Another insurance question -- what a mess!

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MissyJ's picture
Joined: 01/31/02
Posts: 3280
Another insurance question -- what a mess!

Hi all!

I stumbled across one of our new member's blogs titled "Insurance Mess!" After reading through, I agree that's an appropriate title.

Have any of you faced this type of situation with a transfer of coverage from one insurance to another during a pregnancy (with the same employer?) I did many years ago but from what I recall that transition went smoothly nor was I dealing with specialists.

If anyone has advice, please respond on her blog or drop me a note and I can pass the information along.

Thanks!
~Missy

Joined: 08/17/04
Posts: 2226

Things I can say:

She should do the continuity form for care transition. I have do no idea why the specialist says they don't accept that. It has nothing to with them. It's just Humana stating they will pay this provider in network for X amount of time or X amount of visits.

The fact they do not have her on file may stem back from her employer although most enrollment processes can take 10-14 business days from date it is received from the company.

Prescriptions...pay up front, save receipts, ask pharmacy on refund policy. Most pharmacies will refund 7-10days after fill date if you bring in your insurance info. Otherwise you file straight to the insurance company.

They are not responsible for anything that she hadn't asked herself. Her company may never have forwarded that benefit info for the research they said they did...but I would ask that benefits person why she wasn't told of the out of network situation when she provided the info.

*Information expressed here is my own opinion and does not reflect on positions or opinions of my employer*

MissyJ's picture
Joined: 01/31/02
Posts: 3280

Thanks for taking the time to respond! I'll pass it along!

Jenni Beth's picture
Joined: 03/03/11
Posts: 1407

Complain complain complain! If HR told her that everything was "good to go" I would be on the phone or in the office of that person demanding some answers. I'd call the new insurance company and complain and file an appeal as well. In my business I have found that "the squeaky wheel gets the grease".

Joined: 08/17/04
Posts: 2226

The only thing on the appeal is to appeal anything about the network or info from them. They cannot and will not overturn based on what the HR told her. That point can only be taken up with HR which I agree she needs to go to.