Can an insurance compnay change the way it processes claims in mid year? And change everything retroactively?


Can an insurance compnay change the way it processes claims in mid year? And change everything retroactively?

No, not UnitedHealth, not any of the for profit ones. A local one, yes, Advantage, but has been good to me.

I have been getting allergy shots for five years, and finally last summer was told, by the clinic, to stop or, at least, take a break.

The monthly charge would be $30 for which the insurance would approve $13.00, pay the clinic $10.50 and my copay would be the rest: $2.50. (All round numbers)

But for my last visit the insurance would not pay the clinic but stated that my copay would be the whole $13.00.

I was calling and getting different answers but since I no longer was getting the shots and I had other issue I finally paid the cling the $13.00.

Now I am getting the summary of claims processed in December and... all the previous claims show no payment to the clinic. I am responsible for the $13.00.

But these claims, starting January 2024 have been processed. What are they going to do ask the clinic to pay back?

Yes, I am going straight to the top, to the Chief Medical Officer once everyone is back from vacation.

Funny, during the summer I was going to go to the top, mention "Open enrollment." This is over now but I am still going to mention it.

I don't understand how they change the way they process a regular claim in mid year without alerting me. Yes, I know, they can do whatever damn they want. I also need to find out whether they are regulated, or something, by a state agency.

I don't need this sh*t. I am getting too old for this.

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