Note: The below is USA-specific.
Hello! First the good news: I got married in late March this year (yay me!).
In mid-April, I went to my longtime PCP for an annual checkup.
In late April, I decided to use the 30-day window of the life event of our marriage to enroll under my wife's healthcare plan mid-cycle, as it was more cost effective.
What I didn't realize: When one uses a life event to change healthcare elections mid-cycle, the change gets backdated to the date of the actual life event (in this case, our wedding in late March)
My PCP is out-of-network of the new healthcare plan, and that plan has no out-of-network coverage. I knew this (and planned on changing PCPs anyway), but didn't realize that the change would be backdated.
The situation: Due to the backdated healthcare change, I am now left with having to pay for the PCP visit out of pocket, which totals $600. My old insurance doesn't want to pay, as I retroactively wasn't insured with them anymore, and my new insurance doesn't want to pay, as this particular doctor is not covered.
Is there any path here where I am not left with having to pay the entire cost out of pocket? Can I appeal to either insurance, or can I perhaps ask my PCP to reduce the cost on account that I was then retroactively not insured with him (and on account that I have been with him for a few years already)?
I appreciate any suggestions.
P.S.: My wife is a doctor at a large hospital chain, which is why her health plan doesn't have out-of-network coverage, as her employer prefers for their employees and dependents to utilize their own vast network of doctors for all healthcare needs. Which is fine under normal circumstances and I was aware of this before we made the decision that I would go under her health plan.
P.P.S.: The only circumstance under which I am covered for out-of-network expenses is if I happen to be in a location where there are no in-network doctors anywhere nearby. That is, however, not the case in this situation.
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