Anthem lied to me twice?

[jellystyles]

So I have an anthem health HMO plan. I was in Montana for work and needed to have a doctors visit. While at the doctor I asked the secretary to check and see if my insurance would cover the cost of the visit, gave her my card, told her I couldn’t afford to pay anything. While she checked, I called anthem. Like they say to do. Called the number on the back of my card. I told them the same thing and they said, you’re good to go you will not have to pay anything for this visit. The secretary told me the same, and the doctor who saw me even talked to me about it and said that she would wait while I called anthem to make sure I wouldn’t have to pay anything for seeing her that day. So I have my visit. Then a few months later, I get a bill from this clinic for $250. Turns out HMO plans do not cover out of state stuff, my “state of residence” is Ohio even though only my parents live there, I travel for work. I had no idea and no one thought to tell me this while I was signing up for the plan through the marketplace, while I told them that I travel for work and don’t actually live in Ohio anymore. Yes ultimately my fault for not knowing. Anyway, I filed an appeal with anthem against this charge as I was straight up told by the anthem help agent that I would NOT pay a cent for that visit. Told by the doctors office as well. But I know all that matters is calling my actual insurance, which I did.

So, I called anthem yesterday and they said that they denied my appeal because there’s “no record of me calling anthem that day.” But, I checked my call logs….and I have visual proof that I did in fact call them that day. 15 minutes on the phone with the agent.

My question is, aside from calling anthem and explaining this new proof that I have, is there anything I can do against anthem for them LYING to me TWICE? This is just so f’d up. Any advice/insight into this process is much appreciated. I have photos of my call logs for this day they are claiming I didn’t call them on.

 

[2stupiddogs]

@jellystyles Calls to insurance are usually recorded, I would escalate this. You did everything you needed, confirming with the insurance company. If they gave you bad advice, that’s on them.

 

[jellystyles]

@2stupiddogs Exactly! I would not have seen the doctor had I known I’d have to pay $250.

 

[christeveanity]

@2stupiddogs The consumer, the OP in this case, is responsible for knowing what is in their benefits plan. They have an HMO marketplace plan and should be aware they have no out-of-network coverage.

 

[2stupiddogs]

@christeveanity They did the responsible thing, and called their insurance to see what the coverage would be. If the insurance gave the patient bad info, that’s on the insurance company.

 

[jander8629]

@2stupiddogs It’s called detrimental reliance and it is a legal theory. I would also talk to a broker to see about upping your coverage a little bit even with travel insurance, if need be.

 

[mlenadc]

@jellystyles Did they give you a ref # for the call?