Sorry to hear you're going thru that. Agent probably has errors and omissions insurance. You can sue them for coverage if u need to. Probably find a lawyer to take it on contingency. Good luck!
>Should I be concerned?
Probably, but not right now.
There's nothing you can do yourself so focus on your wife, let the agent run it down, deal with the chips when they fall.
Yes you should be concerned. Very concerned. Get the agent's statement about the policy change being "her fault". An email exchange would be fine.
I'm sorry for your wife's illness. On top of everything, it's going to be expensive to treat and there's no telling how the agent or Anthem will respond. You may have to sue the agent, hopefully who has errors and omissions insurance. I would find an attorney now who has experience with insurance coverage.
This is terrible advice. I am fortunate to have our of network benefits on my present insurance that are probably better than the in network benefits I received previously.
You are fortunate to have never tried the out of network benefits on your present insurance. When you do, you will be billed whatever the provider feels like billing you since there is no contract price between the provider and insurer. The insurer will then refuse to cover the amount over their in-network rate, and you will be balance billed the rest. You would be better off negotiating a cash price ahead of time with the provider.
How could it be worse than no coverage, especially for something as expensive as cancer treatment? With my plan that just means a higher deductible and you don’t get lower negotiated rates
For medical care in the US the cash price is frequently substantially lower than the negotiated rate. If they bill insurance the provider has to bill whatever the negotiated price is.
For example the last bill I had was $2700 with insurance or ~$800 cash. If you had crappy insurance it would be better to not use it.
And there is no negotiated rate on out of network providers, so you can expect to be balance billed for everything above the network rate which typically works out worse than negotiating a cash price.
I have gotten businesses to match the insurance rate before. Assuming it is reasonable some money is better than collections. (HDHP and I offered them what my deductible was for that service)
It's possible, but typically providers intentionally are not in-contract with certain insurers because the contracted rate is too low.
There's also the issue of prior authorizations. Contracted providers are required to get them when an insurance company requires it, but an out of network provider will just do the procedure without a prior-auth, and then the insurance company can outright deny the claim.
As a rule, going outside your network is a really bad idea unless you like surprise medical bills. I have learned this the hard way, and many others have as well.
Without knowing any more about your wife's situation, stage 4 cancer can be a disability that qualifies for social security, and in those cases she could be eligible for Medicare - maybe worth looking into to also.
head over to r/insurance and learn more more about errors and omissions insurance.
Yes, you should be mildly concerned. You can always file with your state's insurance commissioner if you need to escalate.
I didn't even know that a state health plan could exclude its major city. Such a plan can even be offered?!
How do they restrict people from coverage in Denver? By zip code of provider location?
If it is a smaller insurance company they might not have a provider network.
If it is a larger insurance company they might restrict by zip code.
Sometimes a larger company will have multiple networks and it can happen that a network doesn't include a large city for cost reasons.
If things aren’t moving quickly enough I would consult (and possibly retain) with a lawyer. Not saying you need to go aggressive on the agent (yet…), but to put yourself in the best position possible in case it does. Just start by asking what your rights are and what outcomes may be made available to you. The severity of your situation may warrant this step.
Give the agent some time to fix the error, but know when to escalate.
Also document everything with the agent, especially the parts they admit fault.
Insurance agents carry errors and omission liability insurance. Sue the agent for negligence if the coverage you requested is not retroactively reinstated.
I would send emails detailing your conversations and try to get something written back from the agent. If you have to sue, a written admission will go a lot farther than "he said he messed up and apologized", especially if the agent changes their story.
Sorry to hear you're going thru that. Agent probably has errors and omissions insurance. You can sue them for coverage if u need to. Probably find a lawyer to take it on contingency. Good luck!
This is the reason a good agent has e&o insurance. Make sure to get documentation it was their fault.
>Should I be concerned? Probably, but not right now. There's nothing you can do yourself so focus on your wife, let the agent run it down, deal with the chips when they fall.
Yes you should be concerned. Very concerned. Get the agent's statement about the policy change being "her fault". An email exchange would be fine. I'm sorry for your wife's illness. On top of everything, it's going to be expensive to treat and there's no telling how the agent or Anthem will respond. You may have to sue the agent, hopefully who has errors and omissions insurance. I would find an attorney now who has experience with insurance coverage.
How in the heck does coverage cover CO and not Denver?
The zip codes are zip-coding and "networking."
Even if it’s out of network though surely they still provide some coverage?!
Out of network coverage is often worse than no coverage. Never go out of network.
This is terrible advice. I am fortunate to have our of network benefits on my present insurance that are probably better than the in network benefits I received previously.
You are fortunate to have never tried the out of network benefits on your present insurance. When you do, you will be billed whatever the provider feels like billing you since there is no contract price between the provider and insurer. The insurer will then refuse to cover the amount over their in-network rate, and you will be balance billed the rest. You would be better off negotiating a cash price ahead of time with the provider.
How could it be worse than no coverage, especially for something as expensive as cancer treatment? With my plan that just means a higher deductible and you don’t get lower negotiated rates
For medical care in the US the cash price is frequently substantially lower than the negotiated rate. If they bill insurance the provider has to bill whatever the negotiated price is. For example the last bill I had was $2700 with insurance or ~$800 cash. If you had crappy insurance it would be better to not use it.
And there is no negotiated rate on out of network providers, so you can expect to be balance billed for everything above the network rate which typically works out worse than negotiating a cash price.
I have gotten businesses to match the insurance rate before. Assuming it is reasonable some money is better than collections. (HDHP and I offered them what my deductible was for that service)
It's possible, but typically providers intentionally are not in-contract with certain insurers because the contracted rate is too low. There's also the issue of prior authorizations. Contracted providers are required to get them when an insurance company requires it, but an out of network provider will just do the procedure without a prior-auth, and then the insurance company can outright deny the claim. As a rule, going outside your network is a really bad idea unless you like surprise medical bills. I have learned this the hard way, and many others have as well.
Obviously going out of network is bad, I am just unsure of "worse than no insurance" bad...
Maybe. Maybe not.
Without knowing any more about your wife's situation, stage 4 cancer can be a disability that qualifies for social security, and in those cases she could be eligible for Medicare - maybe worth looking into to also.
head over to r/insurance and learn more more about errors and omissions insurance. Yes, you should be mildly concerned. You can always file with your state's insurance commissioner if you need to escalate.
I didn't even know that a state health plan could exclude its major city. Such a plan can even be offered?! How do they restrict people from coverage in Denver? By zip code of provider location?
If it is a smaller insurance company they might not have a provider network. If it is a larger insurance company they might restrict by zip code. Sometimes a larger company will have multiple networks and it can happen that a network doesn't include a large city for cost reasons.
Contact your state insurance board to see what can be done
>Should I be concerned? Yes. But for now, do nothing until you hear back from your agent.
Yes. Consider if there are any "life events" that would make you elgible to change insurances.
If things aren’t moving quickly enough I would consult (and possibly retain) with a lawyer. Not saying you need to go aggressive on the agent (yet…), but to put yourself in the best position possible in case it does. Just start by asking what your rights are and what outcomes may be made available to you. The severity of your situation may warrant this step. Give the agent some time to fix the error, but know when to escalate. Also document everything with the agent, especially the parts they admit fault.
I would be highly concerned and I suggest you contact the carrier but I am not sure they will allow a change.
Insurance agents carry errors and omission liability insurance. Sue the agent for negligence if the coverage you requested is not retroactively reinstated.
I would send emails detailing your conversations and try to get something written back from the agent. If you have to sue, a written admission will go a lot farther than "he said he messed up and apologized", especially if the agent changes their story.