PCP visit claim denied

[odeon778]

I apologize if this is not the correct place for this question. My health insurance (Aetna HMO) denied my Primary Care Physician visit ($284). My doctor left the office I use to go to so I found a new PCP and made sure they were in network. I did not realize it needed to be updated through Aetna - I wrongly assumed I could just choose a new one as long as they were in network. When it comes down to it, it was my fault - but is it normal to deny a claim for this? Is there any hope of getting it covered?

 

[odeon778]

It looks like this may have fit better under the Consumer Help Requests forum so please move if necessary\possible

 

[Chazm]

It’s probably because you have an HMO and have to let the insurance company know that you want to switch. At least with Medicare Aetna hmo you do

 

[somarco]

I apologize if this is not the correct place for this question. My health insurance (Aetna HMO) denied my Primary Care Physician visit ($284). My doctor left the office I use to go to so I found a new PCP and made sure they were in network. I did not realize it needed to be updated through Aetna - I wrongly assumed I could just choose a new one as long as they were in network. When it comes down to it, it was my fault - but is it normal to deny a claim for this? Is there any hope of getting it covered?

Yes, you did not follow the HMO rules.

File an appeal, explain the situation, say 3 Hail Mary's and promise never to do this again.

With a bit of luck they will honor the claim.

Otherwise, consider this a small price for failing to follow directions. Could have been a larger claim.