own money. If it doesn't matter, then you wouldn't do anything.
Because anything else would be unprofessional, you can safely assume the getting-away-with-it calculation considers the applicable attorney general and that there is a budget for political contributions as well.
The calculation also includes the probability you contest denial with a lawyer drawn from accurate data across many denials. Because anything else would be unprofessional.
You greatly overestimate the planning and ability of most companies. Most of these companies assume that most people won't contact the AG or an attorney. Most of these companies correct the issue once the AG or regulator gets involved because it's cheaper than fighting. They only fight the really expensive stuff. This is how it works as I've seen it happen.
Did your plan cover out of country expenses?
Yes. Some of the much lower out of country expenses, they approved, and added them to my deductible.
1. File a complaint with the state insurance regulator where your insurance is issued in. You can find this regulator at https://content.naic.org/state-insurance-departments
2. File a complaint with the US Dept. of Labor's Employee Benefits Security Administration (EBSA):
The EBSA, a division of the DOL, handles complaints related to employer-provided health insurance. You can:
Call the EBSA: Toll-free at 1-866-444-3272 to speak with a benefits advisor.
Submit a complaint using the EBSA's online form: https://www.askebsa.dol.gov/WebIntake/
The EBSA will investigate the claim and may contact your employer or insurance provider for more information. You may be contacted for additional details or documents. If the EBSA finds that your rights under ERISA (Employee Retirement Income Security Act) were violated, they may take corrective action on your behalf. Keep copies of all documents and correspondence. You can follow up on the status of your complaint by contacting the EBSA at the phone number above.