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by LorenPechtel 640 days ago
Yup, I've seen it also.

None of the snail mail garbage, but I couldn't pry anything out of the portal. The first attempt with the insurance company produced an e-mail that was utterly useless. The second attempt, when I spelled out the problem with the first, produced a completely different list when it should have been a subset except with a greater distance. Of that list I could reject some based on their websites, some were utterly wrong based on calling the office (and in one case a "never heard of them") one had been in an accident and wasn't currently accepting new patients and that left one. And it was the closest one I had looked at, the distance bit was most certainly not relevant.

They need to put a much shorter timeline on the insurance coming up with a suitable practitioner. Say, maybe a day rather than 60 days. And maybe a month to actually get an appointment. And, for an existing situation the clock is set by any important scripts the patient might have. (My hunt was triggered by my getting dumped by the system--I had been grandfathered in when the practice changed. Then the doctor left and the grandfathering ended.)

1 comments

Simple solution is if the insurance directory says a provider is "in network" than they should be on the hook to honor that and pay the provider and collect the in network deductible from the patient directly. I'd bet that issue would be fixed in a very short time. It is basically fraud for them to have inflated list of supposedly active providers.
While I do agree with the issue of an inflated list I didn't find anyone on their list that actually existed (at least at the office listed) and wasn't actually in network. I found doctors that didn't cover the whole field of their specialty.